Transcript
Federal Diary Live
Wednesday, November 1, 2006; 12:00 PM
The 2007 "open season" for enrolling in the Federal Employees Health Benefits Program begins Nov. 13 and runs through Dec. 11. FEHBP will offer 284 plan choices in 2007, featuring fee-for-service plans, high-deductible health plans and health maintenance organizations. Which plan is the right one for you?
Stephen W. Gammarino , senior vice president for national programs at the Blue Cross and Blue Shield Association, joined The Post's Stephen Barr , who writes the Federal Diary column, to take your questions and comments Wednesday, Nov. 1, at noon ET about health insurance for federal employees and retirees.
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Blue Cross offers two plans in FEHBP--a standard option and a basic option. According to the Office of Personnel Management, which administers FEHBP, premiums in the Blue Cross benefit plan will decline by up to $1.29 per bi-weekly pay period, or stay the same, depending on the enrollment option. Blue Cross currently has more than 56 percent of FEHBP enrollments, OPM reports.
The transcript follows.
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Stephen Barr: Thanks to all joining in this discussion today, especially our guest, Stephen Gammarino, who oversees the federal employee Blue Cross and Blue Shield program. To get the ball rolling, Mr. Gammarino, I'd like to start the discussion with this question: With premiums mostly flat for the major national plans, what should federal employees and retirees focus on during the upcoming open season?
Again, thank you for taking time from your busy schedule to join us.
Stephen W. Gammarino: Each year I look forward to this opportunity to talk with you, Steve, and with the participants in this on-line chat. I find it to be an excellent way to respond to federal employees' questions concerning the changes in our products, the Service Benefit Plan Standard and Basic Options. As always, there is a lot going on in the health insurance industry this year. We made several improvements to our product offerings that people will want to know about. We also have great news about our premiums and we are offering a new vision program. I'm sure federal employees and retirees will have lots of questions about these issues and this is one opportunity to begin addressing them.
We are pleased that our out-of-pocket rates for Standard Option will decrease for 2007 and our Basic Option out-of-pocket costs will remain unchanged for the fourth year. Not all Carriers have maintained relatively flat rates for 2007.
Price should be one factor in an individual's decision to purchase health insurance. Federal employees have a wide selection of plans with very different benefit structures. It is important to look at the benefits, rates, out-of-pocket costs, provider networks, and administrative procedures to find the coverage that is best for you and your family's needs. The Blue Cross and Blue Shield Service Benefit Plan's Standard and Basic Options both have comprehensive benefits, low rates and broad networks.
For more information about our products please look at our Web site, http:/
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Aberdeen, S.D.: Why isn't BC/BS jumping in to participate in the new dental insurance?
Stephen W. Gammarino: Blue Cross and Blue Shield submitted a Dental Proposal to OPM. Blue Cross and Blue Shield was not selected by OPM for the dental insurance product. However, we are really excited about our new vision product, FEP BlueVision. If you have any questions about BlueVision, call 1 800 411BLUE.
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Anonymous: I received a letter yesterday informing me that three hospitals in the INOVA system (Fairfax, Alexandria, and Mt Vernon) are engaged in contract negations with Care First and their status as preferred providers is in question. When will that matter be resolved? Resolution of that matter will bear heavily on the open season decision I and many other No. VA residents will have make.
Stephen W. Gammarino: We know how important your physicians and facilities are to you. That's why the Service Benefit Plan tries its best to maintain some of the largest Preferred provider networks in the country. Unfortunately, our local Blue Cross and Blue Shield Plans sometimes are unable to reach agreement with certain providers on financial or other terms, and a provider decides to leave the network. We realize such changes can have a tremendous impact on our members, and try to assist in such situations with out-of-network benefits or assisting in finding another provider. If you have Standard Option coverage, you can continue to see that provider, however, benefits will be provided at out-of-network levels based on an allowance, and you may be responsible for the difference between our allowance and the provider's billed charge.
Under Basic Option, you must see Preferred providers, and therefore, benefits would no longer be available. Please consult our online provider directory on our Web site, http:/
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Hallandale Beach, Fla.: I retired from the Federal government as a CSRS off-set and am currently enrolled in FEHBP's Blue Cross & Blue Shield that provides full coverage until age 65. At that time, I am obliged to enroll in Medicare which will become my primary coverage with Blue Cross & Blue Shield filling in as supplemental coverage. Where can I find information on the exact roll BC/BS will play especially in regards to drug coverage?
