Federal Diary Live

Are you a new federal employee shopping for health insurance? Are you a federal retiree enrolled in Medicare trying to figure out your best buy in the Federal Employees Health Benefits Program?

Richard G. Miles, president of the Government Employees Hospital Association, joins The Post's Stephen Barr, who writes the Federal Diary column, to discuss the 2005 health insurance plans being made available to civil service and postal employees and government retirees in 2005. Their discussion begins at noon Tuesday, Nov. 16.

GEHA is the third-largest national health insurance plan in FEHBP, with more than 230,000 members and providing coverage to more than 435,000 people. GEHA traces its roots to 1939, when the Railway Mail Hospital Association was formed to help U.S. railroad workers with their medical expenses. Twenty years later, the not-for-profit association expanded to offer health insurance benefits to all federal employees and retirees.

The transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

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Stephen Barr: Thanks to all joining in this discussion today, especially our guest, Richard Miles of GEHA, which is one of the popular FEHBP plans. Richard, we appreciate your time today and, to get this rolling, I'd like to ask you to start with a brief overview of what changes GEHA is making for the 2005 open season. Again, thanks for making time in your busy schedule for us.

Richard G. Miles: Thank you for this opportunity to discuss our plan with your guests. The changes to our existing plans are minimal. The only major change was a $5 increase in the RX copays on the high option plan. However, we are offering a new High Deductible Health Plan coupled with a Health Savings Account/Health Reimbursement Account this year that we are excited about

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Washington, D.C.: What are the premiums for standard and high-deductible options? Thank you.

Richard G. Miles: The bi-weekly premiums are as follows:

High Option -Self $89.29
High Option- Family $181.38

Std Option -Self $33.28
Std Option -Family $75.62

HDHP Plan - Self $44.68
HDHP Plan - Family $103.21

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Bowie, Md.: Hi. Thanks for doing this. Mr. Miles, to what do you attribute to the premium increase in the High Option plan for 2005?Richard G. Miles: The premiums are based upon the average costs of the group insured. Our high option plan has an older membership.

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Washington, D.C.: I've been a very satisfied customer of GEHA's for 20 years. Next spring I become eligible for Medicare and am confused about whether to opt for Part B since I will have GEHA coverage as well. Would you please clarify the pros and cons of opting for Part B when a participant also carries GEHA's standard coverage? Is this a one-time only decision? Thanks very much.

Richard G. Miles: Thank you for your loyalty. When you take Part B of Medicare, GEHA waives the deductible and co-payments related to both Part A and B services. We also are able to receive Medicare claims electronically from the Medicare Intermediary, which means you do not have to hassle with filing claims. It is done automatically for you.

I would encourage you to take Part B and I believe that NARFE recommends to their members to take Part B also.

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Germantown, Md.: As a federal retiree, my current insurance carrier is Mail Handlers. Their premium has gone up so much this year that I am looking to change to GEHA, which is much lower. Is there much difference between the two?

Richard G. Miles: By federal regulations I am not allowed to make direct benefit comparisons but I would encourage you to go to the OPM website for a plan comparison chart. The website is OPM.gov

Another good source for comparative information is Washington Consumers' Guide to Health Plans authored by Walt Francis.

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Reston, Va.: I've had very good experience with GEHA to date. However, I have noticed that this year the high option increased by 18 percent. Is there a connection with the HSA that GEHA added this year?

Richard G. Miles: No, the rates for each plan are actuarially computed based upon each plans' claim experience.

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Crofton, Md.: I'm interested in the GEHA HSA option. Is it true someone who took early retirement (age 52) and has no other insurance (except dental) is eligible? Also, my husband's employer has a flexible medical spending account that is a "use it or lose it" option. Does this conflict with the HSA? Also, if you have money left in the HSA and decide to go back to a PPO in 2006, can you keep the HSA? Richard G. Miles: Yes, it is true that if you don't have any other insurance you may be eligible for the HSA plan. However, your husband's FSA may make you ineligible for coverage under the HSA. Please call our customer service department for a more detailed response. The number is 800-821-6136.

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Stephen Barr: Richard, would you please tell us why GEHA decided to offer a high-deductible/HSA plan for next year? I'm assuming there is going to be a long learning curve for employees interested in this product. How should a person evaluate such a new offering? Again, thanks for taking the time to give us your insights.

Richard G. Miles: GEHA decided to offer an HSA after seeing its popularity in the private sector. We believe that it will take some time for the market to understand the benefits of an HSA plan as it is different and a bit more complicated that traditional insurance. However, we believe it is an exciting opportunity for us to offer something unique and new to the FEHB program.

We believe that one of the key features of our HSA is the small differential between the deductible and the funding for the HSA account. The deductible is $1,100 for self only coverage and the amount contributed to the HSA account is $720 leaving an effective difference of only $380.

