United States

Office of

Personnel Management

The Federal Government’s Human Resources Agency

Retirement and Insurance Service

Benefits Administration Letter

 

Number: 99-414 Date: October 26, 1999 

Subject: 1999 Federal Employees Health Benefits (FEHB) Program: Conducting the

1999 Open Season

GENERAL

 

 FEHB Guides

In our efforts to improve the usefulness, comprehension, and readability of the Guide to

FEHB Plans, we have made several changes to the 2000 Guides. We have rewritten the

Guide text in plain language, to reflect the following changes:

• For the year 2000, the open and closed fee-for-service plans will be displayed on

separate pages. 

• Two new benefit categories will be added to the fee-for-service pages. Those categories

are “Prescription Drug” deductible and “Mail Order Prescription Drug” copayments. 

• We have eliminated the “Accidental injuries” and “Web site” columns from the Guide,

however, links to Plan Web site will still be accessible from the Office of Personnel

Management (OPM) web site (http://www.opm.gov/insure). 

• Several of the fee-for-service columns have been consolidated. We now have a single

column for “Catastrophic limits” rather than the per person/per family breakout, and we

combined the “Surgeon” and “Other” columns into a single “Doctors” column.

• We reversed the order of the Preferred Provider Organization (PPO) and non-PPO

presentations.

• The Health Maintenance Organization (HMO) and Point of Service (POS) sections have

been merged into a single section. The new HMO-POS section will include the

following benefit columns— “Primary Care Doctor Office” copayment, “Hospital Stay

Copay/Coinsurance,” and the copayments for Generic and Brand name prescription

drugs from a participating pharmacy.

_________________________________________________________________________________________

 Civil Service Federal Employees Federal Employees Federal Employees

 Retirement Group Life Health Benefits Retirement

 System Insurance Program System
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•The Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

accreditation ratings will still be shown in a column with the National Committee for

Quality Assurance (NCQA) accreditation ratings. This HMO-POS accreditation

 column, however, will show only whether accreditation was achieved and by whom;

full accreditation details will still be available on our web site.

We also made to the presentation of survey information. This year OPM, FEHB plans, and

enrollees participated in a broad-based survey effort with other public and private

employers by using the Consumer Assessment of Health Plans Survey (CAHPS). This

survey is a widely accepted tool for obtaining customers’ feedback on their experiences

with their health plans. The bar chart showing the percent satisfied with the plan and the

“Top rated plans” column were eliminated. With our use of the CAHPS instrument this

year, we will display the survey’s six composite summaries in addition to overall

satisfaction from the adult questionnaire. Child questionnaire data will not be shown this

year, however results from this questionnaire will be accessible at our web site.

Visitors to our web site will find it more informative and easier to use than last year. You

can link to most of our topics directly from the front home page this year. We still have

our health Plan Profiler (HPP) that lets you view and print summary information about

health plans. This year, enrollees in all states can use this interactive decision tool to

narrow health plan searches. Plan Smart Choice, a link to an interactive survey tool for

help in selecting a plan, will again be available on our web site this year. All FEHB Guides

and plan brochures will be available for downloading.

Counseling Employees

Agencies are responsible for counseling employees who ask for help on health benefits

matters. Counseling should be limited to answering questions about the FEHB Program

and the application of the FEHB law and regulations to particular circumstances.

The FEHB Guides provide summary information that is designed to help employees

narrow their choices of health plans, not to make final decisions. You should refer

employees to the actual plan brochures for specific information vital to making an

informed decision.

You should try to answer employees’ benefit questions by referring them to the brochure

of the plan in question. If the answers cannot be found in the brochure, instruct the

employee to contact the health plan directly. However, do not refer employees to the

plans if their questions concern subjects other than benefits. Answering questions about

FEHB enrollment rules, such as which dependents are eligible for coverage and when

coverage begins and ends, is the responsibility of the agencies, not the health plans. If you

do not know the answer, contact your agency’s headquarters insurance officer.
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Plan Terminations

In BAL 99-411, we notified you of the names of plans that are dropping out of the FEHB

Program, or that are dropping a service area with a separate enrollment code, at the end of

1999. We strongly recommend that you distribute the list of terminating plans and

enrollment codes to all employees so they can check to see whether their plan or

enrollment code will continue to be valid in 2000.