Thank you
Stephen W. Gammarino: Be sure to check the inside page of the Service Benefit Plan brochure for important guidance from OPM. OPM advises that the Blue Cross and Blue Shield prescription drug coverage is equivalent or better than Medicare Part D thus, you do not have to enroll in Medicare Part D and pay extra for prescription drug coverage.
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Stephen Barr: Regarding your new vision insurance, how is it different from benefits offered through the standard option, and what do you see as the major advantage of vision coverage, given the premiums involved? Thank you.
Stephen W. Gammarino: Under our Standard and Basic Options, vision coverage is limited to medical conditions following surgery.
Blue Cross and Blue Shield is pleased to offer a new comprehensive vision care program, FEP BlueVision for 2007. We are very excited to make this new coverage available to active federal employees, annuitants and their qualified dependents. Individuals can enroll in FEP BlueVision whether or not they select the FEP medical coverage. Unlike your health insurance, you will pay the entire premium of your vision benefit. FEP BlueVision has two Plan options with enrollment structured on three tiers. If you are actively employed, the premiums for this new coverage can be taken directly from your paycheck on a pretax basis. If you are a retiree, the premiums can be taken directly from your annuity on an after tax basis.
For 2007, our premiums will be:
Actives - Payroll Deduction Bi-Weekly-on a pre-tax basis
Standard Option
Self : $ 3.97
Self plus 1: $7.94
Self Plus Family: $ 11.92
High Option
Self : $5.01
Self plus 1: $10.01
Self Plus Family: $15.02
Annuitants - Pay monthly, after-tax. Can elect a direct deduction form your annuity, if you choose.
Standard Option
Self : $8.60
Self plus 1: $17.20
Self Plus Family: $25.83
High Option
Self : $10.86
Self plus 1: $21.69
Self Plus $32.54
All FEP BlueVision benefits are available only thorough the FEP BlueVision provider network. FEP BlueVision allows you to have access to 25,000 vision care providers around the country including optometrists, ophthalmologists, national and regional retailers such as Wal-Mart, EyeMasters, Vision Works, Vision World, Value Vision Hour Eyes and Four Eyes.
We think you will find the benefits of FEP BlueVision to be very generous as well. You can receive a comprehensive eye examination and new eyeglasses from your approved provider's exclusive FEP Blue Vision collection for FREE.
If you choose a frame from the exclusive FEP BlueVision frame collections available at most FEP BlueVision providers, you will receive your frames for free.
If you choose a frame outside this collection, you have an allowance of $130 plus a 20% discount on the remainder or balance above the $130 allowance.
Standard lenses for your frames are free.
Both plan options cover the eye examination and lenses on an annual basis, the frame coverage for the High Option is every calendar year. Under the Standard Option, it is every other calendar year. There are NO waiting periods, co-insurances or claims to file and no maximum annual payout.
For more information about FEP BlueVision please visit our Web site, www.fepblue.org, or call our Open Season Information Center at 1-800-411-Blue. Our Open Season Information Center is open from Monday through Friday, 7 a.m. to 11 p.m., Eastern time, and Saturday and Sunday, 9 a.m. to 3 p.m.
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Stephen Barr: It is interesting that, after several years of rising premiums, that the FEHBP national plans are holding the line for 2007. Do you think this hold-the-line can be maintained for the long term, or is this a one-year blip?
Stephen W. Gammarino: Basic Option has maintained that same rate for four consecutive years.
The Blue Cross and Blue Shield Service Benefit Plan is dedicated to providing its members with comprehensive and affordable healthcare choices. To keep premium increases low, we work closely with a number of partners. We are able to leverage the provider discounts that the Blue Cross and Blue Shield Plans have in place to service their extensive commercial business. The deep discounts we receive from the local Plans' networks of providers is an important way that federal employees benefit from the close integration of the Service Benefit Plan with local Blue Cross and Blue Shield Plans.
Of course, we also rely on our members to help us control costs. Our members help by using Preferred providers whenever they can. They also help keep costs low by using generic drugs, by using our wellness and preventive benefits to keep themselves healthy, and by using our 24-hour toll-free nurse triage and health information service, Blue Health Connection (1-888-258-3432). Members can also help keep costs down by using our web based services including the on-line provider directories.
For more information about our products please look at our Web site, http:/
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Stephen Barr: Many Diary readers are interested in dental-vision benefits, and I'm sure that coordination of benefits will be something that arises during 2007 for some of them. Is there a brief primer you can give us on benefits coordination? Thanks!
