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News Release

Tuesday, December 16, 2008
Contact: Michael Orenstein
Tel: 202-606-2402

OPM Announces Benefits Change for Enrollees of Blue Cross and Blue Shield Who Use Out-of-Network Surgeons

New Prior-Approval Service to Give Enrollees Their Cost of Surgery Up-Front

Washington, D.C. -- The U.S. Office of Personnel Management today announced it has taken steps to provide additional protections in 2009 for federal employees and retirees who are enrolled in Blue Cross and Blue Shield's (BCBS) Standard Option and choose to have non-emergency surgeries performed by out-of-network surgeons.

Under the revised benefits provision, BCBS Standard Option enrollees will be responsible for 30 percent of the plan's payment allowance for the surgery to be performed, plus the difference between the plan's allowance and the amount billed by the surgeon. In addition, Blue Cross and Blue Shield will, for the first time, provide prior approval for all non-emergency, out-of-network surgeries of $5,000 or more, enabling enrollees to know in advance how much BCBS will pay for the surgery. BCBS also will provide additional information and assistance to make the patient's costs more transparent. Enrollees must initiate this prior-approval process.

In the past, some BCBS enrollees were unaware they could be responsible for tens-of-thousands of dollars in "balance billing" charges for out-of-network surgeries. Balance billing occurs when a surgeon who is not part of the health plan's network of physicians charges more than the plan's allowance for the provided service. Beginning in January 2009, enrollees can seek help from BCBS to better understand what they will be expected to pay for surgery.

In permitting this revision, OPM advised Blue Cross and Blue Shield and other carriers participating in the Federal Employees Health Benefits Program that other changes to benefits or premiums would not be allowed. No other carrier proposed revisions to this benefit for 2009.

With the change in benefits in Blue Cross and Blue Shield, OPM has instructed federal agencies to accept belated Open Season enrollments through the end of January 2009.

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OPM leads and serves the Federal Government in enterprise human resources management by delivering policies and services to achieve a trusted, effective civilian workforce. By Empowering Excellence in Government through Great People, we provide leadership and support to U.S. agencies on issues including human resources policy and oversight, background investigations, federal employee benefits, retirement services, guidance on labor-management relations, and programs to improve workforce performance. For more information, visit or follow OPM on Twitter, Facebook, or LinkedIn.

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