Federal employees and retirees will have more choice in their health care in 2005, but using that choice to their best advantage will require some hard thinking.

The Federal Employees Health Benefits Program will feature 249 health plans next year, with the large majority of them, as before, health maintenance organizations available only in certain geographic areas. Enrollees in the Washington area will be able to choose among 21 offerings, including HMOs and fee-for-service plans.

Employees and retirees, by and large, should see some moderation in the rate of increase in their premiums. Health insurance premiums will rise an average of 7.9 percent next year, "good news" as Kay Coles James, director of the Office of Personnel Management, put it in her announcement yesterday. [Story on Page A25.]

James said that FEHBP enrollees who sign up for individual coverage will pay an average of $4.32 more biweekly, and those taking family coverage will pay an average of $9.99 more biweekly.

But the expanded choices being offered to employees and retirees will probably require more homework than shopping around based on price alone.

Eighteen of the new plans joining FEHBP next year are "high-deductible health plans," including a "faith-based" HMO in Illinois that will not cover contraceptives or abortions. The plans provide a "health savings account," or HSA, that allows for tax-free contributions and payments for medical expenses.

The Government Employees Hospital Association and the Mail Handlers Benefit Plan will offer nationwide HSA plans. Aetna HealthFund will make them available in most parts of the country, including the District, Maryland and Virginia, and Coventry Health Care of Delaware will make available a high-deductible plan in Maryland.

HSAs will be available to people who do not qualify for Medicare benefits or those who have other insurance plans that might pay the deductible. The high-deductible plans also will offer a "health reimbursement arrangement," which provides benefits similar to an HSA, for those who have Medicare coverage, typically retirees.

In both types of plans, annual deductibles must be at least $1,050 for self-only coverage and $2,100 for self-and-family coverage.

In an HSA, a portion of premiums -- typically, somewhat less than the minimum deductibles -- will go automatically into the savings accounts. HSA enrollees (but not those covered by HRAs) also will be able to contribute an additional amount out of pocket, up to the plan's deductible. That additional contribution, like the portion going in from premiums, will be pre-tax.

Some employees may be attracted to such plans because money in the savings account not spent in a given plan year will be available for use in future years.

Federal employee and retiree organizations have expressed concern that such plans will draw off relatively healthy enrollees, leaving other plans with higher claims rates and higher premiums, known in health insurance lingo as "adverse selection."

"We were very cognizant of that concern," said Abby L. Block, an OPM deputy associate director. "It was a shared concern, and so we carefully designed a product that we believe is unique in the industry."

As a result, perhaps, the premiums for high-deductible plans are not much different from those in traditional FEHBP plans.

For example, the biweekly federal employee share of the Mail Handlers high-deductible plan will be $42.25 for self-only, compared with $45.16 for its standard coverage, and $95.75 for family coverage, compared with $95.64 for standard coverage.

"We did not negotiate bare-bones plans here," Block said. "The deductibles are not terribly far beyond the minimum, and the benefits once you get beyond the deductibles are quite good."

OPM officials said they have no projections on how many of the 8 million FEHBP enrollees -- counting employees, retirees and eligible family members -- might switch to high-deductible plans. They noted that a somewhat similar type of plan that has been in existence for several years, called the consumer-driven option, has only about 16,000 enrollees. Those plans feature an available pool of money, then a deductible, then HMO or fee-for-service coverage.

"We think it will take awhile for enrollees to understand them and get used to them," said Nancy H. Kichak, an OPM deputy associate director.

The annual open season in which employees and retirees can change plans will be Nov. 8 to Dec. 13.

Diary associate Eric Yoder contributed to this column.