If you are a federal worker who isn't covered by Uncle Sam's health program, ask yourself a simple question:

What am I thinking?

Most federal workers and retirees belong to one of the federal health insurance plans. It's a cradle-to-grave program that doesn't discriminate against participants because of age, health or preexisting conditions. And the government pays 72 percent of the premium.

First lady Hillary Rodham Clinton chose it as the model for her national health care plan. Democratic presidential candidate Bill Bradley has proposed putting millions of uninsured--and in some cases, otherwise uninsurable--Americans into the program.

Politicians, active and retired, are covered by the federal program. They know how good it is.

But a small number of feds don't belong to the federal health insurance program. Many experts think they are playing with fire. Most feds who don't participate are covered by a spouse's nonfederal health plan. That may be a great way to save money as long as the plan lasts and the marriage lasts--and until the private-sector partner gets old (as in age 65) and retires.

Some feds see the advantages of the program--lifetime coverage at group rates--when they get ready to retire or their nonfederal spouses die or lose their jobs. By then, in many cases, it is too late. You need to have been enrolled in one of the federal plans for five years before retirement to carry federal health insurance into retirement.

The federal program differs from the typical private-sector insurance program in a number of important ways: Workers and retirees have more choices--15 in the Washington area, compared with four or five in private health plans. Uncle Sam, by law, pays most of premiums. Retired feds can stay in the program as long as they live. So can their survivors and dependent children. And retirees enjoy the same choices and pay the same premiums for the same coverage as active-duty workers, who generally are younger and healthier.

Many private employers skimp on health insurance, which is often their second highest cost of doing business. Many private employers cut off retirees, or they reduce retirees' benefits or raise their premiums. Virtually all of them end coverage when the retiree turns age 65. By contrast, federal coverage is forever.

Insurance expert Bill Smith recommends that feds enroll in the federal program even if their spouses' private-sector plans are better. He suggests that they enroll in a low-premium plan for five years to qualify themselves (and their private-sector spouses) for federal coverage when they retire. Or in case the nonfederal spouse dies, retires or is fired or the marriage ends in divorce.

The Mail Handlers standard option has the lowest premiums of any fee-for-service plan in the federal program. Next year, the employee biweekly premium will be $21.08 biweekly for self-only coverage and $45.76 for family coverage. Several health maintenance organizations also offer low premiums. CapitalCare's biweekly premium will be $25.86 for self-only coverage and $77.47 for family coverage. The George Washington University Health Plan premium will be $24.36 and $62.91, respectively, and Kaiser Permanente's premiums will be $23.50 and $58.10.

Smith says the low-premium Mail Handlers standard plan, available to all workers, is good in every respect--except for prescription drug coverage. "If you have lots of prescription drugs, you should look at another plan," he says, "because of the Mail Handlers high deductible [about $600 a year] in its standard option."

But as an "insurance" plan to guarantee eligibility for federal health insurance when you retire, he says, Mail Handlers is hard to beat.

There is an exception to the five-year rule for military retirees who take government jobs. Their time under the military health insurance program counts as time under the federal civilian health program. Those individuals can sign up for the civilian program during the current open season and be eligible for coverage after they retire based on their time under the military program.

Bottom line: If you are a fed who is dependent on your spouse's private health plan, weigh the premiums you are saving against the risk you both are taking.

Systems Accountants

The Department of Health and Human Services has openings for two systems accountants at the Grade 14 level. Starting pay is $68,570. One of the jobs is designed for part-timers to job share. Call Diane Sellers at 202-260-6760.

Insurance for Couples

Married feds can choose from among 15 health plans in the Washington-Baltimore area. They also have the option of family coverage under one plan or each signing up for self-only coverage. For "best buys" for couples, check this space tomorrow.

Mike Causey's e-mail address is causeym@washpost.com.

Thursday, Nov. 11, 1999