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Tribal Employers Health Insurance

 

Overview

The Office of Personnel Management has changed its policy concerning the participation of tribal employers* to make it easier for them to enroll their employees in the Federal Employees Health Benefits (FEHB) Program.  Learn More

Welcome to the Tribal Federal Employees Health Benefits (FEHB) Program website. This site provides details on the FEHB Program, eligibility, enrollment, plan information, premium rates, and more.

The FEHB Program offers a wide variety of plans and coverage to help you meet your health care needs. The Program is available to eligible employees and eligibile family members of entitled tribes, tribal organizations, and urban Indian organizations (under the Affordable Care Act's incorporation of the Indian Health Care Improvement Reauthorization and Extension Act of 2009). The FEHB Program is administered by the Office of Personnel Management (OPM).

An important hallmark of the FEHB Program is providing choice and competition. The Program is open to every eligible employee regardless of health status. There are no pre-existing condition limitations or waiting periods in the FEHB Program. Every employee has the opportunity to choose the plan that best suits the employee's individual needs. On average, an employee can choose from at least 10 health plans.

The FEHB Program offers a wide selection of health plans for eligible employees and their eligible family members. Eligible employees may choose from:

  • Fee-for-Service (FFS) plans and their Preferred Provider Organizations (PPOs);
  • Health Maintenance Organizations (HMOs) for those who live within the geographic area serviced by the plan; and
  • Consumer-Driven and High Deductible health plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursement accounts, and lower premiums.

Use this site to compare the costs, benefits, and features of different plans. OPM chose the different benefit categories based on enrollee requests, differences among plans, and simplicity. When choosing a health plan, OPM urges you to consider the total benefit package including the premium, covered benefits, out-of-pocket costs, and plan provider (PPO or HMO) availability... View More

The plan brochures show you what services and supplies are covered and the level of coverage. Review the brochures carefully. The brochures are formatted to ensure they are all organized alike. You can get brochures from the health plans or your tribal employer. Be informed when it comes to your health care.

Health information technology, based on broadly accepted standards, will allow patients, health care providers, and payers (insurance carriers) to share information securely, driving down costs by avoiding duplicate procedures and manual transactions. More importantly, HIT will reduce medical errors; for instance, from misread, handwritten prescriptions and emergency care medical decisions made without complete and accurate information. Since privacy and security considerations are central to Federal HIT implementation plans, patient records will be protected from inappropriate disclosure.

* Note: The term tribal employers is used to designate tribes, tribal employers and urban Indian organizations.

Related Videos

FEHB Eligibility

The Patient Protection and Affordable Care Act of 2010 states: (1) tribes or tribal organizations carrying out programs under the Indian Self-Determination and Education Assistance Act; and (2) urban Indian organizations carrying out programs under Title V of the Indian Health Care Improvement Act, are entitled to purchase coverage, rights, and benefits from the Federal Employees Health Benefits (FEHB) Program for their employees.

If a tribe, tribal organization or urban Indian organization participates in FEHB, the tribe employee can elect FEHB coverage, unless their position is excluded by law or regulation. The human resources officer of the tribe, tribal organization, or urban Indian organizations applies these rules and determines your eligibility. However, there are numerous special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions. This chapter in the FEHB Handbook for Tribes explains these provisions. Contract employees, retirees, and volunteers will not be eligible to enroll in FEHB.

Temporary Continuation of Coverage (TCC)

Temporary Continuation of Coverage (TCC) is a feature of the FEHB Program that allows certain people to temporarily continue their FEHB coverage after regular coverage ends. TCC enrollees must pay the full premium for the plan they select (that is, both the employee and Tribal Employer shares of the premium) plus a 2 percent administrative charge.

FEHB for Dependents

Family members eligible for coverage under your Self and Family enrollment are your spouse (including a valid common law marriage) and children under age 26, including legally adopted children, stepchildren, and recognized natural (born out of wedlock) children. Foster children are included if they live with you in a regular parent-child relationship. A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member. The tribal employer will look at the child's relationship to the enrollee to determine whether the child is a covered family member.

