Understanding FEHB: An Overview
The FEHB Program is designed to offer federal employees a broad range of health insurance options. It operates similarly to private sector health insurance programs but is specifically tailored for federal employees. The program's main goal is to ensure that federal workers have access to affordable and quality healthcare services, which is crucial for maintaining a healthy and productive workforce.
FEHB plans are designed to meet the diverse needs of federal employees and their families. The program is administered by the U.S. Office of Personnel Management (OPM) and offers a wide range of plan options, including Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and High Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs). Each plan has its own set of benefits, costs, and coverage options, allowing participants to choose a plan that best fits their needs.
What Does FEHB Insurance Cover?
FEHB plans cover a wide array of healthcare services similar to those found in private insurance plans. These typically include:
- Hospitalization: Coverage for inpatient and outpatient hospital services.
- Physician Services: Visits to primary care doctors and specialists.
- Preventive Care: Routine check-ups, screenings, and immunizations.
- Prescription Drugs: Coverage for medications prescribed by healthcare providers.
- Mental Health Services: Access to psychological and psychiatric care.
- Maternity and Newborn Care: Services related to pregnancy and childbirth.
- Emergency Services: Coverage for urgent care and emergency room visits.
Each FEHB plan may offer additional benefits, so it's essential for participants to review their specific plan details. For example, some plans may offer coverage for alternative therapies, such as acupuncture or chiropractic care, while others may provide additional coverage for dental or vision services. It's important to note that while FEHB plans typically cover a wide range of services, there may be limitations or exclusions, such as coverage for pre-existing conditions or certain experimental treatments.
Who Can Join FEHB?
FEHB is available to a broad group of individuals associated with the federal government, including:
- Active Federal Employees: Most full-time and part-time federal employees are eligible to enroll.
- Federal Retirees: Retired federal employees can continue their FEHB coverage into retirement.
- Family Members: Spouses and dependent children of eligible employees and retirees can also be covered.
To be eligible, you must generally be a full-time or part-time employee and have completed a certain period of service. Specific eligibility criteria can vary, so it's important for potential enrollees to consult the Office of Personnel Management (OPM) for detailed information.
For example, active federal employees must typically complete a one-year probationary period before becoming eligible for FEHB. Retirees must have been enrolled in FEHB for at least five years before retirement to continue their coverage. Dependents, such as spouses and children, must meet specific eligibility requirements, such as being legally married or under the age of 26.
When and How to Join FEHB
Enrollment in the FEHB Program typically occurs during the annual Open Season, which usually runs from early November to mid-December. During this period, eligible individuals can enroll in a plan, change plans, or make adjustments to their current coverage.
To enroll, eligible employees must use the federal employment system, where they can log in and make their selections. Retirees can make changes through the OPM Retirement Services Online portal or by contacting OPM directly.
Outside of Open Season, changes to FEHB coverage are generally not allowed unless certain qualifying life events occur, such as marriage, birth of a child, or loss of other health insurance. These events may trigger a Special Enrollment Period, during which individuals can make changes to their coverage.
Who Pays the Premium?
The cost of FEHB premiums is shared between the federal government and the employee. The government typically pays about 70% of the premium costs, while employees cover the remaining 30%. This cost-sharing arrangement helps make FEHB plans more affordable for employees and their families.
For example, if the total premium for a FEHB plan is $100 per month, the federal government would contribute $70, and the employee would pay $30. This arrangement ensures that federal employees have access to affordable healthcare coverage while sharing the cost burden with the government.
It's important to note that the premium contribution percentage may vary depending on the specific plan and the employee's salary. Higher-income employees may pay a higher percentage of their premium, while lower-income employees may pay a lower percentage. This progressive contribution structure helps ensure that FEHB coverage remains affordable for all federal employees.
How to Choose a FEHB Plan
Choosing the right FEHB plan is a critical decision that depends on various factors, such as:
- Coverage Needs: Consider your healthcare needs and those of your family, including any specific medical conditions that require attention.
- Preferred Doctors and Hospitals: Check if your preferred healthcare providers are in-network for the plans you are considering.
- Cost: Compare premiums, deductibles, copayments, and out-of-pocket maximums across different plans.
- Plan Type: Decide between Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), and High Deductible Health Plans (HDHPs) with Health Savings Accounts (HSAs), depending on your healthcare preferences.
