Your Health Insurance

How the FEHB Program Works

The FEHB Program offers three primary types of health care plans:

• Fee-for-service plans;
• High Deductible Health Plans; and
• Health Maintenance Organization (HMO) plans.

This section provides highlights of the three types of plans. For more detailed information about each of the plans in the FEHB Program, contact a Benefits Counselor.

  Fee-for-Service Plans

Traditional fee-for-service plans

Fee-for-service plans reimburse you or your health care provider for covered services. If you enroll in one of these plans, you may go to any physician, hospital, and other health care providers for care. However, these plans also offer a Preferred Provider network. If you choose to see a provider within the network for your care, the Plan covers a higher percentage of eligible expenses and your out-of-pocket costs are lower.

Traditional fee-for-service plans include:

• The Service Benefit Plan, administered by Blue Cross and Blue Shield; and
• Plans sponsored by unions and employee organizations.

Some employee organization plans are open to all federal employees who hold full or associate memberships in the organizations that sponsor the plans. Other employee organization plans are restricted to employees in certain occupational groups and/or agencies. Generally, the employee organizations require you to pay a membership fee or dues in addition to your health plan premium. (Such membership charges are paid directly to the employee organizations and are not part of the FEHB Program.)

Consumer-driven plans

This is a fee-for-service option that offers participants greater control over how to spend their healthcare dollars. Participants receive funds in a Personal Care Account depending upon which level of coverage is chosen, single or family. The participant then decides which healthcare expenses will be reimbursed from the funds in the Personal Care Account. Unused funds in the account will be rolled over to use the following year. However, if the participant spends all the funds in the account prior to year-end, then the participant must satisy a deductible and pay coinsurance before additional benefits are paid under the traditional health plan. Note: this plan is not related to the Board's Flexible Spending Acount Plan.

Consumer-driven plans include:

• APWU
• Aetna Healthfund.

   High Deductible Health Plans  

About HDHPs

The HDHP features higher annual deductibles (a minimum of $1,000 for Self and $2,000 for Self and Family) and greater out of pocket expenses than other traditional health plans. The maximum out-of-pocket limits for HDHPs participating in the FEHB Program 2005 are $5,000 for Self and $10,000 for Self and Family. Depending on which HDHP you choose, you may utilize both in-network and out-of-network providers. Using in-network providers will lower your out of pocket expenses. With the exception of preventive care, you must meet the annual deductible before the plan pays benefits. Preventive care services are generally paid as first dollar coverage or after a small deductible or copayment.

When you enroll in a HDHP, the health plan determines if you are eligible for a Health Savings Account (HSA) or a Health Reimbursement Arrangement (HRA). Each month, the plan automatically credits a portion of the health premium into your HSA or HRA. You can pay your deductible with funds from your HSA or HRA. If you have an HSA, you can also choose to pay your deductible and out-of-pocket expenses without using your HSA funds thus, allowing your savings account to grow.

Health Savings Accounts

HSAs can only be established by an "eligible participant". An eligible participant is any person who satisfies all four of the following conditions:

• anyone who participates in a high deductible health plan (HDHP)
• anyone not covered by another health plan
• anyone not enrolled in Medicare
• anyone not claimed as a dependent on someone else's tax return

Ineligible participants are those that:

• Receiving Medicare benefits
• Covered under Tricare
• Participants in the healthcare portion of the Flexible Spending Account (FSA)
• Participants in Health Reimbursement Account (HRA)

If you select a HDHP and you are not eligible for an HSA, you will be given an HRA. The health plan will credit a portion of the health plan premium to your account. The amount for either a Self Only enrollment or a Self and Family enrollment is the same as the amounts that would be deposited in to all HSA in the same plan. You can use funds in your account to help pay your health plan deductible and/or qualified medical expenses that do not count toward the deductible. You also can use the account to pay medicare part B premiums.

Health Reimbursement Arrangements

Features of an HRA include:

• Tax-free withdrawals for qualified medical expenses
• Carryover of unused credits, without limit, from year to year
• Credits in an HRA do not earn interest
• Credits in an HRA are forfeited if you switch health plans, or if you leave federal employment other than to retire
• Your HRA is administered by the health plan

High-deductible plans include:

• Aetna
• GEHA.

   HMO Plans  

Health Maintenance Organizations (HMOs) provide health care through designated plan physicians, hospitals, and other providers in particular locations. If you enroll in an HMO, you must use the providers and facilities that participate in the HMO network for your care to be covered. Reimbursements are made directly to the provider or facility.

Each HMO is open to all federal employees who live within the plan's enrollment area. It is very important that you make sure you live in the plan's enrollment area before you enroll in one of these plans. The enrollment area is described in each plan's brochure, which is available from a Benefits Counselor. Contact the HMO directly if you have any questions.

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