Some plans in the Federal Employees Health Benefits (FEHB) program are leaving in 2019. The Office of Personnel Management (OPM) recently issued the list of those plans as well as instructions for those who may be affected.
The FEHB open season runs from Nov. 12 Dec. 10, 2018.
FEHB Plans Leaving the Program in 2019
According to OPM, enrollees in the areas below being dropped who do not change health plans during open season will only have emergency services where they live and they will have to travel to their plan’s remaining service area to obtain medical care in order to receive full benefits from the plan in 2019.
What to do When Your Health Plan is Terminating Coverage in Your Area or Leaving the Federal Employees Health Benefits (FEHB) Program
There are four ways your plan’s enrollment can be affected. Each may require a different response, so be sure to identify your situation.
- Plan leaves FEHB Program entirely;
- Plan reduces its service area and eliminates its enrollment code;
- Plan reduces its service area and keeps its enrollment code; or
- Plan drops an option.
How will I know if my enrollment is affected?
You will receive a letter from your plan stating that it is no longer participating in the FEHB Program, dropping an option, or that it is no longer providing services in your area. You can contact your Human Resources (HR) office with additional questions.
What do I do now that I know my enrollment is affected?
You may need to change your enrollment to another plan during Open Season or during the time period set by OPM. Follow the instructions in the letter you received from your plan.
My plan is leaving the FEHB Program entirely. What happens if I don’t change to another plan?
If you are a federal employee, annuitant, or Tribal employee and you do not change plans, you will be automatically enrolled into the lowest-cost nationwide plan option available as designated by OPM.
My plan is reducing its service area AND eliminating my enrollment code. What happens if I don’t change to another plan?
If you are a Federal employee, annuitant, or Tribal employee and you do not change plans, you will be automatically enrolled into the lowest-cost nationwide plan option available as determined by OPM.
My plan is reducing its service area where I live/work but keeping my enrollment code. What happens if I don’t change to another plan?
You will only have coverage in your area for emergency care services in the new plan year. You must travel to the plan’s remaining service area to receive full coverage for your care.
My plan is eliminating my option. What happens if I don’t change to a remaining option or to another plan?
You will be automatically enrolled into one of the plan’s options that remain. If no options remain that are not High Deductible Health Plans (HDHP), you will be automatically enrolled into the lowest cost nationwide plan option as indicated by OPM. Please refer to the letter you received from your plan for more information.
If my High Deductible Health Plan (HDHP) is terminating coverage in my service area or is leaving the FEHB Program, what happens to my Health Savings Account (HSA) or my Health Reimbursement Arrangement (HRA)?
If you wish to continue contributing to your HSA, you must enroll in another HDHP. If you do not enroll in another HDHP, you can withdraw money from your HSA for qualified medical expenses. You should check Internal Revenue Service (IRS) guidance on use of HSA dollars for non-qualified medical expenses. You should work directly with your fiduciary to make decisions regarding your HSA.
Unless you use your HRA credits, they will be forfeited once the plan you’ve elected becomes effective.
How do I change my enrollment to another plan?
If you are a federal employee, use your agency’s online self-service system such as Employee Express, MyPay, Employee Personal Page, EBIS, etc. If you need additional help, contact your HR office.
If you are a Tribal employee, contact your Tribal Employer.
If you are a Civil Service Retirement System (CSRS) or Federal Employees Retirement System (FERS) retiree, call Open Season Express at 1.800.332.9798 or access Open Season Online at https://retireeFEHB.opm.gov.
If you receive an annuity from another retirement system, please visit www.opm.gov/healthcare-insurance/healthcare/plan-information/enroll/#annuitants for information on how to change your enrollment.
When does my old plan or option stop providing coverage and my new plan or option begin?
Your old plan will continue to provide benefits until the plan you’ve elected during Open Season or during the time period provided by OPM becomes effective. There will be no gaps in coverage
What are my rights if I’m pregnant or I have a chronic or disabling condition?
Under the Patients’ Bill of Rights, enrollees who are seeing a specialist for a chronic or disabling condition or who are in the second or third trimester of a pregnancy have a right to continued treatment for up to 90 days of care (or treatment through the end of post-partum care) following notice that a health plan is leaving the FEHB Program.
How can I compare the different health plans available to me?
There are several resources available to help you compare plans:
- OPM’s Online Comparison Compare tool at https://www.opm.gov/healthcare-insurance/healthcare/plan-information/compare-plans/ (NOTE: This tool will be available for 2019 plans in the first week of November).
- Health Plan Brochures at: www.opm.gov/FEHBbrochures; or for Tribal employees at www.opm.gov/healthcare-insurance/tribal-employers/plan-information
- Consumer’s Checkbook at www.checkbook.org/newhig2/hig.cfm