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Frequently Asked Questions Insurance

Why doesn’t FEHB offer a Self Plus One option for annuitants or employees?

FEHB law does not permit the Program to offer a Self Plus One category.  Pursuant to section 8905 of title 5, United States Code, “An employee [or annuitant] may enroll in an approved health benefits plan under section 8903 or 8903(a) of this title either as an individual or for self and family.”  The law does not allow a Self Plus One option.  Congress would need to change the law to permit this type of enrollment plan.

OPM’s Office of Actuaries has done cost and premium projections on the impact of changing from a two-tiered structure to a multi-tiered structure in the current FEHB Program.  While it might not be readily apparent, because a large number of older two-person families participate in the FEHB Program, the cost of providing health insurance for this older two person group is often nearly twice as high as it is to cover younger members with large families.  The self plus one premium would be based on the health cost of this group.  For this reason, it is not clear that adding additional enrollment options to the FEHB Program would result in any significant benefit to those who ask for the change.  In fact, they might be worse off.

The objective of a group insurance policy like FEHB is to promote the beneficial aspects of risk-sharing.  The Program shares the risk among a large group of enrollees, from those who are sick and high-risk to those who are healthy and low-risk.  By spreading the risk, FEHB enrollees as a whole can get better coverage and lower premiums.  We believe that balancing charges across large demographic groups provides the best value, stability, and equity over the life of program enrollment opportunities.

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