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We are looking for new Community Rated HMOs.
The U.S. Office of Personnel Management (OPM), administrator of the Federal Employees Health Benefits (FEHB) Program, would like to expand nationwide the number of health maintenance organizations (HMO) available in the Program. With the introduction of the medical loss ratio (MLR) regulations, OPM is hoping that health insurance carriers will be interested in either applying or re-applying for participation under this new pricing method, which replaces the similarly-sized subscriber groups (SSSG) method.
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:
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.
The content available is no longer being updated and as a result you may encounter hyperlinks which no longer function. You should also bear in mind that this content may contain text and references which are no longer applicable as a result of changes in law, regulation and/or administration.
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Attachment 3: CASE NOTIFICATION / STATUS UPDATE FORMAT
Attachment 5: FWA Report
Attachment 6: Federal Employees Health Benefits Program Statement about Fraud, Waste and Abuse (FWA) Annual Report Certification
Federal Employees Health Benefits (FEHB) Program Carrier Guidance on Ebola Virus
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HEDIS® Data Collection
The Massachusetts Health Care Reform Act
Attachment 1:Massachusetts Schedule HC
Attachment 2: Massachusetts Schedule HC
Brochure Development, Production and Distribution for 2001
Open Season Material & Reimbursement of Printing Costs
If you want to apply to participate in the FEHB Program, please do the following:
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 plans 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 plans in the program, inform enrollee choice, and link objective performance to profit factors. The first year of data collection using OPM’s new measures hierarchy and pay for performance methodology will be in 2016.
We encourage carriers to become active in the Health Care Payment Learning and Action Network , which HHS has recently established as a means for promoting proven payment-for- value models among private payers.New plans should carefully review the below listed carrier letters for details. Plans may submit comments and questions to email@example.com with a copy to their contract specialist.
The carrier letters listed below can be found on the Carrier Letters page.
Below are links to Frequently Asked Questions we have received from carriers regarding the Performance Assessment.