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Federal Employees Health Benefits Program

FEHB Program Carrier Letter



Health Maintenance Organizations


U.S. Office of Personnel Management
Insurance Services Programs

Letter No. 2006-13(a)

Date: May 1, 2006

Fee-for-service [n/a]   Experience-rated HMO [12]   Community-rated HMO [12]

SUBJECT: 2007 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals

Enclosed are the technical guidance and instructions for preparing your benefit and service area proposals for the contract term January 1, 2007 through December 31, 2007. The guidance and instructions are in five parts:

  • Part One: Preparing Your Benefit Proposal
  • Part Two: Preparing Service Area Changes or Re-designation as a Mixed Model Plan
  • Part Three: Benefits for HMOs
  • Part Four: Preparing Your 2007 Brochure
  • Part Five: Preparing Your Proposal for High Deductible Health Plans (HDHP), Health Savings Accounts (HSA), and Health Reimbursement Arrangements (HRA)

Please refer to our annual Call Letter (Carrier Letter 2006-09) dated April 4, 2006, for policy guidance. Benefit policies from prior years remain in effect.

Send your current benefit packages no later than May 12, 2006, and your complete proposal for benefits, clarifications, and service area changes no later than May 31, 2006, (see Part One: Preparing Your Benefit Proposal). Please send a copy of your proposal electronically on a CD-Rom or other electronic means to your contract specialist in addition to a hard copy. Your proposal should include the corresponding language that describes your proposed changes for Section 5 of the brochure. You do not need to send your fully revised 2007 brochure by May 31. Your OPM contract specialist will negotiate your 2007 benefits with you and finalize the negotiations in a closeout letter.

vWe have implemented a new brochure process for 2007. The new process is a web application that uses database software. The web application will automatically generate a 508 compliant PDF. In June we will issue the 2007 FEHB Program Brochure Handbook update and a 2007 FEHB Program Application User Manual, and we will provide training for all plans on how to use the brochure application. In August we will also send you a brochure quantity form and other related Open Season instructions.

As a reminder, each year we assess carriers' overall performance. We take into consideration your efforts in submitting benefit and rate proposals on time and your accurate and timely production and distribution of brochures. Enclosed for your convenience is a checklist (Attachment VII) with the information you need to provide. Please return the completed checklist along with your benefit and rate proposals.

We look forward to working closely with you on these essential activities to ensure a successful Open Season again this year.

Sincerely,



Robert F. Danbeck
Associate Director
for Human Resources Products and Services

 
PDF Help

Attachment: 2007 FEHB Proposal InstructionsPDF File Icon [745 KB]

Download this Letter as a PDF File PDF File Icon [125 KB]

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This page can be found on the web at the following url: http://www.opm.gov/carrier/carrier_letters/2006/2006-13a.asp