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Healthcare Carriers

Letter to Prospective Applicant

Dear Prospective Carrier:

The U.S. Office of Personnel Management (OPM), administrator of the Federal Employees Health Benefits (FEHB) Program would like to expand the availability of health maintenance organizations (HMO) in the Program. The medical loss ratio (MLR) regulations, a new pricing method, which replaces the similarly-sized subscriber groups (SSSG) method, should interest more health insurance carriers in applying or reapplying for participation in the FEHB Program.

We especially invite qualified applicants from states the U.S. Department of Health and Human Services (DHHS) has determined medically underserved - Alabama, Alaska, Arizona, Idaho, Illinois, Kentucky, Louisiana, Mississippi, Missouri, Montana, New Mexico, North Dakota, Oklahoma, South Dakota, and Wyoming. We are also seeking qualified applicants from the following states that currently do not have HMOs in the FEHB Program: Alabama, Alaska, Connecticut, Maine, Mississippi, Montana, Nebraska, New Hampshire, North Carolina, Rhode Island, South Carolina, and Vermont.

Qualified carriers should submit their applications by January 31, 2013 to participate in the 2014 contract year. The FEHB Program application is available on our website. Once you complete your application, send it via an overnight delivery carrier to:

U.S. Office of Personnel Management
Federal Employee Insurance Operations
Healthcare and Insurance
1900 E Street, NW, Room 3459
Washington, DC 20415-3630

We will consider applications from comprehensive, prepaid medical plan health carriers that offer a complete line of medical services, which includes office visits, hospitalization, emergency care, prescription drug coverage, and treatment of mental conditions and substance abuse. We do not have the authority to contract with companies that offer limited services, such as dental and/or vision plans, prescription drug plans, supplemental insurance, or disability insurance. We cannot consider applications from fee-for-service carriers.

Once we receive your application, we will assign it to a contract specialist, who will contact you to answer any questions about the FEHB Program and the new MLR pricing method. If we approve your application, we will negotiate benefits and rates, and prepare a brochure that serves as the member's statement of contractual benefits for the upcoming benefit year. We conclude benefit and rate negotiations for FEHB carriers in August, and hold an annual Open Season enrollment event in November. Open Season changes are effective the following January.

Please call Healthcare and Insurance, Health Insurance III at 202-606-0737 or 202-606-0755 if you have questions about participation or want us to send you the application materials. We look forward to hearing from you.

U.S. Office of Personnel Management
Federal Employee Insurance Operations
Healthcare and Insurance

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