Federal Employees Health Benefits (FEHB) is one of the top healthcare insurance programs worldwide. An extensive selection of prospects, pre-tax options, the coverage that continues into retirement at the present rate, and an annual open season are some of the advantages of this program. These health plans cover a person and their family’s healthcare needs at feasible rates. Some of the key highlights of the FEHB plans are listed below.
Eligibility
Unless your position is excluded by regulation or law, these plans are for federal employees or employees of specified tribes, urban Indian organizations, or tribal organizations. Your tribal employer or federal agency determines your eligibility and applies these rules. There are some provisions for intermittent schedules, seasonal schedules, temporary positions, and part-time appointments. Eligible people have sixty days from the entry on duty date to sign-up for the chosen plan. Alternatively, you can opt for them during the Federal Benefits Open Season. People with a qualifying life event like divorce, childbirth, or any other event can also make amendments or enroll outside of the Open Season. If you fail to elect within sixty days of your eligibility, it is deemed you declined the coverage. So, you will have to wait for the next qualifying life event or open season to enroll.
No waiting periods
The day your coverage is active, you can begin using the benefits. Furthermore, there are zero limitations even if you switch from your existing plan.
Good choice of options and plans
Federal employee health plans offer a wide range of healthcare plans and options to choose from, including Fee-for-service (FFS) plans, Health maintenance organizations (HMO) plans, and plans offering a Point of Service (POS) product.
Fee-for-Service (FFS) plans
Fee-for-service is a health insurance payment procedure wherein a healthcare provider is paid a specific fee for each service. Usually, the fee-for-service plans follow two approaches – plans with a preferred provider organization (PPO) or non-PPO plans.
FFS plans with a PPO
Under this plan, you can see the medical providers that lower their charges. Hence, your out-of-pocket expenses are low. Moreover, visiting a PPO also means no paperwork or filing for claims. But, opting for a PPO does not affirm PPO benefits for every service availed in the hospital. For instance, radiology services and lab work from independent practitioners within the hospital do not fall under the PPO agreement. Typically, the networks are extensive, but they may only sometimes have the hospitals or therapists you seek. Regardless, the approach will help you save money. Also, enrolling in the FFS plan does not necessarily imply there will be a preferred provider in your neighborhood because while PPOs might be in abundance in one location, they may be almost unavailable in others. Moreover, in the areas with regional Preferred Provider Organizations, the non-PPO benefit is standard. So, if you opt for the PPO-only federal employee health plans, you should opt for PPO providers to get maximum benefits.
FFS plans (non-PPO)
It is one of the more traditional insurance plans. In such plans, once you file for insurance, you will get a reimbursement, or the insurance plan will pay the provider directly for every covered medical expense. Therefore, you can go to any hospital or therapist anytime you require medical attention. However, there are two downsides associated with it. This option is more tedious as there is paperwork involved, and it is also relatively more expensive.
Health Maintenance Organizations (HMO) plans
In this health plan, you receive care via a network of physicians in the specified service areas. Here, the HMO will look after the health care service you get and free you from paying for the covered service or taking care of the paperwork. Your eligibility for the HMO depends on where you work and live. Some HMOs have arrangements or are affiliated with the HMOs in other service areas to conduct non-emergency care if you are away from home or are traveling for an extended period. HMOs reduce your out-of-pocket expenses significantly. Moreover, they offer an extensive range of services, provided you opt for the hospitals and doctors affiliated with the HMO. You will have to bear a co-payment for the specialist and primary physician visits, but there is usually no coinsurance or deductible for in-hospital care.
Plans with a Point of Service (POS) product
These are managed care plans, typically a hybrid between PPO and HMO plans. Like PPO, patients can go outside the network to avail of healthcare services. But, like the HMO, participants can also select an in-network physician who works as their primary healthcare provider. Therefore, the choice lies in the hands of the patients. When they opt for an out-of-the-network plan, they will bear a higher cost unless the primary care provider refers the out-of-network provider.
Choice in coverage
You can opt for individual-only or self-and-family coverage for your spouse and dependent, unmarried children below 22. In some situations, federal employee health plans might also cover children with disability who are over 22 years if they cannot self-support. However, there is a premium payable from a payroll deduction. You also opt for it via pre-tax dollars.
Government contribution
Like the participants, even the government pays for the premium on their behalf. The government bears 72% of the average premium towards the total premium cost but not above 75% of the premium for the chosen plan.
