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1 1 (January 19, 2016)

handle is hein.crs/govcdur0001 and id is 1 raw text is: FF.ri E.$~ & Updated January 19, 2016 The Federal Employees Health Benefits (FEHB) Program: Open Season for the 2016 Plan Year The Federal Employees Health Benefits (FEHB) Program is the largest employer-sponsored health benefits program in the United States. FEHB is administered by the Office of Personnel Management (OPM). Participation in FEHB is voluntary, with 85% of federal employees enrolled and 90% of federal retirees participating. FEHB provides about $48 billion in health benefits annually. According to the most recent estimate from OPM for 2015, there are about 4 million policyholders in FEHB, covering about 8.2 million people, including federal employees, retirees, and their eligible family members. This number includes employees and retirees of the United States Postal Service (USPS). See Figure 1 for a breakdown of FEHB policyholders. Figure I. Profile of FEHB Policyholders, 2015 Source: Congressional Research Service (CRS) analysis of Office of Personnel Management (OPM) data. Individuals have the opportunity to enroll for the first time or change their existing health insurance plan during the annual open season. The open season for the 2016 plan year ran from November 9, 2015, through December 14, 2015. Outside of open season, changes are only allowed for individuals with a qualifying life event, such as marriage. 're - e.M - '-'3 2 Phk- 0ptic > For 2016, there are 252 plan options. FEHB enrollees choose a health plan from a health insurance carrier participating in FEHB. Each carrier offers one or more plans. In general, FEHB health insurance carriers and their health plans fall into two broad categories: fee-for-service (FFS) plans or health maintenance organizations (HMOs). FFS plans are generally available nationwide, and HMOs tend to be locally available. Details for all FEHB plans are available on OPM's website at http://www.opm.gov/ healthcare-insurance/healthcare/plan-information/. As a practical matter, depending on where an enrollee resides, the choices are limited to about 15 different plans. Plan choices change each year, as plans enter or leave the program or change geographic service areas. For 2016, four new local health plans entered FEHB and six local plans left FEHB. The Federal Employees Dental and Vision Insurance Program (FEDVIP) and the Federal Flexible Spending Account Program (FSAFEDS) options are also available during open season. All individuals eligible for FEHB, including retirees, are also eligible to enroll in FEDVIP, which provides supplemental dental and vision insurance. Currently, FEDVIP has more than 1.6 million enrollees in dental plans and more than 1.1 million in vision plans. Active federal employees are eligible for FSAFEDS, which allows employees to pay for some health care expenses with pretax dollars. More than 350,000 federal employees participate in FSAFEDS. In the past, FEHB has offered two enrollment options: self- only and self and family. The Bipartisan Budget Act of 2013 (P.L. 113-67) established a third enrollment option, self plus one, to begin in 2016. The self plus one option allows the enrollee plus one eligible family member to be covered. Enrollment in self plus one is not automatic; enrollees must sign up during open season or during the year through a qualifying life event, such as marriage. For this year only, outside of open season, OPM has created a one-time Limited Enrollment Period from February 1 to February 29, 2016, to allow employees enrolled in self and family extra time to decrease enrollment to self plus one. For employees (other than USPS employees) and retirees in 2016, the weighted average enrollee share of the biweekly FEHB premium for self, self plus one, and self and family is $145.01 and the average government contribution is $336.49, for a total average biweekly premium of $481.50. Figure 2 compares these figures with previous years. Total premiums for employees (other than USPS employees) and retirees will rise by an average of 6.4% in 'O 'T ggon, q g-o a , q X

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