The Federal Employees Health Benefits (FEHB) Program: 2014 Open Season

The Federal Employees Health Benefits (FEHB) Program: 2014 Open Season

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November 28, 2014
The Federal Employees Health Benefits (FEHB) Program: 2014
Open Season
Overview
The 2015 Plan Year
The Federal Employees Health Benefits (FEHB) Program is
Plan Options
the largest employer-sponsored health benefits program in
the United States. FEHB is administered by the Office of
The 2015 plan year runs from January 1, 2015, through
Personnel Management (OPM). Participation in FEHB is
December 31, 2015. For 2015, there are 257 plan options.
voluntary, with 85% of federal employees enrolled and
FEHB enrollees choose a health plan from a health
90% of federal retirees participating. In FY2013, FEHB
insurance carrier participating in FEHB. Each carrier offers
provided about $44 billion in health benefits.
one or more plans. Generally, FEHB health insurance
carriers and their health plans fall into two broad categories:
According to the most recent estimate from OPM for 2014,
fee-for-service (FFS) plans or health maintenance
there are about 4 million policyholders in FEHB, covering
organizations (HMOs). FFS plans are generally available
about 8.2 million people, including federal employees,
nationwide, and HMOs tend to be locally available. Details
retirees, and their eligible family members. This number
for all FEHB plans are available on OPM’s website at
includes employees and retirees of the United States Postal
http://www.opm.gov/healthcare-insurance/healthcare/plan-
Service (USPS). See Figure 1 for a breakdown of FEHB
information/.
policyholders.
As a practical matter, depending on where an enrollee
Figure 1. Profile of FEHB Policyholders, 2014
resides, the choices are limited to about 15 different plans.
Plan choices change each year, as plans enter or leave the
program or change geographic service areas. For 2015,
there are four new local health plans entering FEHB and
five local plans leaving FEHB.
Other program options available during open season are the
Federal Employees Dental and Vision Insurance Program
(FEDVIP) and Federal Flexible Spending Account Program
(FSAFEDS). All individuals eligible for FEHB, including
retirees, are also eligible to enroll in FEDVIP, which
provides supplemental dental and vision insurance.
Currently, FEDVIP has more than 1.4 million enrollees in
dental plans and more than 1 million in vision plans. Active
federal employees are eligible for FSAFEDS, which allows
employees to pay for health care expenses with pretax
dollars. More than 332,000 federal employees participate in
FSAFEDS.
FEHB Premiums

Source: Congressional Research Service (CRS) analysis of Office of
For employees (other than USPS employees) and retirees in
Personnel Management (OPM) data.
2015, the weighted average enrollee share of the biweekly
FEHB premium for both self and family is $136.86 and the
Open Season
average government contribution is $317.49, for a total
average biweekly premium of $454.35. Figure 2 compares
The 2014 open season for the 2015 plan year runs from
these figures with previous years.
November 10, 2014, through December 8, 2014.
Individuals can enroll for the first time or change their
Total premiums for employees (other than USPS
existing health insurance plan during the annual open
employees) and retirees will rise by an average of 3.2% in
season. Outside of open season, changes are only allowed
2015, a smaller increase than the 3.7% increase in 2014.
for individuals with a qualifying life event, such as
Although premiums increased on average by 3.2%,
marriage.
premiums for any given plan may have increased by more
or less or declined. However, looking only at premium
changes may not give a complete picture of year-to-year
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The Federal Employees Health Benefits (FEHB) Program: 2014 Open Season
plan changes, as plans may modify benefits or cost-sharing.
plans have the highest level of FEHB enrollment, with a
For comparisons with other years, see Figure 3.
total of more than 2.5 million (more than half) of FEHB
policyholders. The Standard plan has a higher premium
Figure 2. Weighted Average Biweekly FEHB
than the Basic plan and a deductible, but it has lower co-
Premiums for Employees (Non-USPS) and Retirees,
pays and greater choice of providers, including coverage for
2011-2015
non-preferred and non-participating providers as well as
preferred providers. The Basic plan has a lower premium
and no deductible but higher co-pays, and it only covers
preferred providers. Selected plan details for the Standard
and Basic BCBS plans are listed in Table 1.
Table 1. Employee (Non-USPS) and Retiree Premium
Contributions and Cost-Sharing , Standard and Basic
BCBS Plans, 2015

BCBS
BCBS
Standard
Basic Option
Option
Enrollee share of biweekly
$91.03 (self)
$63.40 (self)
premium
$213.31 (family) $148.46 (family)
Calendar year deductible
$350 per
Source: OPM.
person; $700
None
per family
Figure 3. Average FEHB Premium Increase per Year,
2011-2015
Co-payment for preferred
$20/$30 (The
primary care provider office
calendar year
visit/Preferred specialist office deductible does $25/$35
visit
not apply for
this benefit)
Coinsurance for participating 35% of plan
provider visit
allowance
No coverage,
Coinsurance for
35% of plan
except in special
non-participating provider visit allowance, plus circumstances
any difference
such as
between
emergency care
allowance and
billed amount
Source: Blue Cross Blue Shield (BCBS) Benefit Plan, 2015.
Source: CRS analysis of OPM data, except for the 2015 increase.
http://www.opm.gov/healthcare-insurance/healthcare/plan-
That increase was announced in the OPM press release, “OPM
information/plan-codes/2015/brochures/71-005.pdf.
Announces 2015 Federal Employees Health Benefits Program
Premium Rates” (October 7, 2014).
More Information
For more information about FEHB, see CRS Report
For employees (other than USPS employees) and retirees,
RS21974, Federal Employees Health Benefits Program
the government share of premiums is set in statute at 72%
(FEHBP): Available Health Insurance Options and CRS
of the weighted average premium of all plans in the
Report R42741, Laws Affecting the Federal Employees
program, not to exceed 75% of any given plan’s premium.
Health Benefits (FEHB) Program. Also of interest may be
For USPS employees, the USPS contribution to premiums
CRS Report R43194, Health Benefits for Members of
is collectively bargained.
Congress and Designated Congressional Staff.
Plan Details: Blue Cross and Blue Shield
Ada S. Cornell, Information Research Specialist
The most popular insurance carrier in FEHB is Blue Cross
Kirstin B. Blom, Analyst in Health Care Financing
and Blue Shield (BCBS), which offers two FFS health
IF10004
plans: a Standard health plan and a Basic health plan. These

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The Federal Employees Health Benefits (FEHB) Program: 2014 Open Season

Disclaimer
This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to
congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress.
Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has
been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the
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