OPM Extends Open Season For Insurers

Ruzanna Harutyunyan's picture

The Office of Personnel Management on Friday announced that it will extend the open enrollment period for federal employees and has asked all 269 insurers who participate in the Federal Employees Health Benefits Program to submit new fee schedules for out-of-network surgeries, the Washington Post reports (Davidson, Washington Post, 12/6).

Last week at a House Oversight and Government Reform Subcommittee on the Federal Workforce, Postal Service and the District of Columbia hearing, an official from the BlueCross BlueShield Association said it was willing to reconsider a surgery benefit with which surgeons and patients are unhappy. Beginning Jan. 1, 2009, federal workers under BCBS' Standard Option -- the federal government's most popular coverage option, with four million enrollees -- would have been required to pay up to $7,500 for nonemergency surgical procedures if beneficiaries use an out-of-network physician. After $7,500, BCBS would have covered 100% of the remaining cost.

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 said the new fee effectively changed the Standard Option, a preferred provider plan, into an HMO plan because of the restrictive cost of going to an out-of-network provider.


However, Nancy Kichak, an associate director at OPM, testified that the agency was against the 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 would not have been permitted to change the plan without the approval of OPM (Kaiser Daily Health Policy Report, 12/5).

In a letter to participating insurers, OPM wrote, "Based on a review of benefit changes for services performed by out-of-network providers and concerns raised by enrollees and stakeholders, OPM has determined that some represent and undue burden for plan members. Therefore, OPM is requesting all carriers with out-of-network benefits to re-evaluate their benefits for nonparticipating providers." According to the Post, OPM asked insurance providers to present new fee schedules for out-of-network surgeries by Monday, the previous deadline for open enrollment. The agency extended the new open enrollment deadline to the end of January 2009 (Washington Post, 12/6). An OPM news release stated it will not allow changes to premiums or other types of benefits in 2009, but the agency in a statement said that it will accept "belated enrollments" (CQ HealthBeat, 12/5).

Committee Chair Danny Davis (D-Ill.), who "had made his displeasure with OPM clear" at the hearing, praised the new decision, according to the Post. "OPM is doing the right thing. I am delighted that OPM will be working with BCBS, and the other Federal Employees Health Benefits carriers, to take a second look at how to address the payment of surgical claims billed by nonparticipating providers," he said (Washington Post, 12/6).

Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign up for email delivery at kaisernetwork.org/email . The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. © 2007 Advisory Board Company and Kaiser Family Foundation. All rights reserved.