Utilizing resources like the OPM's FEHB Plan Comparison Tool can be extremely helpful in assessing different plan options. This tool allows participants to compare plans side by side, viewing details such as premium costs, coverage options, and network availability. Additionally, OPM provides detailed plan summaries and enrollment guides to help participants make informed decisions.
It's also important to consider the network of healthcare providers available under each plan. Some plans may have a more extensive network of doctors and hospitals, while others may have more limited networks. Participants should review the plan's provider directory to ensure that their preferred healthcare providers are included in the network.
Can FEHB Continue to Be Used After Retirement?
Yes, one of the key benefits of the FEHB Program is that it allows federal employees to carry their health insurance coverage into retirement. Retirees must have been enrolled in the FEHB Program for the five years immediately preceding their retirement or since their first opportunity to enroll.
This continuity is particularly advantageous as it provides retirees with the security of knowing they will continue to receive healthcare benefits without interruption, ensuring peace of mind during their retirement years.
For example, a federal employee who has been enrolled in FEHB for the past five years before retiring can continue their coverage into retirement. Retirees are generally required to pay the full premium for their FEHB coverage, as the federal government no longer contributes to the cost. However, the premium rates for retirees are typically lower than those for active employees, as retirees are generally older and may have higher healthcare costs.
Difference Between FEHB and FEDVIP
While FEHB provides comprehensive healthcare coverage, the Federal Employees Dental and Vision Insurance Program (FEDVIP) specifically covers dental and vision care, which are not typically included in standard FEHB plans. Here are some key differences:
- Coverage: FEHB covers a wide range of medical services, whereas FEDVIP focuses solely on dental and vision care.
- Enrollment: Enrollment in FEDVIP is separate from FEHB and occurs during the same Open Season. Employees can choose to enroll in one or both programs based on their needs.
- Premiums: FEDVIP premiums are entirely paid by the enrollee, unlike FEHB, where the government also contributes to the premium costs.
For example, an employee who enrolls in both FEHB and FEDVIP would pay the full premium for FEDVIP, while the government would contribute to the cost of FEHB. This allows employees to customize their coverage to meet their specific needs, whether they prioritize medical, dental, or vision care.
It's important to note that FEDVIP plans may offer different levels of coverage, such as basic or comprehensive dental and vision care. Participants should review the details of each plan to determine which option best fits their needs.
FAQs About FEHB
Q: Can I change my FEHB plan outside of Open Season?
A: Generally, changes to your FEHB plan can only be made during the Open Season. However, certain life events, such as marriage, birth of a child, or loss of other health insurance, may qualify you for a Special Enrollment Period.
Q: Are dental and vision benefits included in FEHB plans?
A: Dental and vision benefits are not typically included in FEHB plans and require separate enrollment in FEDVIP for coverage.
Q: Can I keep my FEHB coverage if I leave federal service?
A: If you leave federal service before retirement, you may be eligible for Temporary Continuation of Coverage (TCC), which allows you to continue your FEHB coverage for up to 18 months, although you will pay the full premium plus a 2% administrative fee.
Q: How does Medicare work with FEHB in retirement?
A: Retirees who are eligible for Medicare can choose to enroll in both Medicare and FEHB. Medicare becomes the primary payer, and FEHB serves as secondary coverage, which can help cover costs that Medicare does not.
Q: Is there a waiting period for pre-existing conditions in FEHB plans?
A: No, FEHB plans do not impose waiting periods for pre-existing conditions, ensuring immediate coverage for all eligible enrollees upon plan activation.
resources:
- U.S. Office of Personnel Management Open Season Highlights: https://www.opm.gov/healthcare-insurance/healthcare/reference-materials/reference/federal-benefits-open-season-highlights-2025-plan-year.pdf
- RIF Benefits for Separated Employees Part 2: https://www.opm.gov/policy-data-oversight/workforce-restructuring/reductions-in-force-rif/rif-benefits-for-separated-employees-part-2-health-and-life-insurance-and-retirement.pdf
- Cigna Federal Employee Health Benefits: https://www.cigna.com/employers/insights/federal-employee-health-benefits
- Federal Benefits Information: https://www.ed.gov/about/doing-business-ed/working-ed/onboarding-documents/federal-benefits-information
- Benefit Federal Employees Can't Afford to Lose: https://www.fedsmith.com/2025/05/09/benefit-federal-employees-cant-afford-to-lose/