An employee whose plan or enrollment code will not participate in the Program next year

must enroll in another plan to continue FEHB coverage in 2000. You should monitor

employees who are covered by these terminating plans/codes and follow up with those

who have not submitted a change of enrollment before the end of open season.

Plan Mergers

BAL 99-411 also informed you of plans that are merging with other plans at the end of

1999. Enrollees of the merging plans will be transferred automatically to the surviving

plan, but they may find that their new plan has very different benefits than they were

accustomed to. Employees in plans that merge should read their 2000 brochures

carefully.

 New Health Benefits Registration Form, Standard Form (SF) 2809

We have revised the SF 2809. The revised form is dated July 1999. Information

regarding the new 2809 can be found in Benefits Administration Letter (BAL) 99-215. We

also created a new form, Annuitant/OWCP Health Benefits Election Form (SF 2809-1),

for use by annuitants of other retirement systems for Federal employees and

compensationers. We have provided additional information on this form in BAL 99-216. 

Previous editions of the SF 2809 are not usable, and agencies are expected to use the new

2809’s for all open enrollment changes.

 Annuitant Inquiries

Some annuitants may contact their former employing offices asking for a SF 2809.

· CSRS and FERS - The Office of Personnel Management (OPM) does not use the SF

2809 to register open season changes for Civil Service Retirement System or Federal

Employees Retirement System annuitants. These annuitants should be directed to call

our toll-free service, Open Season Express. Instructions for using Open Season

Express are included in the open season package sent to each enrolled CSRS and FERS

annuitant before open season. If an annuitant loses or does not receive the package,

he/she can get one by calling our Retirement Information Office at 1-88-US-OPM-RET

(1-888-767 6738).
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The hearing-impaired who have access to a TDD machine may call our toll-free

Retirement Information Office TDD number: 1-800-878-5707.

When communicating with OPM -- for any reason -- annuitants should always provide

their CSA/CSF retirement claim number and/or their Social Security Number.

· Other retirement systems - These annuitants should contact their retirement system for

the proper registration form.

· OWCP - Former employees receiving benefits from the Office of Workers'

Compensation should contact the OWCP office that maintains their FEHB records.

CARRIER ACCESS

 Health Fairs

We strongly encourage agencies to hold open season health fairs or to permit

representatives of FEHB carriers to address groups of employees on their plans' benefits,

methods of obtaining services, and similar matters.

Since the number of carrier representatives knowledgeable about the benefit provisions

and claims procedures of the plans they represent is often limited, we encourage agencies

to stagger health fairs, beginning prior to the actual start of open season.

When holding health fairs, remember:

· The purpose of the fair is to inform, not promote. You should discourage carriers from

distributing trinkets, holding raffles, or engaging in similar activities that divert attention

from the primary goal.

·Carrier representatives are expected to confine their presentations to benefit provisions

and claims procedures of the FEHB plan they represent. Questions that do not pertain

to benefits or claims should be referred to agency insurance officials.

 Other Companies

Agencies are frequently contacted by insurance companies that do not participate in the

FEHB Program, but wishes to sell dental insurance or other types of "supplemental"

policies to Federal employees. These companies sometimes send marketing material to

agencies and ask the agencies to distribute it. They may ask to be invited to the agency's

health fairs or even show up at health fairs uninvited.

We strongly discourage agencies from assisting in the marketing efforts of these

companies, including companies FEHB carriers may have contracted with for particular

benefits. To ensure the integrity of the FEHB Program, agencies should limit access to
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their premises to those health plans that actually participate in the FEHB Program; i.e.,

those plans listed in the FEHB Guide.

OPEN SEASON CHANGES

 Permissible Actions

The following changes in registration may be made during open season:

· An eligible employee who is not enrolled may register to enroll.

· An enrollee may change from one plan or option to another, from self only to self

and family, or make any combination of these changes.

New enrollments and enrollment changes for permissible reasons other than the open

season can be made, as usual, between November 8 and December 13, 1999. These

changes, however, may have different effective dates than open season changes, and

should not be mistakenly identified as such.

Whether an employee is enrolling or changing enrollment based on open season or some

other qualifying event, it is important that the correct event number be noted on the SF

2809, so that the correct effective date will be assigned.

 Timely Registration

The employing office must receive an open season change on the SF 2809 no later than

close of business on December 13, 1999, to be considered timely filed.

