Thank you for visiting the Federal Employees Health Benefits (FEHB) Program's carrier application and information web pages. We created the following pages for health insurance companies interested in participating as a health carrier in our Program. There are three screens:

• This first screen provides information on the types of health insurers that the Office of Personnel Management (OPM) can approve for participation in the FEHB program.
• The second screen will ask you to enter specific identifying data such as your name and professional title, your health insurance company and its address. Completing this screen does not constitute submission of your application. We use this information to follow-up with you concerning your interest and your progress in completing the application.
• The third screen will automatically appear once you complete the data we requested on the second screen. On this screen you will find links to the downloadable application files. To apply for participation in the FEHB Program, you must complete all files. OPM must receive your application by January 31.

What types of health insurers qualify for participation in the FEHB Program?

We will consider applications only from comprehensive, prepaid medical plans. The FEHB Program contracts only with health benefits carriers that offer a complete line of medical services, such as doctor's 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 and disability insurance. We can not consider applications from fee-for-service carriers.

We especially invite qualified applicants from the states that the Department of Health and Human Services (HHS) has determined to be medically underserved -- Alabama, Arizona, Idaho, Illinois, Louisiana, Mississippi, Missouri, Montana, New Mexico, North Dakota, Oklahoma, South Carolina, South Dakota, and Wyoming.

We also encourage applicants that HHS, Centers for Medicare and Medicaid Services (CMS), determines to be Federally qualified or that are an approved Competitive Medical Plan (CMP)

We invite you to apply if you believe you qualify to participate in the FEHB Program. Please go to the next screen. If you have a question, please call our HMO contracts office at 202-606-0755 or 202-606-0737 and ask to speak with a contract specialist.

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If you want to apply to participate in the FEHB Program, please do the following:

• Download each of the following Microsoft Word files;
  • Application for FEHB
  • Drug Free Workplace Certification
  • Sample Experience-Rated HMO Contract
  • Sample Community-Rated HMO Contract
  • Anti-lobbying form
• Complete the application and certifications as directed;
• Send the completed application to OPM by January 31; and
• Complete the information form in the next tab. We will then be able to contact you with any significant updates to the materials you downloaded.

Carrier Application Information Form

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• Directory of Headquarters Level Agency Benefits Officers
• Tests and Procedures Identified in the Choosing Wisely Campaign
• Guiding Principles for FEHB Carriers
• Carrier Handbook
• Benefits Administration Letters
• Tribal Benefits Administration Letters
• Indian Tribes Reference Materials
• Medicare
• Title 5, United States Code, Chapter 89 - Health Insurance
• FEHB Regulations - Part 890 of CFR Title 5
• Federal Acquisition Regulation (FAR)
• OPM Federal Employees Health Benefits Acquisition Regulation (FEHBAR)
• FEHB Enrollment Through Tribal Employees
• FedScope
• Federal Employees Health Benefits Program Call Letter

Performance Assessment

• FAQs on Carrier Letter 2014-19 FEHB Health Plan Performance Assessment
• FAQs Carrier Letter 2014-28 Additional Information on the Performance Areas for the FEHB Plan Performance Assessment
• FAQS Measures and Framework Design
• Reporting HEDIS Metrics to the National Committee Quality for Assurance (NCQA) 

Health Information Technology References

Health & Human Services

• Office of the National Coordinator for Health Information Technology (ONCHIT)
• National Health Information Infrastructure (NHII) Home Page
• CMS DOQ-IT Project
• CMS QIO Program (Quality Improvement Organizations)
• The Health Information Technology Leadership Panel: Final Report (Press Release)
• The Health Information Technology Leadership Panel: Final Report

Executive Branch/Congressionally Appointed Commission

• Certification Commission for HIT

Regional Health Organizations (focusing on the States with which HHS-AHRQ has contracts on HIT demos)

• Indiana Health Information Exchange
• Utah Health Information Network
• Blue Cross $50 Million for Massachusetts HIT 
• Information on Rhode Island HIT efforts

Technology Groups

• Health Information and Management Systems Society
• HL-7 (Health Level 7) Home Page
• Webgroup for Electronic Data Interchange (WEDI) Health Data

Federal Employees Health Benefit (FEHB) Program Plan Performance Assessment

The Office of Personnel Management’s (OPM) goal is to improve the health of the populations we serve, ensure the delivery of high quality consumer focused health care, and provide Federal employees and retirees with affordable insurance benefits. We evaluate FEHB Carriers on key parameters of clinical quality, customer service, resource use, and contract oversight.

Many aspects of our performance assessment framework rely on measures from the Healthcare Effectiveness Data and Information Set (HEDIS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS). Scoring measures against national benchmarks helps OPM recognize top performing health insurance carriers in the program, inform enrollee choice, and link objective performance to profit factors. The first year of data collection using OPM’s measures hierarchy and value-based purchasing methodology was in 2016.

We encourage FEHB carriers to become active in the Health Care Payment Learning and Action Network, which the Department of Health and Human Services established as a means for promoting proven value-based payment models among commercial carriers. Carriers interested in joining the FEHB Program should carefully review materials listed under the subject areas on this page.

Below are links to more FEHB Plan Performance Assessment Information: