OPM EASES ENTRY INTO FEHBP FOR SOME FEDERAL EMPLOYEES; CLARIFIES EVENTS PERMITTING ENROLLMENT CHANGES

Washington, D.C. -- Federal employees covered by a spouse's private health insurance plan would get immediate coverage under the government's insurance program if the spouse, for any reason, loses employment and workplace benefits, according to proposed rules changes published today in the Federal Register.

Under the Office of Personnel Management proposal, the rule change affecting spouses has the potential to benefit, among others, the federal employee whose spouse becomes unemployed due to private-sector downsizing.

The rule departs from current regulations by no longer requiring the federal employee's human resources office to make an eligibility determination for the Federal Employees Health Benefits Program (FEHBP) based on the nature of the spouse's job loss.

"Our overriding concern is to make the FEHBP as accessible as possible to federal employees and their families," said OPM Director Jim King. "By opening the program to federal workers who lose health-care coverage under a spouse's private plan, we have accomplished this goal. This is not just good policy....it is good sense."

The OPM proposal also uses changes in family status, including the birth or adoption of a child, in deciding a federal worker's right to acquire FEHBP coverage. Current rules require a change in marital status before permitting new enrollments.

In addition, the proposed rules unveil a user-friendly feature. OPM will improve the readability and presentation of regulations in printed materials, making it easier for employees and agency benefits officers alike to understand and locate needed information. OPM also will standardize, to the fullest extent possible, the effective dates of new health plan enrollments or option changes. Standardization of dates will clear up any doubt among FEHBP enrollees and agency officers on when coverage begins.

Added Director King: "It has been brought to our attention that a significant number of FEHBP enrollees experience some confusion over the finer points of the health program. This, I believe, has been remedied. OPM will more clearly and more concisely communicate benefits and other program details so that enrollees can better understand the system that provides health care to them and their families."

The FEHBP provides medical benefits to more than nine million federal employees, retirees and their dependents. Each year an "open season" is held to give enrollees the opportunity to elect coverage in the FEHBP or to change health plan options, although limited changes in coverage may be made during the course of the year under some circumstances.

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Web page created 2 December 1997