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Lenexa, Kan.: How can your HSA plans provide for reimbursements for Long Term Care Premiums and the Goverment FSA plans do not? Don't you both have to operate under the same IRS rules? Thank you in advance for your answer.

Richard G. Miles: The HSA qualified medical expenses are defined under a different section of the revenue code than is the FSA.

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Washington, D.C.: Currently have our family (self, wife and baby) covered under the wife's company medical plan (she does not work for the government). She may be leaving her company in Spring to stay at home; if so, I will need to get coverage for all of us under my federal job. I know now is open enrollment, but will I be able to add us all in the Spring rather than now since it will be a lifestyle change?

Richard G. Miles: I believe that would be a qualifying event which would allow you to change plans. To verify this you should check with your payroll office.

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Fairfax, Va.: What is the difference between Medicare A and Medicare B? I'm about 40 years away from needing it, but still curious.

Richard G. Miles: Part A of Medicare covers hospital costs and Part B covers out-patient physician charges including lab and x-rays. Coverage in Part A is automatic whereas you will need to pay a portion of the costs for Part B coverage.

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Upper Marlboro, Md.: I am puzzled about this new HDHP plan that is being offered this year. I have a family, so I do the family plan and usually take the high option plan. With this new HDHP plan, would it cost me the regular high option plan cost, plus the HDHP plan cost, or are they different plans? If they are different, then explain the difference please.

Richard G. Miles: They are different plans. You would only pay one premium depending on your selection. The benefits are significantly different and I would encourage you to call our customer service department for details at 800-821-6136 or review the plan comparison charts at opm.gov.

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Sacramento, Calif.: I understand that one may not contribute to a health care FSA and an HSA at the same time. What happens if I'm in your high deductible plan for a few years, save a couple of thousand dollars in the HSA, and then decide to switch to your standard plan. Would I then be able to contribute to an HCFSA, or would I have to wait until the funds in the exisiting HSA were exhausted? Thanks for your help. Richard G. Miles: You are correct in your understanding. You may not have an FSA and an HSA plan at the same time. But once your enrollment in the HSA is terminated you can then use the FSA option. You will not need to deplete the funds saved in the HSA account before using the FSA balance.

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Stephen Barr:: Rick, thanks for that answer. Now, regarding my previous question and the $380 difference: does that mean an enrollee would have to come up with amount out of pocket before the traditional health insurance coverage would kick in? As you can tell, I'm trying to get a handle on all this.

Richard G. Miles: Yes, they are at risk for the $380, which in many cases is less than a normal deductible. However, I also want to point out that dental and vision benefits are provided before the deductible is met. We also provide for $300 worth of preventive benefits before the deductible.

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Washington, D.C.: Just joined the government. I am under my husband's health plan. Should I join now or can I wait for a few more years to join?

Richard G. Miles: This is a difficult question to answer without all the facts. I normally recommend people join as soon as eligible because in order to carry your insurance into retirement you need to have at least 5 years of continuous coverage in the FEHB program. If your husband's plan is provided at no cost to you, you may want to select self only coverage in FEHB. Selecting a low cost plan such as our Std. Option plan would allow you to start accumulating years of coverage at minimal cost to you.

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Stephen Barr:: Thanks again on explaining how HSAs work. Now, what do retirees need to know about an HRA, which, as I understand, is their version of the HSA. Is the contribution into the account the same as with an HSA?

Richard G. Miles: The amount contributed to the HRA is the same but the funding is different. The HSA is contributed once per month in arrears but the HRA will be funded in a lump sum total at the beginning of the effective date of coverage for the year. The HRA funds not used will be carried over to subsequent years but once a person leaves the plan they will forfeit any remaining balance. Whereas in the HSA it belongs to the member. Disbursement from the HRA will be automatic on submitted claims whereas on the HSA the withdrawals are up to the discretion of the member.

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Washington, D.C.: What steps does GEHA take to control costs?

Richard G. Miles: We have a number of strategies and tactics to control costs. PPO networks, precertification of hospital stays and high cost radiological procedures, fraud and abuse programs, to just name a few.

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Pittsburgh, Pa.: You mentioned that enrolling in Medicaare Part B will allow waiver of deductibles in your insurance plan. However, what if the cost of Medicare Part B exceeds any deductibles one incurs, and that includes both memebers of the family, i.e., husband and wife?

Richard G. Miles: I don't quite understand your question but would encourage you to call our customer service department at 800-821-6136. We also have a very comprehensive web site that may be of some benefit. The web address is geha.com

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Washington, D.C.: Consumer Checkbook recommends GEHA as a good fit for Medicare, I'm told. What is your view on this?

Richard G. Miles: I agree.

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Stephen Barr: Richard Miles, thanks for taking questions today. We've run out of time for this session. Thanks to all who participated and took time to read this transcript. We'll be back here at noon next Tuesday with another FEHBP discussion group. See you then!

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