Examining Surgery Benefit For Federal Employees Health Benefit Plan

Ruzanna Harutyunyan's picture

Blue Cross Blue Shield Association, the U.S.' largest provider of coverage for federal employees, has said it is willing to reconsider a surgery benefit with which surgeons and patients are unhappy, but federal officials have said they will not allow it, the Washington Post reports (Davidson, Washington Post, 12/4). Beginning Jan. 1, federal workers under BCBS' Standard Option will be required to pay up to $7,500 for nonemergency surgical procedures if beneficiaries use an out-of-network physician, Roll Call reports. After $7,500, BCBS will cover 100% of the remaining cost (Yehle, Roll Call, 12/3).

The Standard Option, which has four million enrollees, is the federal government's most popular coverage option (Reichard, CQ HealthBeat, 12/3). The fee had been 25% of BCBS' cost, plus an additional fee based on the difference between BCBS' price and the actual charge. Some physicians and enrollees have said the new fee effectively changes the Standard Option, a preferred provider plan, into an HMO plan because of the restrictive cost of going to an out-of-network provider (Roll Call, 12/3).

On Wednesday at a House Subcommittee on the Federal Workforce, Postal Service and the District of Columbia hearing, Stephen Gammarino, a senior vice president of the Blue Cross Blue Shield Association, said that BCBS is re-examining the surgery policy.


However, Nancy Kichak, an associate director at the Office of Personnel Management, testified that the agency is against a possible change. Kichak also said that "it would be unfair to reopen negotiations with a single plan" and not do so with other plans that offer coverage to federal employees. BCBS is not permitted to change the plan without the approval of OPM, according to the Post (Davidson, Washington Post, 12/4).

Extending the Deadline

Although open enrollment for federal employees extends until Monday, many only recently learned of the change, leaving them little time to switch. According to Roll Call, many lawmakers during the hearing were pushing OPM to extend open enrollment to allow federal employees more time to decide on a plan (Roll Call, 12/3). However, Kichak said she is hesitant to extend the open enrollment period (Washington Post, 12/4). She said that allowing federal employees another one to two weeks to decide on a new plan would not allow them enough time to get their membership cards by Jan. 1, 2009, which could mean some enrollees would not have proof of membership in an emergency.

Rep. Danny Davis (D-Ill.) during the hearing said that he wants OPM to take a "hard look" at its stance on extending open enrollment (CQ HealthBeat, 12/3). He later issued a news release calling for an extension, according to the Post (Washington Post, 12/4). CQ HealthBeat reports that "with most lawmakers out of town at least until next week, Congress is in no position to intervene if OPM refuses to budge before the open enrollment period closes" (CQ HealthBeat, 12/3).

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