OPM instructs FEHB insurers on self-plus-one plans

The Office of Personnel Management last week directed insurers who offer coverage under the Federal Employees Health Benefits Program to make sure that rates for the new "self-plus-one" coverage slated to debut with the 2016 plan year are lower than rates for self-and-family coverage.

OPM issued the guidance in the annual "call letter" it issues to FEHB insurers as they begin to work on rates for the upcoming plan year. A change in the law contained in the Bipartisan Budget Act of 2013 added the new coverage option. FEHB now only offers two coverage options: self-only and self-and-family.

Employees and retirees who do not need coverage for more than two people until now have been compelled to purchase self-and-family coverage, even though their medical expenses on average are likely to be lower than those of policyholders with more than two covered individuals.

"As FEHB plans prepare their proposals for 2016 rates and benefits including Self Plus One enrollment types, we expect proposals for Self Plus One rates to be lower than Self and Family rates," the call letter stated. "In no event can Self Plus One rates be higher than Self and Family rates. Likewise, benefits that vary between enrollment type, such as catastrophic maximum, deductibles and wellness incentives should be for dollar amounts that are less than or equal to corresponding benefits in Self and Family enrollment."

"All other benefits, such as copays and coinsurance amounts, should be the same regardless of enrollment type," the letter stated.