The Federal Employees Health Benefit (FEHB) Program provides comprehensive health care coverage for federal employees, annuitants, and their families. There is a wide selection of plans to choose from including, "Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts and lower premiums, or Fee-for-Service (FFS) plans, and their Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO) if you live (or sometimes if you work) within the area serviced by the plan." There is an open season each year for participants to review and choose other plans if desired. A Self-Plus-One option is now available.
Note: The Postal Service Health Benefits (PSHB) Program will replace Federal Employees Health Benefit (FEHB) Program coverage for eligible Postal Service employees, Postal Service annuitants, and their eligible family members starting in 2025. One of the key elements of this new plan is the requirement for those under a certain age to sign up for Medicare Part B to retain their PSHB health care coverage in retirement. This requirement could be added to federal employee’s FEHB Plans down the road.
"After finding and reading your blog post titled Blue Cross Blue Shield to GEHA Plan Comparison I researched and signed up for GEHA. I had never heard of GEHA, but it sounded good, worth a try. We both just went to the dentist, post retirement, and GEHA paid 40% of our bills. That's just amazing, BC/BS didn't pay enough to cover postage. We are paying Medicare, my retirement annuity is still in the estimation stage. I think you have saved us as much as $300-400 a month by using GEHA. Thanks again. Nancy P."
The 2024 FEHB Open Season - November 11, 2024 through December 9, 2024
Select Your 2025 FEHB Plan
(OPM) announced that for plan year 2024, the average total premiums for current non-Postal employees and retirees enrolled in plans under the Federal Employees Health Benefits (FEHB) Program will increase 7.3%. Under the Federal Employees Dental and Vision Insurance Program (FEDVIP), their are numerous dental and vision plans to choose from.
In addition, in an effort to be more “green,” paper copies of health plan brochures will not be automatically mailed to Federal Employees Health Benefits (FEHB) Program members.
The Federal Employees Health Benefits (FEHB) Program has important features, including a wide choice of health plans and competitive benefit packages as well as no health insurance pre existing conditions limitations or waiting periods.
2024 Open Season (November 11, 2024 through December 9, 2024)
You are now able to manage your FEHB account online. To register you will need your Annuity Claim Number and they will ask you to enter a unique user name and password to activate your account. You must register again for each new open season even though you registered for the previous year. I annotated the web site address, user name, and password in the "Federal Retirement Benefits" booklet that I received when I first retired for future reference. Go to https://retireefehb.opm.gov to register and view your options. This service allows you to change enrollment, view transaction history, change or add dependent information, and request health care plan brochures.
The Federal Employees Health Benefits (FEHB) Program helps you and your family meet your health care needs. Federal employees, retirees and their survivors enjoy the widest selection of health plans in the country. You can choose from among Consumer-Driven and High Deductible plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts and lower premiums, or Fee-for-Service (FFS) plans, and their Preferred Provider Organizations (PPO), or Health Maintenance Organizations (HMO) if you live (or sometimes if you work) within the area serviced by the plan.
Many FEHB plans now offer Medicare Advanage plans as well and include Part D coverage.
When you retire your agency will automatically transfer your enrollment to OPM if you are eligible. To continue your health benefits enrollment into retirement, you must:
If you die while a compensationer, your family members can continue your enrollment if you were enrolled for Self and Family or Self + One at the time of your death and at least one of your covered family members receives compensation as a surviving beneficiary under the Federal Employees' Compensation law.
TRICARE holds open seasons annually, this allows participants to select among two plans. The open season runs concurrent with the FEHB open season each year. There are now two options to select from, Tricare Prime and Select. Visit the Tricare site for additional information and you can enroll online.
TRICARE-eligible members of the uniformed services and their families can now enroll in FEDVIP. Uniformed services retirees and their families may enroll in a FEDVIP dental plan. Uniformed services retirees and their families, as well as active duty family members, can enroll in a FEDVIP vision plan if they have also enrolled in a TRICARE health plan. More information is available at https://tricare.mil/.
Tricare requires participants to have Medicare A & B. If you have Tricare you can "suspend” your FEHB healthcare coverage and use Tricare for Life in conjunction with Medicare A & B.
How can annuitants or former spouses suspend FEHB coverage to use TRICARE or CHAMPVA?
They can apply to suspend their coverage at any time. Annuitants can call OPM's Retirement Information Office at 1-888-767-6738 to obtain a suspension form. Callers within the local Washington, DC calling area must call 202-606-0500. Former spouses can get the form from the employing office or retirement system maintaining their enrollment. Eligible individuals must submit a completed suspension form and provide all necessary documentation to show eligibility for TRICARE or CHAMPVA during the period beginning 31 days before and ending 31 days after the date they designate as using TRICARE or CHAMPVA instead of FEHB coverage.
The 2024 Self Plus One rates were recently published for this option. The rate reductions for self plus one continue to be disapointing overall with little cost differences between Self Plus One and Self Plus family coverage. In some cases, the enrollee share of premiums for the Self Plus One enrollment type will be higher than for the Self and Family enrollment type. Enrollees who wish to cover one eligible family member are free to elect either the Self and Family or Self Plus One enrollment type.
Self Plus One enrollment type in the Federal Employees Health Benefits (FEHB) Program allows you to cover yourself and one eligible family member you designate to be covered. All FEHB plans (your health insurance plans) now offer a Self Only, a Self Plus One, and a Self and Family enrollment type.
Self Plus One Resources
OPM announced enhanced benefit offerings in the following areas across the FEHB Program: Fertility Benefits, FEHB and Medicare Coordination, Pharmacy Benefit Design, Gender Affirming Care and Services, Maternal Health, Prevention and Treatment of Obesity, Mental Health and Substance Use Disorders, Telehealth, and Antibiotic Stewardship. Two areas are listed below. Review plan brochures for specifics.