Stephen W. Gammarino: For purposes of coordination of benefits between the FEHBP medical plans and the dental and vision plans, the medical plan is the primary payor and the dental and vision plan pay second.
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Stephen Barr: One of my favorite questions every year goes to the question of prescription drugs. They have been a major driver for premium increases in the past. Is usage trending upward in your Blue Cross plans?
Stephen W. Gammarino: Prescription drugs continue to be a major part of our health plan costs. We continue to encourage members to help us control our cost and their costs by using generic drugs, when they can.
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Washington, D.C.: If I see an ophthalmologist for glaucoma, will exams be covered under the Standard Plan or will I need the Blue vision care plan to cover this medical expense?
Stephen W. Gammarino: The treatment of the medical condition is covered under both Standard and Basic Option.
We encourage your consideration of FEP BlueVision for your routine wellness exams thereafter as well as for prescriptive eyeglasses or contact lenses. For more information, be sure to call 1 800 411BLUE.
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Stephen Barr: As I recall, the Office of Personnel Management has proposed adding a third plan to the Blue Cross menu -- a high deductible with a health savings account. What's the status of that plan, and, if it is put in place, would you see it as a competitor for basic? Thanks.
Stephen W. Gammarino: Federal law does not currently allow the Blue Cross and Blue Shield Service Benefit Plan to offer more than two options, and we already offer the two most popular health care products in the FEHBP. In 2001, we added a new product called Basic Option. Basic Option has been very successful and currently has over 260,000 enrolled contracts. Our larger product, Standard Option has over 2 million contracts. At this time, we are closely monitoring the market place to see how high deductible health plans are received and to understand more fully the impact they can have on our current products. Blue Cross and Blue Shield will continue to focus on meeting our member's needs. We will continue to monitor new products as they come into the market place and we will continue to assess their ability to meet the evolving needs of federal employees and retirees. Member values will be the key driver in making changes to our product portfolio in the future.
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Washington, D.C.: Under the new vision plan are contact lenses covered on an annual basis the same as eyeglasses?
Stephen W. Gammarino: Yes, you can get one or the other annually. For more information, be sure to call 1 800 411BLUE.
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Brunswick, Ga.: Thank you for taking time to answer questions today. Are the dental benefits under the BC/BS Standard plan still being offered in 2007?
Stephen W. Gammarino: Our dental benefits have not changed for 2007. Our current benefits are:
Basic- A member may have exams, cleanings and X-rays twice a year for a $20 copay for each exam. Sealants are also covered for children up to age 16. In Basic Option, a member must receive care from a Preferred provider.
Standard- Benefits are provided according to a fee schedule for exams, X-rays, cleanings, minor restorative procedures and routine extractions. Preferred dentists agree to accept our Maximum Allowable Charge (MAC) for covered services which limits a member's liability to the difference between the fee schedule amount and the MAC.
For more information about our products please look at our Web site, http:/
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Washington, D.C.: As many federal employees are older without families at home, why is there no self plus 1 option for medical?
Stephen W. Gammarino: Federal law prohibits the Blue Cross and Blue Shield Service Benefit Plan from creating three enrollment options. It only permits two enrollment options. They are: self only, and self and family. In contrast, the law establishing the dental and vision programs requires the three enrollment options of self only, self and family, and self plus one.
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Takoma Park, Md: Hi, Many doctors that I have heard of, including my own, are dropping out of Blue Cross' Preferred Provider network. Are you taking any actions to stop this erosion and to lure ones who have left back in?
Thanks!
Stephen W. Gammarino: We know how important your physicians and facilities are to you. That's why the Service Benefit Plan tries its best to maintain some of the largest Preferred provider networks in the country. About 99% of hospitals and 89% of physicians accept the Blue Cross and Blue Shield card. There are more than 500,000 network physicians and 50,000 network hospitals nationwide.
Unfortunately, our local Blue Cross and Blue Shield Plans sometimes are unable to reach agreement with certain providers on financial or other terms, and a provider decides to leave the network. We realize such changes can have a tremendous impact on our members, and try to assist in such situations with out-of-network benefits or assisting in finding another provider. If you have Standard Option coverage, you can continue to see that provider, however, benefits will be provided at out-of-network levels based on an allowance, and you may be responsible for the difference between our allowance and the provider's billed charge.
Under Basic Option, you must see Preferred providers, and therefore, benefits would no longer be available. Please consult our online provider directory on our Web site, http:/
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Stephen W. Gammarino: Thank you for all your questions and interest. If you have any further questions, please feel free to call 1 800 411BLUE or you can log on to http:/
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