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Federal Employee Health Benefits Program (FEHB)
Implemented on July 1, 1960, the Federal Employees Health Benefits (FEHB) Program is the largest employer-sponsored group health insurance program in the world. Managed by the Office of Personnel Management (OPM), the program is governed under 5 Code of Federal Regulations (5 CFR), Part 890, offering eligible employees a choice of plans and options.
The program is voluntary and coverage becomes effective with no medical examination or restrictions because of age or physical condition. The program also offers guaranteed protection that cannot be canceled by the insurance carrier. Each health plan carrier under the FEHB program contracts with the OPM to provide certain health benefits. Contract negotiations are a bilateral process, between OPM and the carrier and the contract period is usually for one year. Each plan carrier charges a different premium. For most employees, the Government contributes up to 75% toward the cost of the premiums while employees pay the remaining balance through payroll deductions.
The program also offers a temporary 31-day extension of coverage after separation from employment, during which you may convert to a non-group policy or enroll for Temporary Continuation of Coverage (TCC).
The Federal Employees Health Benefits (FEHB) Program consists of different types of plans:
- Fee-for-Service with a Preferred Provider Organization
- Health Maintenance Organizations (HMOs)
- Point of Service
- High Deductible Health Plans
- Consumer Driven Health Plans
How you obtain coverage or services and pay for it differs depending on the plan. However, benefits available under all plans include hospital care, surgical care, in-patient and out-patient care, obstetrical care, mental health and substance abuse care, and prescription drug coverage. Specific information on the individual plan types is available on OPM’s website.
Use the Plan Comparison Tool. This is an interactive tool that will direct you to individual health plan brochures, benefit and premium information, and health plan results from member surveys and accreditation reviews.
The DoDEA HR website provides a brief overview of the FEHB program, benefits and election opportunities available to employees. The categories are based on recurring requests for information and the most common life events. You can obtain more comprehensive information by visiting the OPM website or by reading the Federal Employees Benefits Program (FEHB) Handbook. You are also encouraged to take an active and involved approach in understanding your employee benefits specifically in the selection of your FEHB coverage by reviewing available information, resources, and regulatory guidance so that you may make informed decisions regarding health care for you and your family members.
Some benefits features are designed to act as tax savings for you therefore it is recommended you seek financial and/or tax counseling services before making a decision or selection. You should review the brochure for each plan you are considering; especially checking to see if the plan offers the services you think you might need. When choosing a plan, remember there are other things you should consider besides the cost of premiums. Out of pocket expenses, limitations on coverage, how the plan works, procedures to see a specialist and whether you must choose a doctor only from within the plan’s provider network, are among the questions you need to consider when selecting a plan that best fits the needs of you and your family members.
Contracts are negotiated yearly by OPM; therefore, depending upon your circumstances you may be required to wait until an open season to make changes in your plan selection or enrollment.
You should review your Leave and Earnings Statement (LES) on a regular basis to ensure the proper deductions are being withheld for your employee benefit elections and notify your employing agency of any discrepancies immediately.