Fertility Benefits
All Carriers will cover artificial insemination (AI) procedures (intrauterine insemination (IUI), intracervical insemination (ICI), and intravaginal insemination (IVI)) and specific AI drugs listed on the plan’s formulary. These AI drugs and the associated member cost share will vary by plan. Also in Plan Year 2024, all Carriers will cover specific IVF drugs listed on the plan’s formulary for three cycles annually.
Additionally, 25 health plan options, including national plan options, will offer broader coverage of in-vitro fertilization (IVF) related services and benefits. Benefits and member cost share will vary by plan and specific plan information can be found in Section 5 of the benefits plan brochure.
Gender Affirming Care and Services
OPM has continued its commitment in expanding covered benefits and access to gender affirming care for transgender and gender diverse individuals. FEHB Carriers must cover medically necessary interventions deemed appropriate for individuals, based on medical necessity and a review of the individual’s circumstances.
With recent updates to gender affirming medical treatment from recognized entities such as the World Professional Association of Transgender Health (WPATH), the Endocrine Society, and the Fenway Institute, FEHB Carriers were asked to ensure that their medical policies on gender affirming care and services for Plan Year 2024 are updated accordingly.
Examples of these recent updates include:
Information on gender affirming care and services available through plans will be readily accessible to enrollees in Sections 5(b) and 5(f) of the plan brochures and on websites.
For your surviving family members to continue your health benefits enrollment after your death, all of the following requirements must be met:
All of your survivors who meet the definition of "family member" can continue their health benefits coverage under your enrollment as long as any one of them is entitled to a survivor annuity. If the survivor annuitant is the only eligible family member, the retirement system will automatically change the enrollment to Self Only. Your surviving spouse should follow up with OPM to insure this action was taken. If it wasn't, your spouse will be paying considerably higher Family Option premiums.
Under FERS, your surviving spouse who is entitled to a basic employee death benefit, or your surviving children whose benefits are offset by Social Security, may continue your health benefits enrollment by paying premiums directly to OPM.
If the survivor annuity is not large enough to cover the enrollee share of the premiums for your plan, your survivors may either change to a lower-cost plan or option (one in which the enrollee share of the premium is low enough to be withheld from the annuity) or choose to pay the premiums directly to the retirement system. Even if your employing office thinks that the survivor annuity will not cover the enrollee share of the premiums, your retirement system will transfer in the enrollment. The retirement system will notify your survivors of their options and take whatever actions they request.
When your surviving spouse will not receive any survivor benefits because your former spouse has a court-ordered entitlement to a survivor annuity, your surviving spouse can continue FEHB coverage if you had a Self and Family enrollment. The retirement system will notify your surviving spouse of his/her options and take whatever actions are requested.
When the retiree's spouse is not a federal employee they will most likely need FEHB coverage in retirement. The rules are different for CSRS and FERS employees and this is a major consideration for federal employees who intend to retire and leave their spouse other than a full survivors annuity.
Under CSRS your spouse will be eligible for FEHB coverage as long as you provide them with a survivors annuity. It can be any amount. In my opinion it is best to provide a survivors annuity large enough to cover FEHB expenses however it isn't necessary. If you elect a survivors annuity of $3600, enough to cover many plan costs, your annuity will be reduced by 2.5%.
FERS retirees must elect either 50% or 25% survivors annuity for your spouse to be eligible for FEHB coverage in retirement after the annuitant's death. The 50% election will cost you 10% of your full annuity and the 25% survivor annuity election will cost you 5% of your full annuity in retirement.
CLARIFICATION: We receive a number of questions from site visitors about spousal FEHB coverage in retirement. A spouse of an annuitant can continue coverage under the annuitant's FEHB plan after retirement when an annuitant doesn't elect a survivor's benefit until the annuitant's death . After the annuitant's death, the spouse can no longer continue FEHB coverage since in this case the employee did not elect a spousal survivor benefit. Reference OPM's " minimum survivor's benefit for the spouse to be eligible for FEHB covered after the annuitant's death.
If you cancel your FEHB enrollment as an annuitant, you won't be able to reenroll in the FEHB program. There are no exceptions for other employment insurance. However, there is an exception if you suspend your FEHB enrollment because you are now covered by a Medicare Advantage plan, TRICARE, CHAMPVA, Medicaid or similar State-sponsored medical assistance program, or Peace Corps Volunteer coverage, you can restart your FEHB in the future. Annuitants can call OPM's Retirement Information Office at 1-888-767-6738 to obtain a suspension form. Callers within the local Washington, DC calling area must call 202-606-0500.
A suspension form must be completed by eligible individuals and must provide all necessary documentation to show eligibility for TRICARE or CHAMPVA during the period beginning 31 days before and ending 31 days after the date they designate as using TRICARE or CHAMPVA instead of FEHB coverage.
Articles (Additional Information & Cautions)
To reinstate your suspended FEHBP, you will need to contact the Office of Personnel Management (OPM) by.
I changed from an HMO to the Basic Blue Cross plan before retiring. We knew we would be traveling and that Blue Cross was accepted in most, if not all major locations nationwide. The change also dramatically reduced our monthly premiums and our level of service actually improved. We were pleasantly surprised at the efficiency of their plan and the Basic Option 112 plan is fashioned after an HMO model from our perspective. We also considered their Standard plan but didn't feel comfortable with the deductibles and you really don't know what the charges to you would be until after a procedure was done. The benefit of the Standard plan is that you can use any service provider even if they aren't a preferred provider. The Basic plan required you to use preferred providers and if you do use a non-preferred provider you must pay the bill in most cases except for emergency care.
Dennis V. Damp, Retired FAA
