Proposed changes to FEHBP miss the mark

The Office of Personnel Management recently issued new regulations designed to simplify enrollment or amend coverage under the Federal Employees Health Benefits Program. To enroll in the FEHBP or to amend or cancel coverage one must follow a procedure prescribed by OPM and make an appropriate request. OPM defines the term "appropriate request" as a properly completed health benefits or an alternative method deemed acceptable by the employing office and OPM. Alternative methods must be capable of transmitting to the health benefits plans the information they require before accepting an enrollment change of enrollment or cancellation.

If you send in a request for a FEHBP change but fail to use the proper form - or what your agency and OPM consider a suitable alternative - you could be out of luck even if your request is timely and you meet all eligibility criteria. I'm not sure I like that provision. What if you do not have the proper form and do not have a clue as to what would be considered a suitable alternative? Someone who is ill during an open season might find himself in such a situation.

I'm also not happy with a change that allows an employing office to retroactively correct an employee's enrollment code errors. OPM permits such an action if the enrollee reports the error by the end of the pay period following the one in which he received the first written documentation - such as a pay statement - indicating the error.

In my opinion there should be no time limit for correcting errors particularly if the error is made by your agency. For example if you change health plans during an open season but your agency fails to take the proper action you must notify your agency within a stipulated time frame or suffer the consequences. That does not seem fair or logical.

If you have a family enrollment and want to change to individual coverage only you can do so if you provide satisfactory evidence to your employing office that there is no family member eligible for coverage. This might open up a can of worms. For example what if a married employee decides to drop his spouse from a family enrollment without telling her? How would his personnel office decide whether there is an eligible family member? Would it require documentation? Such as what divorce papers? A death certificate? What if his spouse walked out on him? Would the employee still be obligated to provide health insurance coverage for her?

Another strange provision within the regulations applies to retired federal employees who have small annuities. If an annuitant is enrolled in a high-option plan and his annuity becomes insufficient to pay the premium for the high option he is deemed to have enrolled in the standard option of the Blue Cross and Blue Shield Service Benefit Plan. Does that make any sense to you? If an annuitant does not get enough of a pension benefit to cover his high-option premium why can't he mail in a check for the difference?

OPM officials who thought these regulations would permit more efficient administration of the FEHBP must have been dreaming. I see nothing in these regulations that will enable such improvements.

These regulations are written as if all annuitants are mentally incompetent and unable to make decisions concerning their health benefits. Treating annuitants like children and choosing specific plans for them is not what the FEHBP should be spending its time doing.

The expression "If it ain't broke don't fix it " seems most appropriate for this situation.

—Bureaucratus is a retired federal employee who contributes regularly to Federal Computer Week.


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