The Blue Cross-Blue Shield Association, the nation's largest health-insurance company, proposed yesterday to refund $465 million to the government from the reserves of its federal employe health-insurance fund and to send an additional $289 million in refunds to the 1.5 million U.S. workers and retirees who subscribe to its plan.
Refund checks -- ranging from $18 for individuals with standard option coverage to $374 for families with high option coverage -- will be mailed in August if the Office of Personnel Management approves the unprecedented refund.
Association President Bernard R. Tresnowski said the refunds are possible because of a 22 percent drop in the use of the Blue Cross-Blue Shield plan by civil servants and retirees. It comes at a time when the federal government and private insurers have been working to hold down rising health care costs.
Blue Cross-Blue Shield is the largest of the 210 plans in the civil service health program, the nation's largest "company" health plan. Because of greater emphasis on preventive health care and requirements that participants pay a larger share of their medical and hospital bills, most plans in the program say usage is down.
There are more than 400,000 federal workers and retirees in the Washington area; about 40 percent would get a refund.
Blue Cross-Blue Shield informed OPM officials of the proposal yesterday morning. It has also advised key members of Congress. A spokesman for acting OPM director Loretta Cornelius said the agency would give serious consideration to the proposal.
The Washington Post reported last week that the federal health program, which covers everyone from the president to members of Congress to government clerks, has a reserve of $1.9 billion. The program takes in about $7 billion a year. OPM says the government pays about 61 percent of the average total premium.
If approved by OPM, federal workers and retirees who have standard option, self-only coverage with Blue Cross-Blue Shield would get a refund check for $73. Families with standard (low option) coverage would get $79. Refunds for persons with high option coverage would be $173, and families with high-option coverage would get $374.
Postal workers would get smaller refunds -- from $18 to $300 -- because the U.S. Postal Service pays a larger share of their premium.
Premiums this year would not be changed. Persons with individual high option plans would continue to pay $31.31 every two weeks for the coverage, with the government paying $23.93. Family coverage premiums for employes would remain at $67.52 biweekly, with the government continuing to pay $53.36. For the low-option plans, the employe premium would remain $7.55 every two weeks, and $18.67 for family coverage. Government contributions of $22.64 and $53.36, respectively, would remain unchanged.
All federal employes and retirees currently enrolled in the Blue Cross-Blue Shield plan through the federal program would be due refunds, the association said. It has set up a toll-free hotline (800-253-0123) to answer questions about eligibility for refunds.