The health program for federal employees and retirees is set to add a self plus one option effective with the 2016 plan year, although the “one” would have to be someone who would qualify under existing family coverage policies under rules to be proposed Wednesday.
The draft rules from the Office of Personnel Management would carry out an authority enacted late in 2013 to add a third option to the existing choices of self only or self and family coverage.
The current Federal Employees Health Benefits Program open season ends Dec. 8; the self plus one option is to be available in next year’s open season for coverage in 2016.
Adding a self plus one option has been under consideration for years, reflecting arguments by enrollees with only one eligible family member — for example, a married couple with no child under age 26 — that they are subsidizing family enrollees who have multiple eligible family members. The Obama administration proposed the option early in 2013 and it was enacted as part of last year’s late-year budget deal.
Under the rules, an enrollee could designate one other person for coverage, although only a spouse or child who meets current eligibility rules would qualify. “The proposed regulation does not alter current FEHB family member eligibility guidelines,” OPM’s description of the impact says.
That means that a domestic partner would not qualify. The Obama administration several times has proposed extending eligibility to partners of either gender who meet certain standards but Congress has not acted on those requests.
The rules also state that the same coverage changes between the existing two options currently allowed during annual open seasons or at certain “qualifying life events” such as marriage will apply to the self plus one option, as well.
OPM said that a “large percentage” of retirees, for example, who currently have family coverage even though they have no eligible children, “would likely benefit” from switching to self plus one.
“Because the self and family option includes coverage for a larger number of people, a natural assumption would be that premiums (both the portion paid by the government and the portion paid by the federal employee or annuitant) would be lower with self plus one enrollment than with self and family enrollment,” OPM said.
However, it added that the impact on premiums overall is unknown and will depend on enrollment choices.
The separate Federal Dental and Vision Insurance Program already has a self plus one option.