The biggest drawback (if you can call it that) to the federal health insurance program is that it offers participants too many choices.
The 9 million people covered by the Federal Employee Health Benefits Program (known as the FEHBP) have a bewildering array of plans to choose from. In the Washington area, federal workers and retirees can select from at least seven fee-for-service plans (Alliance, APWU, Blue Cross, GEHA, NALC, Mail Handlers and Postmasters) or eight health maintenance organizations. There are some plans open only to special groups of workers, such as Secret Service, Justice Department or CIA workers or Foreign Service personnel.
Retirees can go into the same plans as young, healthy workers and get the same coverage and pay the same premiums.
Under a complex formula, the government pays an "average" of 72 percent of the total premium for both workers and retirees. By union contract, the U.S. Postal Service pays an even larger share of employee premiums.
Former spouses (with a court order) of federal workers or retirees can get lifetime coverage in the federal program. Although they are required to pay the full premium--plus a small fee--it is often a better deal than what they could purchase as individuals.
There is an annual open season for all feds and retirees when they can switch coverage. This year, the open enrollment period runs from Nov. 8 (that is tomorrow) until December. Employees and retirees also can switch at other times of the year if they get married or divorced or their spouse dies. Those in HMOs who move out of the plan's area of service also can have their own "open season" and join another federal health plan.
By law, none of the plans can deny any eligible worker, dependent or retiree coverage because of age or health. And they cannot refuse to cover a preexisting medical condition if they regularly provide treatment for it.
By contrast, private-sector retirees have it relatively easy. Their companies typically offer only one or two fee-for-service plans and a couple of HMO choices. Many of the private plans won't cover their retirees or drop them at age 65. Others will offer partial coverage for retirees (again, usually until age 65) but charge them higher premiums. Often in the private sector, people who marry after retirement (unlike the federal program) cannot cover a new spouse.
Some private plans will pay a bigger share of the premiums than the government does. And some offer a variety of family-type benefits. But the trade-off is that most of those plans don't cover retirees, or they limit their coverage. That allows them to keep a "group" that is generally healthier and always younger than the federal group plan.
In the private sector, the owner of the company, the chief executive and top officers may make so much money they don't worry about health insurance coverage.
In the federal plan, the big bosses--from the president down to members of Congress and heads of agencies--are all in the same plan. Because politicians designed the program and monitor it, they have made sure that it is one of the nation's best.
The FEHBP was to have been the model for President Clinton's ill-fated national health insurance program. Military retirees with Medicare will be allowed to enroll in the federal health plan--on a trial basis in some locations--starting Jan. 1.
The bottom line is that the federal health plan looks good to just about everybody outside the government. Some insiders are less enthusiastic.
But if you are a fed, it is the only group plan--probably--available.
During the open season, we will have a series of columns listing "best buys" for different groups and different needs. Tomorrow we begin with the best buys for singles, as rated by Washington Consumers' Checkbook's Guide to Federal Health Insurance Plans. Previous columns have listed the premiums for fee-for-service plans and HMOs for both workers and retirees.
The Checkbook guide rates plans by total cost--meaning premiums, any special membership fees and likely out-of-pocket costs an individual, family or retiree can expect next year. Bill Smith, insurance expert for the National Association of Retired Federal Employees will--as usual--help us advise retirees on best buys.
As you wrestle with choices over the next few weeks, remember two things:
* You are in good company. Fellow shoppers include current and former feds such as Vice President Gore, House Speaker J. Dennis Hastert (R-Ill.) and Senate Minority Leader Thomas A. Daschle (D-S.D.), former president Gerald R. Ford, first man on the moon Neil Armstrong, etc. You will not be alone.
* Most Americans who aren't covered by the federal program--especially retirees--would love to be faced with the premiums, plans and problems facing active and retired feds.
Mike Causey's e-mail address is firstname.lastname@example.org
Sunday, Nov. 7, 1999