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Outreach Documents Archive
General Information | Tribal Leader Letters | Consultation Minutes | Outreach Documentation | Training Presentations
General Information
Introduction
- Federal Employees Health Benefits (FEHB) law enacted September 28, 1959
- FEHB Program administered by the Office of Personnel Management (OPM)
- Minimum of 15 choices available in the FEHB Program in any given geographical location
- Over 8 million covered lives
- Over $40 billion in annual premiums
OPM Responsibilities
- Administer contracts with carriers
- Negotiate benefits and rates
- Approve plan‘s FEHB brochures
- Audit plans
- Publish FEHB regulations and informational material
- Prepare Open Season materials
- Maintain OPM and FEHB websites
- Provide guidance to agencies and plans
- Resolve disputed health benefits claims
Carrier Responsibilities
- Furnish a plan identification card to each enrollee
- Process claims and/or provide services to enrollee and covered family members
- Maintain provider networks
- Reconsider disputed claims
- Print and distribute plan brochures
Tribal Employer's Responsibilities
- Determine tribal employer/employee contributions toward FEHB premium
- Provide FEHB information and guidance to tribal employees
- Enroll tribal employees in health insurance plan of their choice
- Deduct premiums from employee pay
Picking a Health Plan
- What types of plans are offered?
- Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
- Health Maintenance Organization (HMO)
- Which plan is best?
- Highly individual answer
- Employees must make an informed choice
FFS Plans
- Nationwide
- Fifteen choices open to all employees
- Others open only to specific groups, such as postal workers
- Fewer costs are incurred if PPO providers are used
- Some paperwork if PPO provider is not used
HMOs
- Enrollee must “live” or “work” in HMO‘s enrollment area to enroll (plan may be changed if enrollee or a family member moves)
- Plans operate in a specific geographic area (service area)
- Generally members must use the network and get referrals from primary care doctor
- Out-of-pocket costs are generally limited to copays
- Little, if any, paperwork
FEHB Program Features
- No waiting periods
- No pre-existing condition limitations
Enrollment
- Coverage is effective on first day of pay period after enrollment request is received
- Three enrollment types:
- Self Only
- Self Plus One
- Self and Family
- Do not need to reenroll each year
Family Member Eligibility
- Spouse
- Children under age 26
- Includes:
- Married children
- Adopted children
- Stepchildren
- Foster Children (as long as all requirements are met)
Family Members not Eligible
- Grandchildren, unless foster child requirements are met
- Parents
- Siblings
- In-laws
Open Season
- Held annually from mid-November to mid-December
- Enrollments and changes become effective on the first day of January, the year following the Open Season
- During Open Season can:
- Enroll
- Cancel enrollment
- Change type of enrollment
- Change from one plan or option to another
Additional Opportunities to Enroll or Change Enrollment
- When you experience a Qualifying Life Event
- Common QLEs include:
- Change in Family Status
- Enrollee or family member loses coverage under other insurance coverage
- Enrollee enrolled in an HMO moves from plan‘s service area
| Date | Subject |
|---|---|
| 11/20/2012 | New Flexibility for Tribal Employer Participation |
| 06/20/2012 | FEHB Tri-fold for Tribal Employers |
| 07/19/2011 | Eligibility, enrollment, termination of coverage/disenrollment, and Tribal employer and employee contributions |
| 07/19/2011 | Enrollment and premium collection system and appeals process |
| 07/29/2011 | Work Group Nominations (Tribal Leaders) |
| 07/29/2011 | Work Group Nominations (Urban Indian Organization Leaders) |
| 06/14/2011 | FEHB and FEGLI Presentation at the NCAI Mid-Year conference in Milwaukee, WI |
| 05/02/2011 | Tribal Self-Governance Presentation |
| Date | Subject | Speaker Notes |
|---|---|---|
| April 2012 | Tribal Initial Enrollment Opportunity Presentation | Speaker Notes |
| March 2012 | Tribal Health Benefits - FEHB | |
| March 2012 | Tribal Benefits Part 2 - Eligilbility | |
| March 2012 | Tribal Benefits Part 3 - Enrollment | |
| March 2012 | Tribal FEHB 101 Presentation | Speaker Notes |
| March 2012 | Tribal Eligibility Presentation | Speaker Notes |
| March 2012 | Tribal Enrollment Presentation | Speaker Notes |
| March 2012 | Tribal Standard Forms 2809 & 2810 Presentation | Speaker Notes |
| March 2012 | Tribal Benefits Officer Training: Federal Employees Health Benefits (FEHB) Premium Payment | Speaker Notes |
| May 2011 | Access to FEHB and FEGLI Coverage for Employees of Tribes, Tribal Organizations and Urban Indian Organizations |