Agency will use FEHBP experience to run some health plans under Obamacare

The Office of Personnel Management will draw on its experience running the Federal Employees Health Benefits Program in its new role administering multiple state health plans on the 2010 Affordable Care Act’s insurance exchange network.

Private health insurers that participate in the multi-state plan program on the exchanges will contract with OPM, the agency responsible for administering FEHBP. Providers must offer at least two multi-state plans on each of the exchanges in the 50 states and the District of Columbia. The law allows companies to phase in their coverage in all states and D.C. over four years, though they must offer coverage in at least 31 states in the first year of participation.

The initial open enrollment for plans offered through the exchanges starts Oct. 1, 2013, for coverage beginning in January 2014.

The Affordable Care Act directs OPM to negotiate premiums and benefits with insurance providers who participate in the multi-state plans on the exchanges, similar to the agency’s administration of FEHBP, which provides health care benefits to 8.2 million federal employees, retirees and their dependents. The health reform law created the multi-state plan program to foster competition among health insurance plans in the individual and small group markets in cost and quality, aiming for a level playing field for insurance issuers that participate in the exchanges.

OPM pledged in proposed rules published this week to negotiate the best deals for consumers who purchase their health insurance through the multi-state plans on the exchanges. FEHBP enrollees will be separate from the beneficiary population of multi-state plans, according to the draft rules.

The agency has a good track record administering FEHBP, although average premium hike rates of more than 7 percent a few years ago as a result of benefit changes and rising health care costs irked beneficiaries. Many FEHBP enrollees are generally pleased with their health care coverage, but some federal workers have complained that the cumulative increase in premium rates, co-payments and prescription drug expenses that they’ve experienced during the past few years is much more than the reported average, and it adds insult to injury on top of the ongoing pay freeze.

OPM in September announced that premiums will increase an average of 3.4 percent in 2013; changes in the enrollee share of premiums vary from plan to plan.

The public can comment on the proposed rules through Jan. 4, 2013.

(Image via Kamil Macniak/Shutterstock.com)