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MD360.8.2, PER - Federal Employees' Health Benefits (FEHB), Flexible Spending Accounts (FSAFEDS) and FEDVIP Dental and Vision Open SeasonMaryland Bulletin: 360-8-2 Purpose. To notify employees of the Health Benefits Open Season. Expiration Date. December 10, 2007. Explanation. The Federal Employees Health Benefits (FEHB) Open Season is November 12 through December 10, 2007. In addition to FEHB and FSAFEDS enrollment opportunities, FEDVIP Dental and Vision options are also available for government employees. During open season, any eligible employee who is not currently enrolled my enroll, and any eligible enrollee may change from one plan or option to another, from self only to self and family, or make a combination of these changes. In addition, open season allows employees to change their premium conversion election. An eligible employee who enrolls in FEHB automatically participates in premium conversion unless a waiver is filed. An eligible enrollee may elect to begin participation in premium conversion if they have previously waived participation. Your current health plan should have sent you a copy of its brochure and a notice of its 2008 rates prior to open season. Be sure you review the section of the brochure that describes how benefits have changed for 2008. Please check the following websites for information regarding FEHB and FEDVIP plans for detailed information: The Office of Personnel Management (OPM) has provided this link as a starting point for all information regarding the 2008 FEHB enrollment season: www.opm.gov/insure The 2008 Guide to Federal Employees Health Benefits Plans can be found at www.opm.gov/insure/08/guides. A copy of the guide is attached to the electronic version of this bulletin. Enrollment for the Dental and Vision plans offered through FEDVIP is done through the BENEFEDS web-based system located at www.BENEFEDS.com. Please note that enrollment for dental and vision options is only done through this web-site, and does not take place directly with an insurance plan. To enroll for FSAFEDS, Flexible Spending Account, go to https://www.fsafeds.com/fsafeds/index.asp. Types of Plans Available Under the FEHB Program Fee-For-Service (FFS) plans generally use two approaches: Fee-For Service (FFS) Plans (non-PPO) - A traditional type of insurance in which the health plan will either pay the medical provider directly or reimburse you after you have filed an insurance claim for each covered medical expense. When you need medical attention, you visit the doctor or hospital of your choice. This approach may be more expensive for you and require extra paperwork. Fee-For Service (FFS) Plans with a Preferred Provider Organization (PPO) - A FFS option that allows you to see medical providers who reduce their charges to the plan; you pay less money out-of-pocket when you use a PPO provider. When you visit a PPO you usually won't have to file claims or paperwork. However, going to a PPO hospital does not guarantee PPO benefits for all service received within that hospital. For instance, lab work and radiology services from independent practitioners within the hospital may not be covered by the PPO agreement. Most networks are quite wide, but they may not have all the doctors or hospitals you want. Generally, enrolling in a FFS plan does not guarantee that a PPO will be available in your area. PPO's have a stronger presence in some regions than others, and in areas where there are regional PPO's, the non-PPO benefit is the standard benefit. IN "PPO-only" options, you must use PPO providers to get benefits. Health Maintenance Organization (HMO) - a health plan that provides care through a network of physicians and hospitals in particular geographic or service areas. HMOs coordinate the health care service you receive and free you from completing paperwork or being billed for covered services. Your eligibility to enroll in an HMO is determined by where you live, or for some plans, where you work. Some HMOs are affiliated with or have arrangements with HMOs in other service areas for non-emergency care if you travel or are away from home for extended periods. Plans that offer reciprocity discuss it in their brochure. HMOs limit your out-of-pocket costs to the relatively low amounts shown in the benefit brochures. Most HMOs ask you to choose a doctor or medical group to be your primary care physician (PCP). Your PCP provides your general medical care. In many HMOs, you must get authorization or a "referral" from your PCP to see other providers. The referral is a recommendation by your physician for you to be evaluated and/or treated by a different physician or medical professional. The referral ensures that you see the right provider for the care most appropriate to your condition. Care received from a provider not in the plan's network is not covered unless it is emergency care or the plan has a reciprocity agreement. HMO Plans Offering a Point of Service (POS) Product - In an HMO, the POS product lets you use providers who are not part of the HMO network. However, you pay more for using these non-network providers. You usually pay higher deductibles and coinsurances than you pay with a plan provider. You will also need to file a claim for reimbursement, like in a FFS plan. The HMO plan wants you to use its network of providers, but recognizes that sometimes enrollees want to choose their own provider. Some plans are Point of Service (POS) plans and have features similar to both FFS plans and HMOs. Consumer-Driven Plans - Offers a wide range of approaches to give you more incentive to control the cost of either your health benefits or health care. You have greater freedom in spending health care dollars up to a designated amount, and you receive full coverage for in-network preventive care. In return, you pay significantly higher costs after you have used up the designated amount. The catastrophic limit is usually higher than those in other plans. High Deductible Health Plans with HSA or HRA - In a HDHP, the enrollee pays a deductible of at least $1100 (self-only coverage) or $2200 (family coverage). The annual out-of-pocket amount (including deductibles and co-payments) the enrollee pays cannot exceed $5600 (self-only coverage) or $11,200 (family coverage). HDHPs can have first dollar coverage (no deductible) for preventive care and higher out-of-pocket co-payments and coinsurance for services received from non-network providers. HDHPs offered by the FEHB program establish and partially fund HSAs for all eligible enrollees and provide a comparable HRA for enrollees who are ineligible for an HSA. The HSA premium