When it comes to providing sparkling dental benefits, virtually all of the federal health plans have, shall we say, lots of cavities.
That not-so-hot dental coverage may get better, but before you begin practicing your dazzling new smile before the mirror, check your wallet. And consider this background information:
At present, the best dental coverage in the Federal Employees Health Benefits Program is offered by health maintenance organizations. Best means HMOs pay half to (in rare instances) about two-thirds of the dental tab.
The health insurance program is the nation's biggest and a trendsetter for many, if not most, large employer health plans. The federal program covers 9 million people worldwide. Locally, those covered include Vice President Gore, senators, representatives, CIA agents and virtually all other federal employees and retirees. It also covers their children and spouses and can cover grandchildren and ex-spouses, too.
If you aren't in the program, chances are the man beside you in the subway or the woman next door is.
Workers and retirees have lots of choices in terms of coverage and premiums. There are seven national plans, such as Blue Cross, and dozens of local HMOs. The government pays 72 percent of the total premium -- adjusted annually -- for life. Even so, many workers and retirees think the cradle-to-grave program could stand some improvements -- especially in dental benefits.
Most workers and retirees prefer the costlier fee-for-service plans over HMOs. Fee-for-service plans offer a wider choice of doctors and hospitals. HMOs, with their emphasis on managed care, offer lower premiums, minimal paperwork and, in many cases, only token co-payments.
The differences present a problem for federal workers with big families, dental problems, or both. Each year during the health insurance open season -- when they pick the coming year's coverage -- they must weigh the value of dental benefits to them in deciding between fee-for-service and HMO.
Health plans have been "strongly encouraged" by the Office of Personnel Management to beef up dental benefits next year. Generally, that means offering policyholders the option of buying (with their own money) an optional piggyback dental benefit.
OPM right now is negotiating 2000 benefits and premiums with carriers. The results will be announced this summer, and workers and retirees will have an open season -- in late November and early December -- to pick coverage for next year.
OPM has told carriers it would be prudent for them "to offer dental and vision coverage to FEHB members as non-FEHB benefits and to list such coverage prominently on the non-FEHB page of your plan brochure." OPM eventually will require carriers to offer expanded coverage. This is part of a strategy to make government-as-employer more "family-centered" and "family-friendly." As the next presidential election gets closer, you will be hearing and seeing those terms a lot.
Some plans already offer the dental option. Policyholders pay the full premium but get group rate prices from participating dentists.
So the option to pay for better dental coverage is coming next year. So is an estimated premium increase that will average 10 percent.
If politicians don't lose interest in "family-friendly" after the next election, better dental and vision benefits as part of the basic plan also will be here someday.
In the meantime, read the brochure carefully during the open season.
And keep flossing!
The Drug Enforcement Administration headquarters in Arlington has openings for Grade 12 and 13 employee relations specialists. Call Gail Fleming at 202-307-5550.
President Clinton has nominated Robert M. Tobias to the new oversight board created by Congress to monitor the Internal Revenue Service. Tobias, longtime president of the National Treasury Employees Union, has decided not to run for reelection in August. He plans to teach at the university level and write, along with his IRS oversight duties.
Sen. Paul S. Sarbanes (D-Md.) will speak at the June 24 luncheon of the Federal Executive Institute Alumni Association at the Fort McNair Officers Club. For details, call 703-406-0573.
Mike Causey's e-mail address is email@example.com
Tuesday, June 8, 1999