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Outreach Documents Archive

General Information | Tribal Leader Letters | Consultation Minutes | Outreach Documentation | Training Presentations

General Information


  • Federal Employees Health Benefits (FEHB) law enacted September 28, 1959
  • FEHB Program administered by the Office of Personnel Management (OPM)
  • Minimum of 15 choices available in the FEHB Program in any given geographical location
  • Over 8 million covered lives
  • Over $40 billion in annual premiums

OPM Responsibilities

  • Administer contracts with carriers
    • Negotiate benefits and rates
    • Approve plan‘s FEHB brochures
    • Audit plans
  • Publish FEHB regulations and informational material
  • Prepare Open Season materials
  • Maintain OPM and FEHB websites
  • Provide guidance to agencies and plans
  • Resolve disputed health benefits claims

Carrier Responsibilities

  • Furnish a plan identification card to each enrollee
  • Process claims and/or provide services to enrollee and covered family members
  • Maintain provider networks
  • Reconsider disputed claims
  • Print and distribute plan brochures

Tribal Employer's Responsibilities

  • Determine tribal employer/employee contributions toward FEHB premium
  • Provide FEHB information and guidance to tribal employees
  • Enroll tribal employees in health insurance plan of their choice
  • Deduct premiums from employee pay

Picking a Health Plan

  • What types of plans are offered?
    • Fee-for-Service (FFS) with Preferred Provider Organization (PPO)
    • Health Maintenance Organization (HMO)
  • Which plan is best?
    • Highly individual answer
    • Employees must make an informed choice

FFS Plans

  • Nationwide
    • Fifteen choices open to all employees
    • Others open only to specific groups, such as postal workers
  • Fewer costs are incurred if PPO providers are used
  • Some paperwork if PPO provider is not used


  • Enrollee must “live” or “work” in HMO‘s enrollment area to enroll (plan may be changed if enrollee or a family member moves)
  • Plans operate in a specific geographic area (service area)
  • Generally members must use the network and get referrals from primary care doctor
  • Out-of-pocket costs are generally limited to copays
  • Little, if any, paperwork

FEHB Program Features

  • No waiting periods
  • No pre-existing condition limitations


  • Coverage is effective on first day of pay period after enrollment request is received
  • Three enrollment types:
    • Self Only
    • Self Plus One
    • Self and Family
  • Do not need to reenroll each year

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

Open Season

  • Held annually from mid-November to mid-December
  • Enrollments and changes become effective on the first day of January, the year following the Open Season
  • During Open Season can:
    • Enroll
    • Cancel enrollment
    • Change type of enrollment
    • Change from one plan or option to another

Additional Opportunities to Enroll or Change Enrollment

  • When you experience a Qualifying Life Event
  • Common QLEs include:
    • Change in Family Status
    • Enrollee or family member loses coverage under other insurance coverage
    • Enrollee enrolled in an HMO moves from plan‘s service area
Tribal Leader Letters
Date Subject
4/24/2017 Tribal Leader Letter
12/28/2016 Tribal Leader Letter
8/31/2016 Tribal Leader Letter
11/20/2014 Tribal Leader Letter
7/19/2012 Tribal Leader Letter
Attachment 1: Tribal Employer FAQs - Federal Employees Health Benefits (FEHB) Program
Attachment 2: Dear Tribal Leader Letter FACT SHEET
Attachment 3: Indian Tribal FEHB Q & A
Attachment 4: Tribal Benefits Officer Training: Federal Employees Health Benefits (FEHB) Program Features
Attachment 5: Timeline
Attachment 6: Tribal Federal Employees Health Benefits (FEHB) Handbook Highlights
12/21/2011 Tribal Leader Letter
Attachment 1: Timeline for Enrollment
Attachment 2: 2012 FEHB Guide for Tribal Employees
Attachment 3: 2012 Tribal FFS Rates
Attachment 4: 2012 Tribal HMO Rates
05/02/2011 Tribal Leader Letter
05/02/2011 Urban Indian Organization Leader Letter
10/05/2011 Tribal Leader Letter

Consultation Minutes
Date Subject
1/2012 January Tribal/Federal Technical Work Group Teleconference Meeting Minutes
Attachment A: Slides for the January Work Group Meeting Minutes
12/2011 Tribal/Federal Technical Workgroup Meeting Minutes
11/2011 Tribal/Federal Technical Work Group Teleconference Meeting Minutes
11/2011 Attachment A: Implementation of Section 409: Access to FEHB
08/2011 DST National Meeting 8/16/11 Consultation Minutes
07/2011 CRIB- NPIHB 7/21/11 Consultation Minutes
06/2011 NCAI 6/14/11 Consultation Minutes

Outreach Documentation
Date Subject
11/20/2012 New Flexibility for Tribal Employer Participation
06/20/2012 FEHB Tri-fold for Tribal Employers
07/19/2011 Eligibility, enrollment, termination of coverage/disenrollment, and Tribal employer and employee contributions
07/19/2011 Enrollment and premium collection system and appeals process
07/29/2011 Work Group Nominations (Tribal Leaders)
07/29/2011 Work Group Nominations (Urban Indian Organization Leaders)
06/14/2011 FEHB and FEGLI Presentation at the NCAI Mid-Year conference in Milwaukee, WI
05/02/2011 Tribal Self-Governance Presentation

Training Presentations
Date Subject Speaker Notes
April 2012 Tribal Initial Enrollment Opportunity Presentation Speaker Notes
March 2012 Tribal Health Benefits - FEHB
March 2012 Tribal Benefits Part 2 - Eligilbility
March 2012 Tribal Benefits Part 3 - Enrollment
March 2012 Tribal FEHB 101 Presentation Speaker Notes
March 2012 Tribal Eligibility Presentation Speaker Notes
March 2012 Tribal Enrollment Presentation Speaker Notes
March 2012 Tribal Standard Forms 2809 & 2810 Presentation Speaker Notes
March 2012 Tribal Benefits Officer Training: Federal Employees Health Benefits (FEHB) Premium Payment Speaker Notes
May 2011 Access to FEHB and FEGLI Coverage for Employees of Tribes, Tribal Organizations and Urban Indian Organizations
Control Panel