Nearly a year after Congress approved and President Barack Obama signed the provision into law, the Office of Personnel Management is describing how the new self-plus-one option would work under the Federal Employee Health Benefit program.
OPM is expected to issue a proposed rule Dec. 3 in the Federal Register, requesting comments on its plan for the new coverage option.
“The self plus one enrollment type will be available starting in the 2015 Open Season for the 2016 plan year,” OPM wrote in the proposed rule. “A self plus one enrollment will cover the enrollee and one eligible family member, designated by the enrollee.”
Once the rule is finalized, the FEHBP will offer three types of coverage: self; self-plus-one; and self-plus-family.
The proposed rule said the government will pay the lesser of two options: 72 percent of the programwide weighted average of the premiums for 2016, or no more than 75 percent of the total premium of a particular plan the employee or retiree selects.
“This government contribution calculation will apply to the three-tier enrollment structure,” the proposal stated. “Because actual enrollment data for a new three-tier structure will not be available in advance, OPM will determine the weighted average for use in calculating the government contribution and the employee contribution for the first plan year in which the self plus one enrollment type is made available.”
OPM says under its current policies, self-plus-one enrollees should expect to have lower premiums, while those with more than one dependent should expect to pay more for insurance.
“A large percentage of annuitants who currently have self and family coverage would likely benefit from a self-plus-one premium tier, resulting in mandatory savings to the government because the government share of annuitant premiums will decrease,” the proposed rule stated. “As enrollees shift from self and family enrollments, OPM will closely monitor the effect on premiums for those remaining in that enrollment type. If premiums for active employees with more than one covered family member rise, there will be increasing costs to the government (assuming appropriation of necessary funds).”
OPM long was hesitant to move to a self-plus-one option, citing concerns it would disrupt the risk-sharing inherent in large group plans.
But the President included a proposal in his fiscal 2014 budget proposal, and Congress included a provision establishing the self-plus-one option in the bipartisan budget bill approved last December. The architects of the budget deal said it would align the federal program with insurance options in the commercial market and help “spread costs across different enrollment types,” according to a summary of the bill.
FEHBP carriers are planning to implement the self-plus-one enrollment category, starting in 2016.
“It will align health plans with other federal benefits that OPM currently offers — the employee-pay-all dental and vision benefits. And, it allows an employee or retiree to choose a less expensive option, which covers only the enrollee and one family member,” she said at an OPM press conference on FEHBP changes for 2015.