Is your family dinner scene always a quiet candlelight affair for two?

Or does feeding time at your household look more like the Brady Bunch meets the Three Stooges?

Uncle Sam doesn't care.

Regardless of family size, federal workers and retirees in the same health plans pay the same premiums. And get the same government. But that is where the resemblance ends.

Couples who are ticked off because they pay the same premiums as large families can take comfort--if that is the term--in the fact that the parent or parents of big families typically shell out a lot more for medical coverage, year after year.

The fact that more isn't always merrier is important when families are shopping for health insurance. Like now. The current open enrollment period ends Dec. 13. Many insurance shoppers focus almost exclusively on premiums. That can be a mistake.

Generally speaking, premiums tell only part of the health cost story. Your out-of-pocket costs, for services not covered by your insurance, can mount up quickly. For example:

A family of two and a family of 22 will pay the same annual premium--about $1,740 next year in the Blue Cross standard option if the preferred provider option is exercised. But the big family--unless nobody gets sick, has an accident or sees the doctor or dentist--almost certainly will shell out lots more next year.

The Consumers' Checkbook Guide to Year 2000 Health Insurance Plans for Federal Employees rates "best buys" by the total cost of the plan to you. That total cost includes premiums and out-of-pocket costs you face.

For a family of two with "average" medical costs next year, the guide estimates a total of $2,630 in premiums and out-of-pocket costs in the Blue Cross standard PPO option.

A family of four, the guide says, will pay the same premium in that plan, but its total costs next year for "average" expenses will be $2,810. Bigger families are likely to pay much more in total.

Here are the Checkbook guide's ratings (total costs) that a family of four can expect to pay next year with the health-maintenance organizations and fee-for-service plans available to feds in the Washington-Baltimore area. Again, the totals include premiums and projected out-of-pocket costs:

HMOs: Kaiser Permanente, $1,950; George Washington Health Plan, $2,080; Aetna US Healthcare standard option, $2,090; Prudential, $2,310; M.D. IPA, $2,430; CapitalCare, $2,560; Aetna high option, $2,630; Free State, $3,380.

Fee-for-service plans: Secret Service, $2,760; Blue Cross standard, $2,810; Association Benefit, $3,330; Mail Handlers standard option, $3,430; Postmasters standard, $3,600; GEHA, $3,810; American Postal Workers Union plan, $3,830; Foreign Service, $3,880; National Association of Letter Carriers plan, $3,900; Mail Handlers high option, $3,970; Alliance, $4,500; Blue Cross high option, $4,520; SAMBA (special agents) plan, $4,600; Postmasters high option, $7,810.

In most plans, families who don't use the preferred provider option (doctors and hospitals in the network) can expect to pay an additional $1,000 next year for average costs.

The Secret Service, Association Benefit, Foreign Service and SAMBA plans are limited to employees in selected agencies only.

Open Season Danger

Tuesday's column carried a warning to federal workers and retirees whose current health plan won't be part of the federal program next year. The warning was okay for retirees but misstated the dangers for active-duty feds.

Here's the official word from the Office of Personnel Management:

Retirees whose health plan is leaving the federal health program at the end of the year will automatically be enrolled in the Blue Cross standard option for 2000 if they don't pick another plan.

But for workers, the picture is much grimmer than I painted it.

Active-duty feds whose plans are leaving the program must pick another plan during the open season. If they don't--even though some agencies will give them extra time to shop--they will lose health plan coverage for 2000. They won't be able to reenter the federal health program until the next open season, and their coverage won't begin until January 2001.

Transit Subsidies

Some agencies are giving employees up to $65 per month to help pay for bus or subway fare. Some aren't. For a list of participating agencies--and information on how to nudge your agency into participating in the subsidy program--check this space tomorrow.

Mike Causey's e-mail address is

Monday, Nov. 22, 1999