Kicking off a series on the Federal Employee Health Benefits (FEHB) program. In this introductory article, we summarize the General Overview of OPM’s FEHB Handbook.
OPM’s FEHB Handbook is a dense digital document that details all the technicalities around health insurance for active and retired federal workers and their family members. In this series, we’re attempting to summarize the government’s guide in more digestible chunks. This first article will look at the first part of the handbook’s introduction.
If you’re looking for a real quick overview of the FEHB program, check out our article, Top 5 Important Facts to Remember About FEHB.
Learn all about FEHB plans, TriCare, FEDVIP coverage, and Medicare at our no-cost webinar
The FEHB program began in 1960, entitling the federal workforce and their eligible family members to health insurance, except for some government positions that are excluded from participating by law. For the majority of federal workers who are able to get a health plan through FEHB, they pay 25% of the premium cost while Uncle Sam covers the remaining 75%.
The number of available health plans in the program exceeds 200. There are HMO (Health Maintenance Organization) plans, most of which require the covered individual to live or work in a specified location, and then there four types of national health plans: Preferred Provider Organizations (PPO), Fee-for-Service Plans (FFS), high deductible health plans (HDHP), and consumer-driven health plans (CDHP). Feds can enroll in FEHB or switch plans during the annual “Open Season,” which runs from mid-November to early December.
Health Insurance Contracts
The full contract that is negotiated between OPM and health insurance carriers is never sent to the enrollee, but both OPM and the carrier each must send the insured person a brochure to provide important information about the given plan. Legal complaints by an FEHB participant have to be filed against OPM, not the insurance provider, in the appropriate US Federal District Court. The health plan carrier does have the right to garnish a federal employee’s paycheck to collect unpaid deductibles and copayments.
The next article in this FEHB series will review the second half of OPM guide’s introduction, focusing on the legal responsibilities of OPM, the employing agency, the insurance carrier, and covered individuals. And don’t forget to check out our FEHB Webinars!
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Until Next Time,
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