GovernmentExecutive.com

There's a cardinal error that federal employees make during open season for health benefits: Doing nothing.

"The most common mistake people make is not to pay any attention and stay in the plan they're in without thinking about it," said Walton Francis, a self-employed economist and policy analyst. "As a result, they often wind up in a plan that one way or another doesn't meet their needs."

Francis is the principal author of the 2006 Washington Consumer's Checkbook "Guide to Health Plans for Federal Employees."

Open season started Monday and runs until Dec. 12. Picking a plan from among what is sometimes dozens of choices in an area can be daunting, but the potential savings make it worth some research. Below are suggestions for finding a deal.

Check for changes

Take a minute to look at the brochure for your current plan. OPM requires every plan to publish brochures each year detailing benefits and prices. The brochures are in a standard format. Each brochure's second section is titled, "How We Change." Just make sure the changes aren't for the worse. Locate online brochures here by selecting your state and then your plan.

Use the resources at your disposal

Many agencies subscribe to privately published guides to the federally offered plans, such as ones by Washington Consumers' Checkbook and PlanSmartChoice. These booklets provide detailed information on out-of-pocket costs. Here's a list of agencies that subscribe.

Also, take a look at this tool on the OPM Web site. You can plug in your ZIP code and get a list of plans available in your area. You can then select up to four plans and the site will lay them side by side for cost and benefit comparison.

Attend a fair

There are about 1,300 open season fairs across the United States, with representatives from participating plans on hand to answer your questions, said Joel Ebben, vice president of managed care for the Government Employees Hospital Association. Ask your agency for details.

Look deeper than names

Many providers offer high-option and standard-option plans. Don't assume high-option plans, which offer more coverage in return for higher premiums, are better. According to Francis, double or triple premiums don't guarantee double or triple coverage.

Use your favorite health care provider as a tie-breaker

When multiple plans offer equally better deals than your current plan, break the tie by asking your favorite doctor what plans he or she works under. That way, you can potentially stay with your favorite hospital, gynecologist or pediatrician under your new plan.

Remember that some plans include built-in savings accounts

Did you know that high-deductible plans have a built-in health savings account? The high-deductible option, which was offered for the first time last year, deposits a portion of premiums paid into an HSA, where funds are deducted pre-tax and are tax free if used for health care. The accounts roll over from year to year, too, so healthy enrollees can build a nest egg over time.

Know the difference between HMOs and PPOs

An HMO is a health maintenance organization; many local plans are HMOs and they often offer lower premiums but a small network of covered physicians. A PPO, which stands for preferred provider organization, is often a national plan that encourages in-network health care, but not as strictly as an HMO does.

Consider the downsides

What are the disadvantages to switching plans? Instability, for one. New enrollees have to wait for a new health care card. They may also need to switch to providers working under the new plan, and must adjust to the new plan's rules.

COMMENTS

• Steve is spot on with his comment. Sure, all plans will accept you (they have to) but if you have a pre-existing condition they will "underwrite" that coverage. In effect, you are on your own should you have any health issue related to the underwritten coverage. In short -- no coverage or minimal coverage of pre-existing conditions. This is especially good to remember when selecting a plan even if you are perfectly healthy. If you have a major health problem, you will be essentially stuck forevermore with whatever health insurance carrier you have when the medical condition happens. GovExec.com reader Posted November 18, 2005 2:16 PM
• Yes! The trend is to check little and/or do nothing. However, the phrase "pre-existing conditions" is often unknown, misunderstood or not realized; with respect to the impact of changing. There are serious impacts to the employee or family members who may/may not fall into this unbeknownst trap. Articles like this one, often suggest make a change, but make no effort to explain to those the downside of "pre-existing conditions." If not careful, the gain in options or economic relief leads to no coverage of a pre-existing condition excluded under the "pre-existing condition" clauses. Buyer (employee) beware! Steve Posted November 17, 2005 2:12 PM