The Employee Express contractor (OPM Macon, GA) must receive changes via Employee

Express no later than midnight on December 13.

 Belated Registration

An employing office has the authority to accept a late registration if it determines that the

employee was unable to submit a SF 2809 on time because of circumstances beyond the

employee's control. While we normally encourage agencies to make limited use of this

authority, we recommend that you take a liberal view in cases where an employee's plan is

terminating its FEHB participation.

If you decide to accept an employee's late registration, write "Belated open season

enrollment/change" in the "Remarks" section of the SF 2809. Attach to copy 1 of the SF

2809 the employee's statement explaining why he/she could not register on time, or add

your own note if the reason was an agency problem.

If you decide that the delay in filing is not due to a cause beyond the employee's control,
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do not accept the employee's late request. Notify the employee in writing that you are not

approving the late enrollment. Give the reason for your denial and include a statement of

the employee's right to request reconsideration within 30 days after the date of your

notice.

 Effective Dates

From not enrolled to enrolled - Effective the first day of the first pay period which begins

on or after January 1, 2000, and which follows a pay period in any part of which the

employee was in pay status. However, the enrollment of a new employee who happens to

register for the first time during open season is effective the same as for all new

employees; i.e., the first day of the first pay period after the employing office receives the

SF 2809.

Enrollment change - Effective the first day of the first pay period which begins on or

after January 1, 2000, regardless of whether or not the employee was in pay status during

the preceding pay period.

Belated open season action - Effective retroactive to the first day of the first pay period,

which begins on or after January 1, 2000. This effective date is the same as that of an

open season change filed on time. However, if the belated change is from not enrolled to

enrolled, the requirement of having been in pay status during the preceding pay period

must also be met.

Cancellation - Effective the last day of the pay period in which the employing office

receives the SF 2809. Enrollees may cancel their health insurance at any time without

waiting for an "event" or an open season. The effective date is therefore different from the

effective date of actions related to open season.

 Cancellation

Agencies should be sure to counsel employees about the consequences of canceling their

enrollment.

$Remember that in order to continue FEHB coverage after retirement, an employee must

have been covered under the FEHB Program continuously for the five years of service

immediately before retirement or, if less than five years, for all periods of service during

which he/she was eligible for FEHB coverage.

· If an employee is canceling his/her enrollment in order to be picked up as a family

member by a spouse's open season enrollment, be sure to coordinate the effective date of

the cancellation with the effective date of the spouse's enrollment to prevent a break in

coverage.
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AGENCY ACTIONS

 Prompt Processing

It is imperative that agencies process open season enrollments and enrollment changes

promptly. Payroll offices should process enrollee and carrier copies of SF 2809 daily.

Timely processing is critical.

·Gaining carriers must be notified of new enrollments so the carrier can complete the

paperwork necessary to provide coverage for the employee and covered family

members and issue identification cards to the new enrollees.

·Losing carriers must be notified as soon as possible of enrollment terminations so they

won't guarantee or provide benefits to ineligible employees or family members.

 Verification of Employee Coverage

Employees often become concerned when they do not receive their identification cards

from a new plan within a short time after the end of open season. If an employee asks you

about this, you should first contact the payroll office to determine when the carrier was

notified of the change. If more than three weeks have passed since the payroll office sent

the SF 2809 to the carrier, contact the carrier to determine the reason for the delay and to

relay the employee's request for identification cards.

An employee may need verification of coverage under his/her plan before the carrier

processes the enrollment or enrollment change. You should verify that the employee is

covered under the plan and inform the requesting party (e.g., carrier, doctor, hospital) of

the effective date of the coverage. You should also remind employees that their copy of

the SF 2809 is acceptable as proof of enrollment until they receive their identification

cards from the plan.

Employees who make open season changes electronically via Employee Express and who

do not receive new identification cards by the effective date of the change may obtain a

letter confirming their coverage by calling the Employee Express Help Desk at 912-757-

3030, or by requesting your help.
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Reconciliation Requests

After open season is completed, agencies will receive requests from carriers to reconcile

their enrollment records. These requests must receive the highest priority. The

reconciliation process is critical to ensure that carriers receive the proper premium

payments and that enrollees are properly reflected on plans' records.

Abby L. Block, Chief

Insurance Policy

 and Insurance Division