If you do not change plans, you will automatically be enrolled in the lowest cost country plan option determined by OPM. Image: REDPIXEL.PL/Shutterstock.com
This year more than in past years, the makeup and number of providers under the Federal Employees Health Benefits program have changed. With that in mind, OPM recently released a Federal Benefits Quick Facts Bulletin that began by pointing out the four ways your current FEHB plan enrollment may be affected, namely by:
1. Leave the program completely
2. Reducing its service area and eliminating the registration code
3. Reduce your service area and keep your registration code
4. Removing an option (such as Standard or High)
He then included a series of questions for you to consider, which I have summarized below.
How do I know if my subscription is affected?
Your plan will send you a letter saying it no longer participates in the FEHB program, no longer provides coverage in your area, or is eliminating an option.
What should I do if my registration is affected?
Change your subscription to another plan during the Open Season or during a period established by OPM.
My Plan leaves the FEHB program entirely. What happens if I don’t switch to another plan?
If you do not change plans, you will automatically be enrolled in the lowest cost country plan option determined by OPM.
My plan is to reduce their service area and remove my registration code. What happens if I don’t switch to another plan?
If you do not change plans, you will automatically be enrolled in the cheapest national plan available as determined by OPM.
My plan reduces their service area where I live or work but keeps my enrollment code. What happens if I don’t switch to another plan?
You will only have coverage for emergency care services in the new plan year, and you will have to travel to the remaining service area of the plan to receive full coverage.
My plan is to eliminate my option. What happens if I don’t switch to a remaining option or another plan?
You will automatically be enrolled in one of the remaining plan options. If a High Deductible Health Plan is the only one left, you will automatically be enrolled in the lowest cost national plan option identified by OPM.
If my High Deductible Health Plan (HDHP) ends coverage in my service area or leaves the FEHB program, what happens to my Health Savings Account (HSA) or Health Reimbursement Agreement (HRA)?
If you want to continue contributing to your HSA, you must enroll in another HDHP, If you do not do so, you will not be eligible to make contributions to your HSA; however, you may still be able to claim waivers for qualified medical expenses. Note: Unless you use your HRA credits, they will be lost once the plan you have chosen becomes effective.
How do I change my subscription to another plan?
If you are a FERS employee, you can use your agency’s online self-service system, such as Employee Express, MyPay, Employee Personal Page, EBIS, etc. If you are a CSRS or FERS retiree, you can call Open Season Express at 1-800-332-9798.
When will my current plan or option stop providing coverage and my new plan or option begin?
There will be no gaps in coverage. Your current plan will continue to provide benefits until the effective date of the new plan you elect during the Open Season or during a period designated by OPM. Open Season enrollment changes will be effective on the first day of your first full payment period in January 2023.
What are my rights if I am pregnant or have a chronic or disabling condition?
After being notified that a plan is leaving the FEHB program, enrollees who see a specialist for a chronic or disabling condition or who are in the second or third trimester of a pregnancy have the right to continue treatment for up to 90 days or until the end . of post-partum care.
If you are an employee, you can get more information about FEHB plans, premiums, plan comparisons, etc., at https://www.opm.gov/healthcare-insurance/open-season/active-federal- employees. If you are a retiree, go to https://www.opm.gov/healthcare-insurance/open-season/federal-retirees-other-annuitants.
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