Civil Service Federal Employees Federal Employees Federal Employees

Retirement Group Life Health Benefits Retirement

System Insurance Program System

United States

Office of Personnel Management

Retirement and Insurance Service

Benefits Administration Letter

Number: 98-413 Date: October 2, 1998 

Subject: 1998 Federal Employees Health Benefits (FEHB) Program Open Season: 

Notice to Employees 

GENERAL

This Letter contains a sample announcement for agencies to use to notify their employees of the

upcoming FEHB open season, as well as instructions to agencies concerning the notification.

 

REQUIRED LANGUAGE

1. Office of Management and Budget (OMB) - The Office of Management and

Budget has asked us to advise agencies to include the following statement in the

agencies' notices to employees about open season:

Please note that information you provide by enrolling in the Federal

Employees Health Benefits Program may also be used for computer

matching with Federal, State, or local agencies' files to determine whether

you qualify for benefits, payments, or eligibility in the Federal Employees

Health Benefits Program, Medicare, or other Government benefits

programs.

2. Temporary Continuation of Coverage (TCC) - The FEHB law requires that

before open season, all employees eligible for FEHB, whether enrolled or not, be

notified of their rights under temporary continuation of coverage. We have

included language about TCC in our suggested announcement. If you prepare

your own open season announcement, be sure to include this TCC language. 

 

NOTICE TO EMPLOYEES

Agency Responsibility - Agencies and installations must inform their employees and

participating former spouses and TCC enrollees, in advance, of the dates and purpose of

open season. The following is a suggested announcement which may be adapted for

publication by the most efficient means:
Benefits Administration Letter 98-413 2

SUGGESTED ANNOUNCEMENT

SUBJECT: 1998 Health Benefits Open Season

A Federal Employees Health Benefits (FEHB) open season will be held from

November 9 through December 14, 1998. Before open season begins, your

current health plan will send you a copy of its brochure and a notice of its 1999

rates.

During open season, any eligible employee who is not currently registered may

enroll, and any eligible enrollee may change from one plan or option to another,

from self only to self and family, or make a combination of these changes.

Enrollees who wish to continue their current enrollments do not need to take any

action during this open season. However, enrollees whose plans will not be

participating in the FEHB Program after December 31, 1998, or whose plans

dropped the enrollment code they are enrolled in, MUST enroll in a different

plan to continue FEHB coverage in 1999. (See attached lists of terminating

plans and codes.) [If you don't attach the list, include the names of the

terminating plans within the text of your announcement.]

There are three basic types of plans available under the FEHB Program:

1. Managed Fee-for-Service Plans - These plans reimburse you or

your health care provider for covered services after the services are

received. If you enroll in one of these plans, you may choose your

own physicians, hospitals, and other health care providers.

These plans are considered "managed" because they all contain

features such as precertification of hospital admissions and

utilization review of ongoing care. In addition, most of the fee-forservice plans have preferred provider arrangements in many parts of

the country. By using preferred providers, you can reduce your

out-of-pocket expenses and, in some cases, receive enhanced

benefits.

Fee-for-service plans include the Blue Cross Blue Shield Service

Benefit Plan and plans sponsored by unions and other employee

organizations. Several employee organization plans are open to all

eligible employees who are full or associate members of the

organizations that sponsor the plans; other employee organization

plans are restricted to certain groups and/or agencies. (See the

employee organization plan brochures for information about

membership requirements and membership dues, which are in

addition to your biweekly or monthly premiums.)
Benefits Administration Letter 98-413 3

2. Health Maintenance Organization Plans (HMOs) - These plans

provide a comprehensive array of medical services, emphasizing

prevention and early detection of disease, through contracted

physicians, hospitals, and other providers in particular locations.

Each HMO is open to employees within the plan's enrollment area. 

You cannot enroll in an HMO if you are located outside its

enrollment area. Refer to the plan's brochure if you have any

questions about the enrollment area. If you are enrolled in an

HMO, be sure to review the brochure carefully to see if there

are any changes in the plan's service area which would require

any action on your part.

