No Waiting Periods. Your coverage starts right away, without a waiting period, medical examination or restrictions because of age or physical condition.

  A choice of coverage. You can choose self only coverage just for you, or self and family coverage for you, your spouse, and unmarried dependent children under age 22. Under certain circumstances, your FEHB enrollment may cover your disabled child 22 years old or older who is incapable of self-support.

  A choice of plans and options.

• Managed fee-for-service plans
• Plans offering a point of service product
• Health Maintenance Organizations

  A Government contribution. The Government contributes toward the total cost of your premium. In 1998, the Government will pay up to $1714.96 for each self only enrollment and $3699.02 for each family enrollment.

The Government usually pays 75% of the total premium. The maximum dollar contribution, if youre paid every two weeks, is $65.96 self only and $142.27 self and family. The monthly rates are $142.91 self and $308.25 family. However, some plans get less than the maximum because the Government contribution cannot exceed 75% of a plans total premium. The Government contribution for part-time employees may be different. See your personnel office to get the exact amount.

  Salary deduction. You pay your share of the premium through a payroll deduction.

  Annual enrollment opportunities. Each year you have the opportunity to enroll or change plans. During the Open Season, you may enroll if you are eligible and not now enrolled, change plans or options, or change from self only to family. (You may change from family to self only at any time.)

  Continued group coverage. The FEHB Program offers continued FEHB coverage:

• for you and your family when you retire from Federal service (normally you need to be covered in FEHB for the five years before you retire),
• for your former spouse if you divorce and you have a qualifying court order (see your personnel office for more information),
• for your family if you die, or
• for you and your family when you move, transfer, go on leave without pay, or enter military service (certain rules about coverage and premium amounts apply; see your personnel office).

• for you and your family if you leave Federal service (including when you cant carry FEHB into retirement),
• for your covered dependent child if he or she marries or turns age 22, or
• for your former spouse if you divorce and you do not have a qualifying court order (see your personnel office for more information).

FEHB and You

Managed care is an important part of the FEHB Program. You will find managed care features in all the plans described in this Guide. Common features of managed care are pre-admission certification, the use of primary care providers as "gatekeepers" to coordinate your medical care, and a network of physicians and other providers.

If you are eligible for FEHB coverage, you may enroll in a managed FFS plan. Some of these plans are open to all enrollees, but some of these plans require that you join the organization that sponsors the plan. Other managed FFS plans limit enrollment to certain employee groups.

You may also enroll in a POS or an HMO if you live (or sometimes if you work) in the specific geographic area where the plan provides services. Membership requirements and/or limitations that apply to a managed FFS plan also apply to any POS product the plan may be offering (see above).

In deciding which plan to choose, you should consider your and your familys medical needs, the cost of each plan, and the type of health benefits plan (FFS, POS, HMO) you prefer. You can help get the right kind and quality of care at the right price by carefully comparing the plan information in this Guide and carefully reviewing the plans brochure before making any final decisions. You can get copies of brochures from your personnel office, by contacting the plans directly at the numbers shown in this Guide, or on the World Wide Web. Plans that have a in the column labeled "Website" have their own website.

The 1998 Guide to Federal Employees Health Benefits Plans for Federal Civilian Employees, plan brochures, and other information, including links to plan Websites, are available on the World Wide Web. The Guide and brochures are also available on OPM ONLINE. Anyone who has a personal computer, modem, phone line and communications software can access OPM ONLINE by dialing 202/606-4800.

National Committee for Quality Assurance (NCQA)

We have listed the accreditation status of the FEHB plans who requested an NCQA review. The following symbols appear in the NCQA status column to designate the accreditation status.

 Full Accreditation. This status is granted for a period of three years to those plans that have excellent programs for continuous quality improvement and meet NCQAs rigorous standards.

 One-Year Accreditation. This status is granted to plans that have well-established quality improvement programs and meet most NCQA standards. NCQA reviews the plans again after a year to determine if they have progressed enough to move up to Full Accreditation.

 Provisional Accreditation. This status is granted for one year to plans that have adequate quality improvement programs and meet some NCQA standards. When these plans demonstrate progress, they can qualify for a higher level of accreditation.

 Denial. This status indicates plans were reviewed but did not qualify for any of the above categories.

Note: The absence of an NCQA status symbol next to a plans name could be because:

• the plan is too new to be reviewed,
• not all of the plans FEHB rating area was reviewed,
• the plan might have merged with another plan and that plan was not reviewed,
• a plans review decision is pending, or
• a plan chose not to be reviewed.

1997 Customer Satisfaction Survey Results

The Ratings.  We surveyed enrollees and asked them to rate various aspects of their health plan on a five-point scale of poor, fair, good, very good, and excellent. Selected results are shown for the percentage of enrollees in each plan who rated their plan good, very good or excellent in the following categories (Some categories apply only to POS and HMO plans or only to FFS plans):

• Ability to see the same doctor on most visits,
• Access to medical care (arranging for and getting care),
• Access to medical care in an emergency (POS and HMO only),
• Choice of doctors available through the plan (being able to find doctors you are satisfied with),
• Costs you personally have to pay (FFS only),
• Coverage (range of services covered),
• Explanation of care (what is wrong, what is being done, and what to expect),
• Getting appointments when sick,
• How quickly claims are processed (FFS only),
• Quality of care (from doctors and other medical professionals), and
• Results of care.

A bar graph for each plan shows the percentage of plan enrollees who indicated one of three levels of satisfaction.

Example: 

In the example, 19% of respondents are extremely satisfied, 46% are very satisfied, and 23% are satisfied.

Plans with an overall satisfaction score that is significantly higher than the average overall score are identified with a the column labeled "Top rated plans". Scores that are significantly higher than the average for any of the rating elements are printed bold in green; scores that are significantly lower than the average are printed in red italics.

Understanding the Survey Results. The error range for overall satisfaction is less than 6% at the 95% level of confidence. In other words, if we repeated the survey, we would expect similar results 95% of the time.

Although the survey was based on a random sample of plan enrollees, enrollees opinions may vary depending on age, education level, state of health, and other characteristics. We have adjusted the results shown in this Guide for these differences. Generally, adjusted results are not much different from the unadjusted results.

If your plan is not rated in this Guide, it is because the plan is new to the FEHB Program or the number of respondents was too small for us to reliably include their opinions.

Questions regarding the Federal Employees Health Benefits Program should be directed to the Office of Insurance Programs at our <Feedback Page>.

Updated Monday, December 22, 1997