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Frequently Asked Questions Insurance

Why are the enrollee shares for some Self Plus One enrollments higher than Self and Family enrollee shares for the same plan?

For most enrollees (95%), the enrollee share for Self Plus One will be lower than the enrollee share for Self and Family. However, it is possible that some plans will have higher enrollee shares for Self Plus One enrollments than for Self and Family enrollments. The statutory formula that is used to calculate the Government Contribution is based on the average of all plan premiums and requires that OPM calculate a maximum contribution for each enrollment type. In other words, there is a limit to how much the government will contribute towards the cost of a Self Only, Self Plus One, or Self and Family enrollment. The government contributes the lesser of the maximum contribution or 75% of the total premium. The remaining amount is the enrollee share (how much the enrollee must pay). In some cases, such as plans with a premium cost that is above the program average, this calculation may result in a higher enrollee share for a Self Plus One enrollment than a Self and Family enrollment.

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