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The U.S. Office of Personnel Management (OPM) last month announced new actions to ensure that family members of federal employees and retirees who participate in the Federal Employees Health Benefits (FEHB) program are eligible.
In a benefits administration letter on April 17, OPM outlined requirements for federal agencies and carriers regarding new enrollment measures that will ensure comprehensive verification and review of family member eligibility.
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According to OPM, the actions include:
– OPM directs agencies to confirm employees’ relationships to spouses and family members when an enrollment change is made during Open Season. Specifically, the BAL requires that agencies verify a meaningful sample of family members included in Open Season elections from the prior year.
– OPM also previewed that federal employees will be required to provide eligibility documentation for all new family member enrollments during Open Season in subsequent years.
– OPM is continuing to crack down on bad actors. OPM will use its newly completed FEHB Master Enrollment Index (MEI) to run queries that can spot certain enrollment irregularities in existing enrollments. If irregularities are found that merit further inquiry, OPM will notify agencies to review those enrollments. OPM currently requires all agencies to notify enrollees of the consequences of improper enrollments, including fines and imprisonment.
“Today’s actions build on years of progress addressing issues in FEHB enrollments,” OPM said. “Collectively, these requirements ensure that agencies are verifying documentation provided during each of the key periods when an employee might make a change.”
To read the BAL, “Annual Agency Review of FEHB Open Season Actions – Family Member Eligibility“, go here.