Health Insurance
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:
- Fee-for-Service (FFS) plans and their Preferred Provider Organizations (PPOs);
- Health Maintenance Organizations (HMOs) for those who live within the geographic area serviced by the plan; and
- Consumer-Driven and High Deductible health plans that offer catastrophic risk protection with higher deductibles, health savings/reimbursement accounts, and lower premiums.
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
- Enrollment Form (SF2809) Employee Guidance
- Enrollment Form (SF 2809)
- What Changes Employees Can Make Outside of Open Season
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
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Tribal employees who are considered common law employees and meet FEHB requirements for the type of employment are eligible to enroll in FEHB. Check with your tribal employer to see if you are eligible to enroll.
For details on the common law standard, please see pages two through five.
Contract employees, tribal retirees, and volunteers are not eligible to enroll in FEHB.
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Please contact your tribal employer for the specific date of when your Initial Enrollment Opportunity begins.
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Please contact your tribal employer for the specific dates or the specific time period of your Initial Enrollment Opportunity.
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It is your opportunity to enroll in an FEHB health plan. You cannot enroll in the FEHB Program at any other time unless it is during the annual open season (approximately mid-November through mid-December each year) or if you experience a Qualifying Life Event.
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Two types of plans are available:
- Fee-for Service plans
- Health Maintenance Organizations (HMO)
Both types offer several plan designs and options such as a point-of-service product, high deductible, and consumer-driven options.
For more information on each type of plan, please view the Plan Information tool.
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- You will not have FEHB health insurance coverage.
- You will not be able to enroll in an FEHB health plan until the annual open season (approximately mid-November through mid-December each year) or if you experience a Qualifying Life Event.
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What is the effective date of my health insurance coverage for the Initial Enrollment Opportunity? View more
Please contact your tribal employer for the specific effective date of when your health insurance coverage will begin. Generally, the effective date of coverage should be the first day of the month following the end of the Initial Enrollment Opportunity.
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Your costs include both your share of premiums and out-of-pocket expenses. Premium information can be found on the tribal rates page. You can view information on both premiums and your out-of-pocket costs in the 2016 FEHB brochures. Tribal employers are expected to provide an employer contribution to premium that is the same as the Government contribution for Federal employees. A tribal employer may pay more than the Government contribution amount, but not less.
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Complete and submit a Standard Form 2809, Employee Health Benefits Election Form to your tribal employer. For information on how to fill out the SF 2809, please visit the SF 2809 Guidance for Tribal Employees.
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You can find information on:
- Benefits in the individual health plan brochures
- Plan Comparison Tool Compare the FEHB plans available to you based on your zip code. See premium rates, selected benefits, health plan consumer satisfaction survey results, and links to other health plan quality indicators
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The FEHB health plan brochures are available. In this tool, you'll see a map of the United States. When you click on a state, three charts will appear showing all available plans in the state with links to their health plan brochures. Simply find the plan that interests you and click the link to its brochure.
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Several items can help you choose an FEHB plan that best meets your needs:
To compare plan benefits and out-of-pockets costs:
For a full list of resources see the Initial Enrollment Opportunity Resources.
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
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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.