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Self-Plus-One Premiums Won’t Be Higher Than Family Coverage Option

OPM tells federal health benefits providers that yet-to-be-determined 2016 premiums for the new option will be capped.

Insurance providers in the Federal Employees Health Benefits Program cannot charge higher premium rates in 2016 for the self-plus-one option than the rates for self and family, the Office of Personnel Management has announced.

OPM expects proposals for self-plus-one rates “to be lower than self and family rates” but told health care providers in a March 13 “call letter” that they would be capped at the self and family rates. The actual premium rates won’t be known until fall 2015.

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

The annual letter instructs providers on the terms for benefit and rate proposals for the upcoming year, and outlines OPM’s priorities for the largest employer-sponsored health care program in the country. Carriers must submit their 2016 benefit and rate proposals to OPM by May 31, 2015.

The big change for 2016 is the debut of the self-plus-one option for federal employees enrolled in FEHBP. The self-plus-one coverage option, included in the 2013 budget deal, will give feds with a spouse and no dependents a new enrollment choice. Feds interested in self-plus-one will be able to sign up for it during the 2015 Open Season which starts Nov. 9.

Enrollees have long complained about the lack of a self-plus-one option. FEHBP offers self-only and family coverage; those enrollees with spouses and no dependents must choose the family plan if they want coverage extended to their spouse. Some enrollees have balked at having to pay more for the family plan when they don’t have children.

Retired Rear Adm. Earl Gay, senior advisor to OPM Director Katherine Archuleta, said on Thursday that the agency expects “a smooth implementation” of self-plus-one.

“The new enrollment type will provide more flexibility to FEHB [program] members,” Gay said, during remarks at the annual program carrier conference. “And, it will bring our program more in line with other large employers, including state and local governments that offer three-tiered enrollment options.” 

This year, federal employees and retirees are paying an average of 3.8 percent more toward their health insurance premiums. Those with self-only coverage are contributing an average of $2.93 more per paycheck, while those with family coverage are paying about $6.89 more. The increase is steeper than the rise in the government’s portion of the premiums, which rose 3 percent for this year. The employee share is increasing faster because employees are choosing better plans that require more out-of-pocket costs. Overall, the government pays about 70 percent of employees’ premiums. Still, OPM has pointed out repeatedly that 2015 marks the fourth consecutive year in which the increase was below 4 percent -- the longest such streak since the mid-1990s.

“We also offered our customers more choices of plans,” Gay said on Thursday, of 2015 coverage. “I hope that together we can continue such record premium stability and program growth.”

OPM also plans to focus in the next year on preparing for the 2018 implementation of the excise tax on high-cost employer-sponsored health coverage mandated by the Affordable Care Act. Promoting preventive health and wellness remains a priority, as well as encouraging participation in Medicare Part B, optimizing delivery of prescription drug benefits and expanding access to care, including treatments for autistic children and infertility, the letter said.

This story initially misstated the level at which premiums for the new option would be capped. It has been corrected and the headline has been changed for clarity. 

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