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Healthcare & Insurance Tribal Employers

 

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

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 eligible family members of entitled and enrolled Tribes or tribal organizations carrying out programs under the Indian Self-Determination and Education Assistance Act (ISDEAA) or the Tribally Controlled Schools Act of 1988 (TCSA) (25 U.S.C. 2501 et seq.) and urban Indian organizations carrying out programs under Title V of the Indian Health Care Improvement Act (IHCIA) . 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. Every employee has the opportunity to choose the plan that best suits the employee's individual needs.

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

Use this site to compare the costs, benefits, and features of different plans. 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.

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, your tribal employer, or view plan brochures online. Be informed when it comes to your health care.

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

Use the FEHB Plan Comparison Tool to view and compare health plans.

FEHB Eligibility

If a tribe, tribal organization, tribally controlled school 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, tribally controlled school or urban Indian organization applies these rules and determines your eligibility. Contract employees, retirees, and volunteers are not eligible to enroll in FEHB.

Family Member Eligibility

  • Spouse
  • Children under age 26
  • Includes:
    • Married children
    • Adopted children
    • Stepchildren
    • Foster Children (as long as all requirements are met)

Family Members not Eligible

  • Grandchildren, unless foster child requirements are met
  • Parents
  • Siblings
  • In-laws

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.

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

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

  • 2016 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.

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