Federal employees can access unique benefits In this article, we will go into the specifics of Federal Employee Health Benefits (FEHB) and address critical questions about the scope, duration, special perks, and cost of health insurance for federal employees.
What Health Benefits Do Federal Employees Get?
Federal employees are entitled to various health benefits under the FEHB program. Federal employees, retirees, and survivors can access the most comprehensive healthcare options. According to OPM, as of 2021, 84% of employees are enrolled in this program. This health benefits program boasts an extensive list of health plans, allowing federal employees to choose the one that best suits their needs.
They can choose between 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 work within the area serviced by the plan. The diversity of plans ensures that individuals and families can tailor their coverage according to their unique health requirements.
Do Federal Employees Get Lifetime Health Insurance?
One of the noteworthy aspects of FEHB is that federal employees can enjoy lifetime health insurance coverage. Upon retirement, employees who have enrolled in the program for at least five years can continue their health insurance coverage into their retirement years. This invaluable perk gives retirees the peace of mind that their health needs will be adequately met, even after the end of active service.
What Are The Special Benefits For Federal Employees?
Federal employees can access unique benefits from standard health coverage that enhance their overall well-being. Mental health services, preventive care, and wellness programs are integral to the FEHB program. Additionally, federal employees can utilize flexible spending accounts (FSAs) and health savings accounts (HSAs) to manage medical expenses efficiently. These unique benefits contribute to a holistic healthcare approach, promoting physical and mental wellness among federal employees.
What Happens If I Happen To Transfer?
When transferring from one agency to another, your Federal Employees Health Benefits (FEHB) enrollment will remain active as long as you do not have a three-day gap in employment and are qualified for coverage in your new post.
What Happens When Employees Go On Leave Without Pay?
Unless you cancel your FEHB enrollment, it will remain active for up to one year while on unpaid leave. You must pay your portion of the premiums. Your human resources department will explain how to make premium payments.
What Happens The Family’s Coverage If The Employee Dies?
If you have a self and family enrollment and one family member is entitled to a survivor annuity, your surviving eligible family members can continue to receive health benefits after your death. Your retirement system will handle your survivors appropriately.
Can An Enrollment Be Cancelled?
Enrollment can be canceled during an open season or upon a qualifying life event, ensuring coverage cancellation aligns with the event. If you have waived premium conversion participation, enrollment can be canceled anytime. Cancellation takes effect on the last day of the pay period but not for a 31-day extension, Temporary Continuation of Coverage, or conversion to an individual policy.
If you cancel your enrollment, you may not be able to re-enroll until an event (e.g., open season or family status change) allows it.
To continue receiving health benefits after retirement, you must re-enroll before retirement and meet all eligibility requirements. If you plan to re-enroll to qualify for retiree coverage, remember that you may need to retire earlier than expected. If you do not maintain coverage for five years, you may not be eligible for retirement coverage. When you cancel your enrollment, you accept this risk.
You may want to consider enrolling in a lower-cost plan instead of canceling. To avoid gaps in coverage, you can coordinate the effective dates of your cancellation and new coverage.
For more information on enrollment and termination, see the FEHB Handbook.
Related: Federal Employee Loans: A Guide
What Are The Rights and Responsibilities of a Federal Employees Health Benefits (FEHB) Enrollee?
The FEHB Program, a key component of the healthcare system, upholds the Patients’ Bill of Rights and Responsibilities, ensuring consumer protection and quality initiatives. Employees can expect the following:
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If your health plan cancels your provider’s contract due to a chronic or disabling condition, you can continue seeing your current specialist for up to 90 days after termination. If you drop out of the FEHB Program during pregnancy or in the second or third trimester, you can continue seeing your provider if you enroll in another plan.
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The right to inspect and copy your medical records upon request. You may request that a physician correct a record that is not accurate, relevant, or comprehensive. If the physician does not change your record, you may add a brief statement.
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Direct access to women’s health care providers for routine and preventative treatment.
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Emergency department coverage for screening and stabilization without authorization in case of significant injury or impairment.
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Receive direct access to a qualified specialist within your provider network for complex or severe medical issues requiring frequent specialty treatment. When the plan requires it, authorizations will be issued for an acceptable number of direct access visits under an approved treatment plan.
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Assurance that provider contracts will have no “gag rules” that could prevent communication regarding medically necessary therapy.
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Provides detailed information on plan performance, provider network, physician and facility characteristics, and care management.
Is Federal Employee Health Insurance Expensive?
The cost of health insurance under the FEHB program varies based on factors such as the chosen health plan, coverage level, and individual circumstances. While federal employees benefit from employer contributions that help offset the cost, they are still required to pay a portion of the premiums. Generally, FEHB is considered affordable relative to many other private sector plans, and the program’s wide array of options allows employees to find a plan that aligns with their budget and healthcare needs.
However, research done by the Government Executive shows that Federal employees and annuitants will pay an average of 7.7% higher in FEHB premiums in 2024. According to OPM, the key causes for the premium hike are the growing cost and utilization of prescription medications, emergency department care, and outpatient care. This premium increase is lower than the 8.7% increase in 2023 but still significantly more significant than previous years.
Conclusion
Federal Employee Health Benefits are critical to ensuring the health and well-being of federal employees throughout their careers and into retirement. The FEHB program, which offers a variety of health plans, lifelong coverage options, and unique benefits, demonstrates the government’s commitment to the health of its employees. While expenses vary, the general view is that federal employee health insurance provides good coverage at a fair price. As federal employees traverse their career paths, they may rest confident that the extensive and comprehensive FEHB program is looking for their health needs.
