Office of Personnel Management

Retirement and Insurance Group

1920 1954 1959 

 

1986 

Benefits Administration Letter

Number: 95-407 Date: September 25, 1995 

SUBJECT: FEHB Open Season: Notice to Employees

______________________________________________________________________________

GENERAL

______________________________________________________

 Purpose This Letter contains a sample announcement for notifying

employees of the upcoming open season and instructions to

agencies concerning the notification.

______________________________________________________________________________

REQUIRED LANGUAGE

______________________________________________________

 OMB The Office of Management and Budget has asked that OPM advise

agencies to include the following statement in the agencies'

notifications 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.

______________________________________________________

 TCC The FEHB law requires that, before each open season, all

employees eligible for FEHB, whether enrolled or not, be notified

of their rights under temporary continuation of coverage.
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Benefits Administration Letter 95-407

Until last year, this requirement was met by including this

information in the FEHB Guides, which were distributed to all

eligible employees.

However, since the information in the FEHB Guides has been

streamlined, and the FEHB Guides will not be distributed to all

eligible employees, agencies must include TCC information in their

notices to employees about open season.

! We have included language in the suggested announcement. 

If you prepare your own notice, rather than using our

suggested announcement, be sure to include this TCC

language.

______________________________________________________________________________

NOTICE TO EMPLOYEES

______________________________________________________

 Agency Agencies and installations must inform their employees

 Responsibility 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:

SUGGESTED ANNOUNCEMENT

SUBJECT: 1995 Health Benefits Open Season

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

November 13 through December 11, 1995.

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.
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Benefits Administration Letter 95-407

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

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

participating in the Program after December 31, 1995, or whose plans dropped

an enrollment area having a separate enrollment code, must enroll in a

different plan to continue FEHB coverage in 1996. (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 two basic types of plans available under the FEHB Program:

1. Fee-for-service Plans - These plans reimburse you or your health

care provider for covered services. If you enroll in one of these

plans, you may choose your own physician, hospital, and other

health care providers. Most of the fee-for-service 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 Service Benefit Plan sponsored by

Blue Cross and Blue Shield 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 employee

organization groups and/or agencies. (See the employee

organization plan brochures for information about membership and

membership fees, which are in addition to your biweekly or monthly

premiums.)

2. Prepaid Plans - These are also called comprehensive medical

plans/health maintenance organizations. They provide or arrange

for health care by designated physicians, hospitals, and other

providers in particular locations. Most services under a prepaid plan

must be performed by the plan's participating providers.

Each prepaid plan is open to employees within the plan's enrollment

area. You cannot enroll in a prepaid plan if you are located outside

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

questions about the enrollment area.

Before open season begins, your current health plan will send you a copy of its

brochure and a notice of its 1996 rates. 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 and enrollment areas which would require any action on
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your part.

Benefits Administration Letter 95-407

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

[location] to obtain a copy of the 1996 FEHB Guide. This Guide contains a

comparison chart that gives general information about each plan and shows the

biweekly and monthly premium rates. Do not rely solely on these booklets

when deciding to enroll in or change enrollment to a specific plan. If, after

reviewing the FEHB Guide, you decide that 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.

How to Enroll or Make an Enrollment Change during Open Season:

Employees wishing 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 in open season.

New enrollments and changes in current enrollments elected during open

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

beginning on or after January 1, 1996]. If you change plans, any covered

expenses incurred between January 1, 1996, and the effective date of the open

season change will count toward the 1995 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 your enrollment

for up to 18 months. TCC is also available 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 in which you or your

dependent must enroll for TCC. Contact your personnel office for a copy of RI

79-27 to obtain additional information.
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Benefits Administration Letter 95-407

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.

_____________________________________________________________________

_________

Abby L. Block, Chief

Insurance Policy

 and Information Division