By Stephen Barr
Thursday, December 6, 2007
The health insurance program for federal employees and retirees is all about choice and competition, and there seems to be plenty in this open enrollment season.
For 2008, the program offers 283 health plans -- national plans and local health maintenance organizations -- with most employees and retirees eligible to join from a dozen to 20 plans, depending on where they live and their occupation. Most plans are open to all, but some specialize in providing medical coverage to specific groups, such as intelligence and law enforcement employees.
While it is easy to spot the choices available in the Federal Employees Health Benefits Program, it is harder to see the competition among the plans. That's partly because the Office of Personnel Management, which administers the FEHBP, discourages plans from drawing comparisons with competitors or marketing against one another.
But the insurance plans do compete, and a number appear to have stepped up their efforts to add subscribers and tout their services. For example:
¿ Aetna is calling attention to its launch of an online, interactive "personal health record" that the company hopes will help enrollees take better stock of their health care.
A search engine scans claims information, such as doctor visits and diagnostic treatments and prescriptions, and, if necessary, alerts enrollees about possible problems or opportunities to improve care. Enrollees also may enter family health histories, immunization records, allergies and other data into their records.
¿ The American Postal Workers Union has been reminding union members that its collective bargaining agreement with the U.S. Postal Service means the agency will pay 95 percent of the premium next year for enrollees in the APWU Health Plan consumer-driven option.
As a general rule, the government pays for about 75 percent of the overall cost of each FEHBP plan, up to a maximum amount set by a complex formula. The maximum contribution for next year is about $3,800 for individuals and $8,600 for families. Enrollees shoulder the cost of premiums above the government's share, and their premium share can be much higher for the more expensive plans in FEHBP.
¿ The Association Benefit Plan is available only to civilian employees of the intelligence community and the FBI and retirees of the CIA. The plan features a "best doctors" program and discounts on dental, vision and hearing services.
The best doctors program permits enrollees to obtain a second opinion on serious medical conditions from top specialists, who recommend a change in treatment about 60 percent of the time and challenge the initial diagnosis about 20 percent of the time, according to plan officials.
¿ The Blue Cross and Blue Shield Association points to its national federation of 39 independent companies and its huge share of the federal market -- about 4.7 million employees, retirees and family members of the nearly 8 million Americans covered by FEHBP.
For 2008, the Blue Cross standard option and the basic option will add coverage for hearing aids for children and will improve ambulance benefits.
¿ The Government Employees Health Association emphasizes that premiums are not changing for its standard option and high-deductible health plans, and that it offers a vision benefit with GEHA health and dental plans.
¿ Kaiser Permanente has announced there will be no co-payment for preventive services, and it will provide generic drugs at lower cost in 2008.
Preventive services include routine physicals, well-child exams, mammograms and Pap smears, routine immunizations, and prostate and colorectal cancer screenings. Co-pays for preventive services cost $30 for adults this year at Kaiser.
The health plan also continues to improve electronic services, which permit Kaiser enrollees to schedule and cancel doctor appointments, send e-mail to their doctors and print out their health histories. An electronic medical record, launched in 2003, is being improved in phases, according to the company.
¿ The Mail Handlers Benefit Plan will offer a new "value option" next year that the company calls the lowest-priced plan in the FEHBP.
The value option offers 100 percent coverage for preventive care, including screenings, immunizations, and maternity and well-child care. It operates as a national fee-for-service preferred provider plan.
There are many other choices in FEHBP for next year. Some plans will be reducing premiums, some will be increasing co-pays and deductibles, and a number are repackaging benefits to make them more attractive.
Comparing plans is difficult, and experts recommend studying plan brochures and using the OPM benefits guide, which permits online comparisons of up to four plans at a time. The annual guide to health plans published by Washington Consumers' Checkbook magazine provides detailed information about how FEHBP works, compares the total costs of plans and makes recommendations on how to shop wisely for health care.
This weekend will be the last chance for such homework. The open season ends on Monday.
Stephen Barr's e-mail address isbarrs@washpost.com.
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