Updated January 19, 2016
The Federal Employees Health Benefits (FEHB) Program:
Open Season for the 2016 Plan Year
Overview
The Federal Employees Health Benefits (FEHB) Program is
the largest employer-sponsored health benefits program in
the United States. FEHB is administered by the Office of
Personnel Management (OPM). Participation in FEHB is
voluntary, with 85% of federal employees enrolled and
90% of federal retirees participating. FEHB provides about
$48 billion in health benefits annually.
According to the most recent estimate from OPM for 2015,
there are about 4 million policyholders in FEHB, covering
about 8.2 million people, including federal employees,
retirees, and their eligible family members. This number
includes employees and retirees of the United States Postal
Service (USPS). See Figure 1 for a breakdown of FEHB
policyholders.
Figure 1. Profile of FEHB Policyholders, 2015
Source: Congressional Research Service (CRS) analysis of Office of
Personnel Management (OPM) data.
Open Season
Individuals have the opportunity to enroll for the first time
or change their existing health insurance plan during the
annual open season. The open season for the 2016 plan year
ran from November 9, 2015, through December 14, 2015.
Outside of open season, changes are only allowed for
individuals with a qualifying life event, such as marriage.
The 2016 Plan Year: January 1–
December 31, 2016
Plan Options
For 2016, there are 252 plan options. FEHB enrollees
choose a health plan from a health insurance carrier
participating in FEHB. Each carrier offers one or more
plans. In general, FEHB health insurance carriers and their
health plans fall into two broad categories: fee-for-service
(FFS) plans or health maintenance organizations (HMOs).
FFS plans are generally available nationwide, and HMOs
tend to be locally available. Details for all FEHB plans are
available on OPM’s website at http://www.opm.gov/
healthcare-insurance/healthcare/plan-information/.
As a practical matter, depending on where an enrollee
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 2016, four
new local health plans entered FEHB and six local plans
left FEHB.
The Federal Employees Dental and Vision Insurance
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: selfonly 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;
enrollees must sign up during open season or during the
year through a qualifying life event, such as marriage. For
this year only, outside of open season, OPM has created a
one-time Limited Enrollment Period from February 1 to
February 29, 2016, to allow employees enrolled in self and
family extra time to decrease enrollment to self plus one.
FEHB Premiums
For employees (other than USPS employees) and retirees in
2016, the weighted average enrollee share of the biweekly
FEHB premium for self, self plus one, and self and family
is $145.01 and the average government contribution is
$336.49, for a total average biweekly premium of $481.50.
Figure 2 compares these figures with previous years.
Total premiums for employees (other than USPS
employees) and retirees will rise by an average of 6.4% in
https://crsreports.congress.gov
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.
Although premiums increased on average by 6.4%,
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
plan changes, as plans may modify benefits or cost-sharing.
For comparisons with other years, see Figure 3.
than the Basic plan and a deductible, but it has lower copays and greater choice of providers, including coverage for
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.
Figure 2. Weighted Average Biweekly FEHB
Premiums for Employees (Non-USPS) and Retirees,
2012-2016
Table 1. Employee (Non-USPS) and Retiree Premium
Contributions and Cost-Sharing , Standard and Basic
BCBS Plans, 2016
Source: OPM.
Figure 3. Average FEHB Premium Increase per Year,
2012-2016
Enrollee
share of
biweekly
premium
Calendar year
deductible
Physician
outpatient
care
copayment
for preferred
providers
Hospital Care
for preferred
providers
Out of
Pocket
Maximum for
preferred
providers
Source: CRS analysis of OPM data, except for the 2016 increase,
which was announced in the OPM press release, “Open Season for
Federal Health Benefits, Dental and Vision,” September 29, 2015.
For employees (other than USPS employees) and retirees,
the government share of premiums is set in statute at 72%
of the weighted average premium of all plans in the
program, not to exceed 75% of any given plan’s premium.
For USPS employees, the USPS contribution to premiums
is collectively bargained.
Plan Details: Blue Cross and Blue Shield
The most popular insurance carrier in FEHB is Blue Cross
and Blue Shield (BCBS), which offers two FFS health
plans: a Standard health plan and a Basic health plan. These
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
BCBS
Standard Option
BCBS
Basic Option
$100.18 (self only)
$231.31 (self + one)
$238.24 (self & family)
$68.48 (self only)
$160.75 (self + one)
$164.20 (self & family)
$350 per person;
$700 per family
Primary Care: $25
Specialist Care: $35
(deductible does not
apply)
None
Inpatient: $350 per
admission (deductible
does not apply)
Outpatient: 15% of
the Plan allowancea
(deductible applies)
$5,000 for Self Only
$10,000 for Self +
One and Self & Family
Inpatient: $175 per
day up to $875 per
admission
Outpatient: $100 per
day per facility
Primary Care: $30
Specialist Care: $40
$5,500 for Self Only
$11,000 for Self +
One and Self & Family
Source: Blue Cross Blue Shield (BCBS) Benefit Plan, 2016,
https://www.opm.gov/healthcare-insurance/healthcare/planinformation/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
services.
More Information
For more information about FEHB, see CRS Report
R43922, Federal Employees Health Benefits (FEHB)
Program: An Overview, and CRS Report R42741, Laws
Affecting the Federal Employees Health Benefits (FEHB)
Program. Also of interest may be CRS Report R43194,
Health Benefits for Members of Congress and Designated
Congressional Staff.
Ada S. Cornell, Senior Research Librarian
Namrata K. Uberoi, Analyst in Health Care Financing
https://crsreports.congress.gov
IF10324
The Federal Employees Health Benefits (FEHB) Program: Open Season for the 2016 Plan Year
Disclaimer
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