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Frequently Asked Questions Insurance

How is OPM handling rebates for enrollees who move between plans or drop FEHB coverage and will not get the benefit of the rebate?

Fewer than 4% of enrollees change FEHB plans each year.  As is the case when we receive other types of refunds and rebates for FEHB, such as improper payments, MLR rebate funds will be used to offset future increases for the plan from which we receive a rebate. Individuals who are no longer enrolled or switch plans do not get the benefit of the MLR rebate for their previous plan.  This is consistent with HHS rules for treatment of rebates for non-Federal governmental plans in 45 CFR part 158, which do not require a precise match of rebate to enrollee in group markets.  Since the rate adjustment involves no new cost it assures that the maximum benefit is provided to the greatest number of individuals.

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