Rewriting the Rules of the Road

One of OPM’s cultural values is to “ask why.” Why do we do things the way we do them? Why does a process exist? Why do we collect one piece of data and not another? Why are we still relying on a framework developed for a bygone era?

Today, we are asking “why” in the context of one of our most important responsibilities: helping ensure that federal employees, retirees, postal workers, and their families have access to high-quality, affordable health benefits. To that end, we have updated our Guiding Principles for Federal Employees Health Benefits and Postal Service Health Benefits carriers.

I know at first blush that may sound boring – an internal policy exercise that’s a real snoozer. But, hear us out. It’s not. These principles are the rules of the road for the health insurance carriers that participate in programs serving 8.3 million Americans who serve, or have served, our country. And those rules drive results.

The last time we updated these rules prior framework was in 2006. That was the same year that Twitter (now X) launched, Google (now Alphabet) acquired YouTube and, of course, who can forget the tragic death of Crocodile Hunter Steve Irwin. Oh, and the iPhone was a year away from launch. Times have changed.

Most people were not comparing healthcare costs on a phone, expecting digital claims tools, or using online provider search the way they do today. Artificial intelligence was not part of the everyday conversation about operations, fraud detection, customer service, or data analysis. Healthcare delivery itself looked very different. Value-based care, price transparency, digital therapeutics, telehealth, cybersecurity, and data interoperability were either early concepts or nowhere near as central as they are now.

Yet federal health benefits programs must operate in the world as it exists today, not as it existed twenty years ago. That is why we are modernizing the principles that guide our work with carriers. The goal is simple: better benefits, better value, better oversight, and a better experience for the people these programs serve.

First, now more than ever, affordability has to be at the center of the conversation. Federal employees and retirees work hard for their paychecks. Postal workers and their families deserve a system that respects the premiums they pay. Taxpayers also have a direct stake in these programs because they fund the agency contributions for their employees’ health premiums. Every dollar spent through FEHB and PSHB should be spent with discipline, purpose, and a clear expectation of value. Expecting 10-12% annual premium increases ad nauseum is just not reasonable.

Affordability does not mean cutting corners or reducing benefits. It means asking carriers to manage costs intelligently, design benefits efficiently, support value-based care, and give enrollees clearer information about what care costs and what choices are available to them. The best healthcare system is not the one that simply pays more claims. It is the one that helps people get the right care, at the right time, in the right setting, with the best possible outcome.

Second, program integrity must be non-negotiable. Fraud, waste, and abuse are not abstract accounting problems. They raise costs for enrollees, weaken trust in government, and divert resources from legitimate care. Carriers must actively prevent, detect, and address improper payments, overbilling, weak vendor oversight, and other risks across the system.

This is an area where OPM is going to be increasingly data-driven. We should not be satisfied with finding problems years after the fact. Modern oversight means using data, audits, analytics, and clear accountability to identify risks earlier and act faster. The fraud, waste, and abuse initiatives that we launched recently will not operate in a vacuum. Our carrier partners will be critical to our success here.

Third, we need a health benefits ecosystem that is digitally enabled and secure by design.

A federal employee should not have to navigate a confusing maze to understand benefits, check a claim, find a provider, file an appeal, or compare costs. A retiree should not have to wonder whether the information they are seeing is accurate or complete. A postal worker should not have to experience a benefits system that feels decades behind the rest of daily life.

Modern consumer expectations are not unreasonable. They are the baseline. Enrollees should have clear, plain-language, accessible information. Digital tools should be intuitive. Data submitted to OPM should be accurate, complete, and timely. Systems should be secure, resilient, and built for the future.

Fourth, OPM needs clearer and more consistent expectations for how carriers perform.

A principle is only useful if it changes behavior. These updated principles will anchor how OPM communicates with carriers, evaluates plan performance, conducts oversight, and advances strategic initiatives across FEHB and PSHB. They are not a slogan. They are a management framework.

We are telling carriers what matters: broad access to care, competitive benefits, affordability, consumer empowerment, compliance, financial strength, operational excellence, secure digital capabilities, accurate data, and protection of enrollee and taxpayer resources. That clarity is good for OPM. It is good for carriers. Most importantly, it is good for the millions of Americans enrolled in these plans.

Finally, these updates reflect a broader truth about government: stewardship requires modernization - not chasing the newest technology for its own sake, but rather making government work better. It means measuring performance. It means reducing unnecessary complexity. It means replacing outdated assumptions with current facts. It means building systems that are accountable to the people who rely on them and the taxpayers who fund them.

Healthcare is personal. It affects families, finances, retirement decisions, recruiting, retention, and peace of mind. A strong federal workforce deserves a health benefits system that is affordable, outcome-based, transparent, and member-focused.

We shouldn’t demand excellence from our employees while tolerating outdated and sub-par performance for the benefits that support them.

These updated Guiding Principles reflect our commitment to federal employees, retirees, postal workers, families, carriers, and taxpayers: we will protect these programs, improve them, and insist that they evolve with the needs of the people they serve.

We will continue to ask “why.” That is the standard. That is the work. And that is what good stewardship requires.