Civilian Employees on Active Military Duty

If tribe employees keep their FEHB enrollment during military service, they may continue their enrollment for up to 12 months while they are on military duty. They are responsible for the enrollee share of the premium during this period, just like any other employee in leave without pay status. Current Federal law extends the 12-month period an additional 12 months. During this additional period, they must pay both the employee and the tribal employer’s share of the premium, plus an additional 2 percent of the total premium, on a current basis.

The employing office may waive the requirement that tribe employees pay their share of FEHB premiums during all or any part of the 24-month period if their orders show that they are called to active duty in support of a contingency operation. If their employing office waives the premium, it must remit the full premium (employee and agency share) to OPM on a current basis.

Enrollment

When a tribal employer chooses to participate in the Federal Employees Health Benefits (FEHB) Program, the Initial Enrollment Opportunity occurs. It is the time period for eligible tribal employees to enroll in the FEHB Program. Please check with your tribal employer to see if they have elected to participate in FEHB and if they have, when your Initial Enrollment Opportunity occurs.

During the annual FEHB Open Season, which is held mid-November through mid-December, anyone eligible to participate in the FEHB Program may enroll, change health plans or options, cancel FEHB enrollment, and change participation in premium conversion (waive or begin participation). If the tribe, tribal organization or urban Indian organization participates in premium conversion, employees may change their premium conversion status.

Outside of Open Season, newly eligible employees may enroll within 60 days of their becoming eligible for the FEHB program, members who move outside of the area covered by their HMO may enroll in a different FEHB plan covering their new location. OPM may announce special enrollment opportunities affecting members of specific plans only. There are also a number of other circumstances (qualifying life events) which can make you eligible to enroll or change your FEHB coverage outside of Open Season.

Instructions for Making an Open Season Enrollment Change

To make any of these changes, employees can submit Standard Form 2809, Employee Health Benefits Election Form to your Human Resources Office.

Premiums

In the tables below, you can find the monthly premiums, the total premiums, and the minimum amount your tribal employer must pay for each health plan (this amount is the same amount that Federal agencies contribute for their employees). Be sure to check with your tribal employer as there are some tribal employers who may choose to pay a larger portion of your premiums (up to 100 percent).

Initial Enrollment Opportunity

When a tribal employer chooses to participate in the Federal Employees Health Benefits (FEHB) Program their eligible tribal employees must elect to either enroll, or not enroll in the FEHB Program. This is called the Initial Enrollment Opportunity. Please check with your tribal employer for the dates of your Initial Enrollment Opportunity.

Frequently Asked Questions

Resources

The following resources will provide guidance as to what coverage and premiums best suits your needs.

  • Tribal FastFacts: Intro to FEHB

    This FastFact provides an overview to the FEHB Program with frequently asked questions

  • Tribal FastFacts: Choosing a Plan

    This FastFact provides questions you should consider before selecting a health plan.

  • Tribal FastFacts: FEHB for New/Newly Eligible Tribal Employees

    This FastFact provides an overview to the FEHB Program to New/Newly Eligible Tribal Employees

  • FEHB Guide for Tribal Employees

    The Guide includes information about the FEHB Program, provides guidance for making enrollment decisions, and has instructions for employees during the Initial Enrollment Opportunity. It also includes charts with plan premiums and basic benefits information.

  • Quick Guide

    The Quick Guide provides answers to over 30 commonly asked questions about the FEHB Program.

  • 2014 Premiums

    You can find the monthly premiums, the total premiums, and the minimum amount your tribal employer must pay for each health plan. Be sure to check with your tribal employer as the rates listed reflect the maximum amount you will be required to pay. Some tribal employers may choose to pay a larger portion of your premiums (up to 100 percent).

  • Enrollment Form (SF 2809)

    To enroll during your Initial Enrollment Opportunity, complete and submit the Health Benefits Election Form to your tribal employer.

  • Health Plan Brochures

    Health plan brochures provide a wealth of information including the listing of covered services, benefits, and premiums.

  • Compare Health Plans

    OPM's health plan comparison tool.

  • PlanSmartChoice

    Health plan comparison tool. It assists you in deciding which health plan best meets your personal needs and estimates your total health care cost before selecting a health plan.

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