3. Plans Offering a Point of Service (POS) Product - Some FEHB

plans blend their features. A number of fee-for-service and HMO

plans now offer both forms of health care delivery, known as "in

network" and "out of network." In an HMO that offers a POS

product, the POS product acts like a fee-for-service plan: The

HMO's enrollees may use non-affiliated (out of network) providers if

they wish, but the services will cost them more--in terms of

deductibles and coinsurance--than if they used plan providers.

In a fee-for-service plan with a POS product, the POS product acts

like an HMO: If they agree to let their medical care be managed by a

plan-affiliated gatekeeper physician (in network), plan enrollees will

get a better benefit, usually in the form of richer benefits and lower

copays or coinsurance.

If you are considering enrolling or making an enrollment change, contact [location]

to obtain a copy of the 1999 Guide to Federal Employees Health Benefits Plans. 

The FEHB Guide contains a comparison chart that gives general information about

each plan and shows the biweekly and monthly premium rates, as well as detailed

results of the 1998 Customer Satisfaction Survey and the accreditation status of

those plans that took the initiative to seek review by the National Committee for

Quality Assurance (NCQA) and/or the Joint Commission on Accreditation of

Healthcare Organizations (JCAHO). 

Do not rely solely on the FEHB Guide when deciding whether to enroll in or

change enrollment to a specific plan. If, after reviewing the FEHB Guide, you

decide you are interested in making an enrollment change, consult the plan's

brochure for a complete description of benefits.

Brochures for all plans will be available for your inspection at [location]. Due to

the limited quantity available, please return the brochures after you have reviewed

them. If you change health plans, however, you may keep the brochure for that

plan.

Internet Availability: If you have access to the Internet, you should know that all 1999
Benefits Administration Letter 98-413 4

FEHB Guides and health plan brochures will be available from the Office of Personnel

Management’s web site (http://www.opm.gov/insure). The Guides and brochures will be

available in PDF format for downloading and printing, as well as a text version suitable for

the visually-impaired. In addition, the web site will contain links from the Guides and

brochures to health plan web sites for additional information about the plans, as well as

links to other related web sites.

How to enroll or make an enrollment change during open season: Employees

who wish to enroll or change their enrollment must complete a Health Benefits

Registration Form [Standard Form (SF) 2809]. These forms are available from the

[name and room number of appropriate office] and must be completed and

submitted to that office prior to the close of business on the last day of open season. 

We ask your assistance in making desired changes as early as possible during open

season.

[Agencies whose employees have access to Employee Express to make open season

changes should provide information about using the system.]

New enrollments and changes to current enrollments elected during open season

generally will become effective January [first day of the first pay period beginning

on or after January 1, 1999]. If you change plans, any covered expenses incurred

between January 1, 1999, and the effective date of the open season change will

count toward the 1998 deductible of the plan you are changing from. 

Temporary Continuation of Coverage (TCC): You should be aware that if you

leave Federal employment, you will probably be eligible for TCC (unless you are

separated for gross misconduct). TCC can continue for up to 36 months for

dependents who lose eligibility as family members under your enrollment. This

includes spouses who lose coverage because of divorce and children who lose

coverage because they marry or reach age 22.

TCC enrollees must pay the total plan premium (without a Government

contribution) plus a 2% charge for administrative expenses. There are specific time

frames within which you or your dependent must enroll for TCC. Contact your

personnel office for a copy of RI 79-27 for more information.

Please note that information you provide by enrolling in the Federal Employees

Health Benefits Program may also be used for computer matching with Federal,

state, or local agencies' files to determine whether you qualify for benefits, 

payments, or eligibility in the Federal Employees Health Benefits Program, Medicare, or

other Government benefits programs.

 
Benefits Administration Letter 98-413 5

 Abby L. Block, Chief

 Insurance Policy 

 and Information Division