5 things that could be coming to your FEHBP plan in 2016

Expect some new health care options when open season rolls around later this year. We break down the Office of Personnel Management's letter to insurers about 2...

Expect some new health care options and fuller coverage when open season rolls around later this year. The Office of Personnel Management is huddling with insurers at an Arlington, Virginia, hotel to deliberate, cajole and negotiate the contours of federal families’ health coverage in 2016. The extensive insurance program, which covers more than 8 million federal employees, retirees and family members, is considered a key selling point for federal jobs.

“Because of the continued partnership between OPM and the insurance industry, we can guarantee the people we recruit for federal service, that the benefit packages we offer them are on par with anything offered by any private sector employer,” OPM senior adviser Earl Gay told insurers during the opening session.

The agency has asked insurers to submit their proposed plans and rates by May 31. OPM expects to complete benefit and rate negotiations by mid-August, it said in a recent letter to insurers filled with recommendations for how they can improve health benefits, save money and make it easier for participants to navigate their health care choices.

Here are five things that OPM would like health insurers to do in 2016:

  1. Empty nesters, Self Plus One is coming
  2. In the letter, OPM said insurers should price premiums under this new option for couples somewhere in between the current categories of “self” and “family.” Gay told his audience that OPM expected a smooth implementation of the new option.

    “It will provide more flexibility to our FEHBP members and it will bring our program in line with other employers, state and local governments that offer the three-tiered enrollment options,” he said.

  3. More insurers could foot the bill for sex-change operations and drugs
  4. OPM removed in July a ban on coverage of services, drugs and supplies related to sex changes, but that was not early enough in the year for most insurers to work it into their 2015 plans. Come 2016, they should propose to cover these services, OPM said in the letter.

  5. You’ll be able to compare the cost of drugs online
  6. By the time open season rolls around this fall, you should be able to go to insurers’ websites to compare the cost of drugs. That’s if you’re a plan participant, or even just considering switching to that plan.

    OPM also urged insurers to contain drug costs by dividing drugs into four categories for pricing: generics, preferred brands, non-preferred brands and specialty drugs. The agency said insurers also can cut their costs by cutting some pharmacies out of their networks. If insurers follow suit, it could mean fewer places to fill your prescriptions.

  7. You might make some money if you just take this test
  8. OPM is encouraging plans to offer cash or other rewards to participants who go through health-risk and biometric screenings once every three years. Those screenings should now include gestational diabetes, the letter says. Insurers should offer intensive behavioral counseling for overweight or obese people at risk of heart disease.

  9. More incentives to join Medicare Part B
  10. More federal retirees are deciding not to enroll in Medicare Part B at first blush. In the letter, OPM said insurers needed to provide clear incentives for enrollment. The agency suggested that insurers improve coordination between their FEHB plans and Medicare Part B, especially when it comes to prescription drugs.


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