Wellness and disease prevention appear higher on FEHBP radar

Plans in the Federal Employees Health Benefits Program increasingly are seeking to promote wellness and prevention to cut long-term costs, according to Walton Francis, author of Consumers' Checkbook Guide to Health Plans for Federal Employees. The Office of Personnel Management is continuing to push initiatives that steer beneficiaries toward healthier lifestyles, while insurance plans are offering benefits not explicitly outlined in contracts to meet enrollees' specific needs, he said.

Health plans participating in FEHBP in 2011 were required to eliminate cost sharing for preventive care, such as immunizations, tobacco cessation and health screenings. For 2012, OPM encouraged insurance providers to include additional benefits, such as concrete incentives for federal workers to participate in wellness initiatives and prevention programs to reduce childhood and adult obesity.

More plans are offering gym membership reimbursement and incentives for completing health assessments or other wellness programs. For example, GEHA has incentives for healthy behavior and resources to teach enrollees about nutrition, exercise, weight loss, smoking cessation and managing cholesterol, diabetes and stress. According to Julie Browne, GEHA vice president of managed care and marketing, the plan also has targeted programs for beneficiaries taking certain medications or who need special help with high-risk maternity care, cancer treatments or transplants.

"We focus extra resources on those with multiple health conditions who are at high-risk for hospitalization," Browne said. "Doing so can help these members with improved health, reduced health care costs and better quality of life. Preventive care services help GEHA reduce premium costs for all members."

Francis called these kinds of prevention and management tools "revolutionary improvements" in FEHBP.

"The ability of the plans to tailor the benefits they offer to particular enrollees in a way that's intelligent and sensible for . . . cost control -- they improve on that a little bit every year," he said. "It's a very small percentage that accounts for a very large fraction of the cost. It makes a big difference in controlling costs and in the health of employees."

Open season, the period when federal workers can change their health insurance election without penalty, runs from Nov. 14 to Dec. 12.