funding or HRA credit amounts vary by plan. If you are considering enrolling or making an enrollment change, please review the 2008 Guide to Federal Employees Health Benefits Plans (FEHB Guide). The FEHB Guide contains a comparison chart that gives general information about each plan. The Guide also shows the biweekly and monthly premium rates, as well as the accreditation status of those plans that took the initiative to see review by the National Committee for Quality Assurance (NCOA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and/or American Accreditation Healthcare Commission (URAC). Do not solely rely on the FEHB Guide when deciding whether to enroll or change enrollment to a specific plan. If you decide you are interested in making an enrollment change after reviewing the FEHB Guide, you should consult the plan's brochure for a complete description of benefits. How to Enroll or Make an Enrollment Change During Open Season Employees who wish to enroll or change their FEHB enrollment should do so using NFCs Employee Personal Page (EPP). If you do not have access to EPP, you may complete a Health Benefits Registration Form, Standard Form 2809. These forms are available at: www.opm.gov/forms/. Forms must be completed and submitted to Human Resources before the close of business on the last day of open season (No later than December 10, 2007.) Employees who wish to change their premium conversion election must complete a FEHB Premium Conversion Waiver/Election Form. You should make desired enrollment changes as early as possible during open season to ensure timely processing. New enrollments, changes to current enrollments, and changes to premium conversion elections made during open season generally will become effective the first day of the first pay period being on or after January 1, 2008. If you change plans, any covered expenses incurred between January 1, 2008 and the effective date of the open season change will count toward the 2007 deductible of the plan you are changing from. Information that you provide by enrolling in the Federal Employees Health Benefits Program may be used for computer matching with Federal, state or local agencies' files to determine whether you qualify for benefits, payments, or eligibility in the Federal Employees Health Benefits Program, Medicare or other Government benefits programs. FEDVIP Dental and Vision Benefits through BENEFEDS The Office of Personnel Management (OPM) has contracted with ten plans (seven dental plans and three vision plans) to provide comprehensive dental or vision services to Federal and USPS employees, annuitants, and survivor annuitants under the new Federal Employees Dental and Vision Insurance Program (FEDVIP). These FEDVIP plans have gone through an extensive evaluation through a competitive bidding process. Enrollment in FEDVIP takes place exclusively through BENEFEDS at www.BENEFEDS.com or by telephone at: 1-877-888-FEDS (1-877-888-3337) or TTY 1-877-889-5680. Enrollment in FEDVIP does NOT take place directly with an insurance plan. FEDVIP coverage will be effective December 31, 2007 for those who enroll during Open Season. FEDVIP coverage is the only government-wide dental or vision program that qualifies for pre-tax deduction of premiums (premium conversion) for employees. Key features of all FEDVIP plans include the following:
There is only one FEDVIP. These are the ten official FEDVIP dental and vision plans: Dental
Vision
Flexible Spending Accounts (FSA) Open Season The Flexible Spending Account (FSA) Program, as known as FSAFeds, lets you set aside tax-free money to pay for health and dependent care expenses. The result can be a discount of 20 to more than 30 percent on services you routinely pay for out-of-pocket. The following website provides information concerning Flexible Spending Accounts: https://www.fsafeds.com/fsafeds/index.asp. You must make an election to enroll in a FSA during the FEHB Open Season. Enroll online anytime during Open Season (November 12 - December 10, 2007) at https://www.fsafeds.com/fsafeds/index.asp or call toll-free at 1-877-FSAFeds (1-877-372-3337) Monday through Friday, from 9 am until 9 pm Eastern Time and an FSAFeds Benefit Counselor will help you enroll. If you are a Federal employee eligible for FEHB - even if you're not enrolled in FEHB - you can choose to participate in either, or both, of the flexible spending accounts (Health Care Flexible Spending Account and Dependent Care Flexible Spending Account). However, if you enroll in a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA), you are not eligible to participate in a HCFSA. If you are not eligible for FEHB, you are not eligible to enroll for a Health Care FSA. However, most employees are eligible to enroll for the Dependent Care FSA. Information pertaining to the Flexible Spending Account Program can be found at: http://www.opm.gov/insure/06/guides/70-01/flexible_account.asp. The Federal Long-Term Care Insurance Program Long term care is help you receive when you need assistance performing activities of daily living such as bathing or dressing yourself. This need can strike anyone at any age and the cost of care can be substantial. The Federal Long Term Care Insurance Program can help protect you from the potentially high cost of long term care. This coverage gives you control over the type of care you receive and where you receive it. It can also help you remain independent so you won't have to worry about being a burden to your loved ones. Long term care insurance is something you must apply for and pass a medical screening (called underwriting) in order to be enrolled. Certain medical conditions will prevent some people from being approved for coverage. By applying while you're in good health, you could also avoid the risk of having a change in health disqualify you from obtaining coverage. Also, the younger you are when you apply, the lower your premiums. The Federal Long Term Care Insurance Program accepts applications from eligible persons at any time. You will have to complete a full underwriting application, which asks a number of questions about your health. However, if you are a new or newly eligible employee, you (and your spouse, if applicable) have a limited opportunity to apply using the abbreviated underwriting application which asks fewer questions. If you marry, your new spouse will also have a limited opportunity to apply using abbreviated underwriting. Qualified relatives are also eligible to apply with full underwriting. Contact. If you have any questions, please call Holly Marken at 443-482-2938. /s/ Mark A. Rose forJON F. HALL |
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