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Questions and answers about federal employee health insurance

Federal Diary

Open season for the Federal Employees Health Benefits program is a time for workers and retirees to consider the many health insurance offerings available to them and to make any changes. Open season ends on Dec. 14. This is the first year for self-plus-one coverage, which allows participants to purchase health insurance for two eligible people instead of family coverage.

The Federal Diary asked experts to list key questions about the program and provide the answers. Here are some of the questions and answers provided by David Snell, director of federal benefits services for the National Active and Retired Federal Employees Association; Walt Francis, chief author of Checkbook’s annual Guide to Health Plans for Federal Employees & Annuitants;  and John O’Brien, Office of Personnel Management health care and insurance director.


Question: If I do not want to change my health insurance during the Open Season, what do I need to do?

Answer: You do not have to do anything to continue your federal health insurance that you currently have unless the plan or the plan option you are under is not going to be offered in 2016.  If you are an active federal employee and enrolled in a plan that is not going to be available under the federal program in 2016, you must make a change during the open season or you will not have any health insurance.  If you are a retiree and the plan you are enrolled in is not participating in the federal program after this year, then you should make a change in your health insurance. However, if retirees fail to make an active change in their health insurance coverage, then the Office of Personnel Management will automatically enroll them in the Blue Cross Blue Shield Service Benefit Plan and in the same coverage (self-only or s-Self-and-family) that they had under the discontinued plan. OPM will notify the affected enrollees when this happens.

Question: I’m a federal retiree and am covered as a dependent under my spouse’s private employer group health insurance and my own federal health insurance.  I’m thinking about canceling the federal coverage and just use the benefits under my spouse’s health insurance and save myself premium money. Will I be able to re-enroll in the Federal program later?

Answer: No, as a retiree if you cancel your FEHBP enrollment you will not be able to re-enroll unless you are re-employed in the federal government.


Question: How much money will self-plus-one save?

Answer: Savings usually range between $100 and $200, but they are sometimes less, and sometimes self-plus-one costs more. The big savings come from changing plans. Since you are going to have to go through an enrollment change anyway to get self-plus-one, take a look at one or two of the plans we show as saving one or two thousand dollars, or more, compared to the higher cost plans.

Question: Why doesn’t self-plus-one cost just double two self-only enrollments?

Answer: Most self-plus-one families are empty nesters, and much older than young families. Older people cost a lot more. They cost as much per person even with Medicare, and many don’t have Medicare yet or didn’t sign up for Part B.

Question: What is the best plan for people with FEHB and Medicare Parts A and B?

Answer: There is no simple answer, since even with a Medicare wrap-around in which you pay nothing for hospital or doctor with Parts A and B, drug benefits will still vary. Plans that we rate as very good buys are Aetna Direct Consumer Driven, MHBP High Deductible, APWU Consumer Driven, Blue Cross Basic, GEHA Standard, NALC Hi, NALC Consumer Driven, and in the DC metro area Kaiser Standard, MD-IPA, CareFirst Standard, and CareFirst High Deductible.

Question: Does Blue Cross Basic have the same Medicare waiver as Blue Cross Standard for federal retirees?

Answer: Both plans cover you 100 percent for hospitals and doctors with Parts A and B for network providers. Blue Cross Standard does the same all other physicians that participate in Medicare, like most other plans with the waiver (NALC High, GEHA Standard, Aetna Direct, etc.). But with Blue Cross Basic you only get Medicare coverage outside the network. Since Part B pays 80 percent, this is still a very good situation, and with the premium savings we rate Basic as a very good buy.


Question: For individuals that have not made an Open Season election where can they enroll or change their enrollment?

Answer: Federal Employees Health Benefits (FEHB) Program: Employees — most employees can use an online self-service system. Information is available at

Retirees — go to Open Season Online at or call Open Season Express (the Open Season Express phone line is a dedicated line for annuitant FEHB Open Season actions only) at 1-800-332-9798, TTY 1-855-887-4957. Due to the high volume of calls we strongly encourage enrollment changes be made online.

Federal Employee Dental and Vision Insurance (FEDVIP): All enrollments and enrollment changes are made through BENEFEDS. Go to or call 1-877-888-3337, TTY 1-877-889-5680.

Federal Flexible Spending Account Program (FSAFEDS): (employees only): go to  or call 1-877-372-3337 or TTY 1-800-952-0450.

Question: Is there any difference in benefits between a self-plus-one enrollment and a self-and-family enrollment in the same plan option?

Answer: Benefits do not differ between enrollment types. Please review your plan brochure available at for details.

Question: I am currently enrolled in a self-and-family enrollment and only have one eligible family member (either a spouse or an eligible child). Should I switch to self-plus-one?

Answer: OPM, your agency, and your carrier cannot make enrollment decisions for you and you will not automatically be enrolled in self-plus-one. To make an Open Season enrollment change you must make a positive election. Roughly 95% of enrollees who qualify for self-plus-one will pay less in premiums if they switch to the self-plus-one enrollment. It is important to take a look at your plan details, including premiums and benefits, before making an enrollment decision. In addition, you will be able to increase or decrease your enrollment type during the annual Open Season, or outside of Open Season if you experience a QLE that is consistent with current FEHB guidelines. Individuals who do not participate in premium conversion, including annuitants, may decrease their enrollment at any time.