The Federal Employees Health Benefits (FEHB) Program: Open Season for the 2016 Plan Year

The Federal Employees Health Benefits (FEHB) Program: Open Season for the 2016 Plan Year

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Updated January 19, 2016
The Federal Employees Health Benefits (FEHB) Program:
Open Season for the 2016 Plan Year
Overview
participating in FEHB. Each carrier offers one or more
The Federal Employees Health Benefits (FEHB) Program is
plans. In general, FEHB health insurance carriers and their
the largest employer-sponsored health benefits program in
health plans fall into two broad categories: fee-for-service
the United States. FEHB is administered by the Office of
(FFS) plans or health maintenance organizations (HMOs).
Personnel Management (OPM). Participation in FEHB is
FFS plans are generally available nationwide, and HMOs
voluntary, with 85% of federal employees enrolled and
tend to be locally available. Details for all FEHB plans are
90% of federal retirees participating. FEHB provides about
available on OPM’s website at http://www.opm.gov/
$48 billion in health benefits annually.
healthcare-insurance/healthcare/plan-information/.
According to the most recent estimate from OPM for 2015,
As a practical matter, depending on where an enrollee
there are about 4 million policyholders in FEHB, covering
resides, the choices are limited to about 15 different plans.
about 8.2 million people, including federal employees,
Plan choices change each year, as plans enter or leave the
retirees, and their eligible family members. This number
program or change geographic service areas. For 2016, four
includes employees and retirees of the United States Postal
new local health plans entered FEHB and six local plans
Service (USPS). See Figure 1 for a breakdown of FEHB
left FEHB.
policyholders.
The Federal Employees Dental and Vision Insurance
Figure 1. Profile of FEHB Policyholders, 2015
Program (FEDVIP) and the Federal Flexible Spending
Account Program (FSAFEDS) options are also available
during open season. 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 1.6 million enrollees in
dental plans and more than 1.1 million in vision plans.
Active federal employees are eligible for FSAFEDS, which
allows employees to pay for some health care expenses
with pretax dollars. More than 350,000 federal employees
participate in FSAFEDS.
New This Year: The Self Plus One Option
In the past, FEHB has offered two enrollment options: self-
only and self and family. The Bipartisan Budget Act of
2013 (P.L. 113-67) established a third enrollment option,
self plus one, to begin in 2016. The self plus one option
allows the enrollee plus one eligible family member to be

covered. Enrollment in self plus one is not automatic;
Source: Congressional Research Service (CRS) analysis of Office of
enrollees must sign up during open season or during the
Personnel Management (OPM) data.
year through a qualifying life event, such as marriage. For
this year only, outside of open season, OPM has created a
Open Season
one-time Limited Enrollment Period from February 1 to
Individuals have the opportunity to enroll for the first time
February 29, 2016, to allow employees enrolled in self and
or change their existing health insurance plan during the
family extra time to decrease enrollment to self plus one.
annual open season. The open season for the 2016 plan year
ran from November 9, 2015, through December 14, 2015.
FEHB Premiums
Outside of open season, changes are only allowed for
For employees (other than USPS employees) and retirees in
individuals with a qualifying life event, such as marriage.
2016, the weighted average enrollee share of the biweekly
FEHB premium for self, self plus one, and self and family
The 2016 Plan Year: January 1–
is $145.01 and the average government contribution is
December 31, 2016
$336.49, for a total average biweekly premium of $481.50.
Figure 2 compares these figures with previous years.
Plan Options
For 2016, there are 252 plan options. FEHB enrollees
Total premiums for employees (other than USPS
choose a health plan from a health insurance carrier
employees) and retirees will rise by an average of 6.4% in
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The Federal Employees Health Benefits (FEHB) Program: Open Season for the 2016 Plan Year
2016, a greater increase than the 2.8% increase in 2015.
than the Basic plan and a deductible, but it has lower co-
Although premiums increased on average by 6.4%,
pays and greater choice of providers, including coverage for
premiums for any given plan may have increased by more
non-preferred and non-participating providers as well as
or less or declined. However, looking only at premium
preferred providers. The Basic plan has a lower premium
changes may not give a complete picture of year-to-year
and no deductible but higher co-pays, and it only covers
plan changes, as plans may modify benefits or cost-sharing.
preferred providers. Selected plan details for the Standard
For comparisons with other years, see Figure 3.
and Basic BCBS plans are listed in Table 1.
Figure 2. Weighted Average Biweekly FEHB
Table 1. Employee (Non-USPS) and Retiree Premium
Premiums for Employees (Non-USPS) and Retirees,
Contributions and Cost-Sharing , Standard and Basic
2012-2016
BCBS Plans, 2016

BCBS
BCBS
Standard Option
Basic Option
Enrollee
$100.18 (self only)
$68.48 (self only)
share of
$231.31 (self + one)
$160.75 (self + one)
biweekly
$238.24 (self & family)
$164.20 (self & family)
premium
Calendar year $350 per person;
None
deductible
$700 per family
Physician
Primary Care: $25
Primary Care: $30
outpatient
Specialist Care: $35
Specialist Care: $40
care
(deductible does not
copayment
apply)
for preferred

providers
Source: OPM.
Hospital Care Inpatient: $350 per
Inpatient: $175 per
Figure 3. Average FEHB Premium Increase per Year,
for preferred admission (deductible
day up to $875 per
2012-2016
providers
does not apply)
admission
Outpatient: 15% of
Outpatient: $100 per
the Plan allowancea
day per facility
(deductible applies)
Out of
$5,000 for Self Only
$5,500 for Self Only
Pocket
$10,000 for Self +
$11,000 for Self +
Maximum for
One and Self & Family
One and Self & Family
preferred
providers
Source: Blue Cross Blue Shield (BCBS) Benefit Plan, 2016,
https://www.opm.gov/healthcare-insurance/healthcare/plan-
information/plan-codes/2016/brochures/71-005.pdf.
a. The “Plan allowance” is the amount BCBS uses to determine

their payment and the enrollee’s cost-share for covered
Source: CRS analysis of OPM data, except for the 2016 increase,
services.
which was announced in the OPM press release, “Open Season for
Federal Health Benefits, Dental and Vision,” September 29, 2015.
More Information
For more information about FEHB, see CRS Report
For employees (other than USPS employees) and retirees,
R43922, Federal Employees Health Benefits (FEHB)
the government share of premiums is set in statute at 72%
Program: An Overview, and CRS Report R42741, Laws
of the weighted average premium of all plans in the
Affecting the Federal Employees Health Benefits (FEHB)
program, not to exceed 75% of any given plan’s premium.
Program. Also of interest may be CRS Report R43194,
For USPS employees, the USPS contribution to premiums
Health Benefits for Members of Congress and Designated
is collectively bargained.
Congressional Staff.
Plan Details: Blue Cross and Blue Shield
Ada S. Cornell, Senior Research Librarian
The most popular insurance carrier in FEHB is Blue Cross
Namrata K. Uberoi, Analyst in Health Care Financing
and Blue Shield (BCBS), which offers two FFS health
plans: a Standard health plan and a Basic health plan. These
IF10324
plans have the highest level of FEHB enrollment, with a
total of more than 2.5 million (more than half) of FEHB
policyholders. The Standard plan has a higher premium

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The Federal Employees Health Benefits (FEHB) Program: Open Season for the 2016 Plan Year

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