The Benefits of Federal Employee Health ( FEHB ) Program is a "managed competition" system through which employee healthcare benefits are provided to civil government employees and government annuitants United States of America. The Government accounts for 72% of the weighted average premiums of all packages, not exceeding 75% of the premium for one package (calculated separately for individual and family coverage).
The FEHB program allows several insurance companies, employee associations, and unions to market health insurance plans to government employees. This program is managed by the United States Office of Personnel Management (OPM).
Video Federal Employees Health Benefits Program
History
The program was created in 1960. The sponsorship of health insurance companies in the United States became prevalent during World War II, as one of the few ways in which employers can escape from wage restrictions and restrictions on price control on employee wages. The government initially proposed a system that would revolve around a predominantly government-directed plan, but unions and employee associations, who had sponsored their own plans, protested. By reflecting the political pressures created, Congress modified the proposals of the Executive Branch and all existing "in-grandfather" plans into the program. Thus, through what is essentially a historical accident and political compromise, the competitive system between the consumer-driven health plans has been created.
Maps Federal Employees Health Benefits Program
Packages
The choice between the health plan is available to employees during the "open enrollment" or "open season" period, after which the employee will be fully covered in whatever plan he chooses without limitation on pre-existing conditions. After annual enrollment, changes may only be made to "eligible life events" such as marriage, divorce, adoption or childbirth, or changes in employment status of a spouse, until the subsequent annual open season, where employees may register, remove or change from one plan to another plan. The exact dates of the open season change from year to year, but usually from Monday's second full week in November to Monday, the second full week of December. Registration begins at or near the beginning of the calendar year, and lasts until a different plan choice is made in the next open season or through an eligible life event. In practice, there is a lot of inertia in registration, and only about 5 percent of employees are changing plans in most of the open season.
Premiums vary from plan to plan and are paid in part by the employer (the US government agency that the employee is working for or, for annuitants, OPM) and the remainder by employees. The employer pays an amount of up to 72 percent of the average plan premium for an independent or family coverage (not exceeding 75 percent of the premium for the selected package), and the employee pays the rest. This dollar amount is recalculated annually as health care costs and plan premiums increase. Certain employees (such as postal workers) have a higher portion of their premiums paid as a result of collective bargaining agreements. The exact percentage of average paid by employers is relatively unimportant for the design of this program and has changed over time to be more generous. What matters is that this is a "closed premium" design, in which all marginal costs join a plan with a premium near, at, or above the average of all plans covered by enrollee. In other words, the registrant pays all their costly option fees, but reap the rewards if they make the saving option. This creates constant pressure on the plan, because to attract registries, they must keep costs down, while balancing these incentives on offering benefits and customer service, to achieve a position that will maximize their earnings and registrations profits. The feature of the program is arguably its greatest strength and the main reason that an expert sums it up has "outperformed Medicare every way - in keeping costs both for consumers and government, in product benefits and innovation and modernization, and in consumer satisfaction," decades after decade.
In 2010 about 250 plans participated in this program. Approximately 20 plans nationally or almost nationally, such as those offered by some unions such as the National Association of Letter Carriers, by some employee associations, and by national insurance companies such as Aetna and Blue Cross and Blue Shield Association on behalf of its member companies. There are about 230 plans available locally, almost all HMOs. The FEHB program is open to most federal employees. For example, in 2014 members of the United States Congress and their staff are excluded from FEHB and are required to purchase health insurance through health care exchanges due to the Affordable Care Act. However, the federal government makes a premium contribution to the purchase of this health insurance. The FEHBP fee is approximately $ 40 billion in 2010, including premium and out-of-pocket costs. It enrolls about four million employees and annuitants and, with their dependents, a total of eight million people. While registrations are about one fifth of Medicare's largest health insurance program, it spends less than a tenth since most registrants are under 65 and costs far fewer than the average Medicare parent and disabled.
The FEHB program relies on consumer choice among competing private plans to determine costs, premiums, benefits, and services. This model is in stark contrast to that used by the original Medicare. In Medicare, the premiums, benefits, and payment rates are all centrally determined by law or regulation (no bargaining and no dependence on volume discounts in the original Medicare; this parameter is fixed by fiat). Some people criticize the FEHB model because both monopsonist and federal government purchasing power are used to control costs. This controversy is similar to that surrounding the law for Medicare Prescription Drug Coverage passed during the George W. Bush administration. However, over time, the FEHB program has outperformed the original Medicare not only in cost control, but also in increased benefits, enrollee services, fraud prevention, and expenditure avoidance and the "barrel of pig" alert. (Medicare Part D also controls costs much better than originally estimated through a competitive consumer choice plan system similar to the model after the FEHB program.)
One of the most prominent features of the FEHB program is the possible option. There are three broad types of plans: fee-for-service and preferred provider organization (PPO), usually offered in combination; HMO; and high deductible health plans and other consumer-driven plans. In Washington, D.C., a metropolitan area, plans are open to all federal and annuitant employees including 10 cost-for-services and PPO plans, seven HMOs, and eight plans that are subtracted and controlled by consumers. A number of similar options are offered in almost all major metropolitan areas, and in many small towns and rural areas. The program is sometimes criticized for offering these options, but there are many ways applicants can get advice and help, including advice from colleagues and friends, newspaper articles and magazines in both public and private media that specialize in federal or pensioners, OPM publications and websites, and some online tools that compare cost, benefits, and service plans. As a consumer friendly service, OPM requires all plans to publish brochures that explain the benefits in plain English and in standard formats that facilitate comparison of plans and which can be easily downloaded in PDF format. Almost all plans provide Web sites that provide detailed information not only on the merits, but also on their provider panel and drug formulary. There is no published evidence that either in the FEHB program or in two other federal programs offering various plan options, Medicare Advantage and the Medicare Prescription Drug program, consumer confusion is a serious problem, or that health insurance options are more complicated to deal with than other consumer choices among complex products or services, such as options for purchase or car service, choice among physicians, or choice among life insurance and other insurance products. One study found that in all Medicare recipients, the elderly and educated were much lower than the general population, but were able to substantially reduce their drug costs by choosing, albeit imperfectly, the Medicare prescription drug plan that reduced the cost of the drug from what would be much more expensive. A recent evaluation of the FEHB program found that the Open Season movement reduced the average premium by about 1 percent compared to previous registration patterns, despite the tendency of registrants to remain in the current plan without considering alternative options.
In the FEHB program, the federal government sets minimum standards that, if met by insurance companies, enable it to participate in the program. The result is many competing insurance plans that are available to federal employees. Local plans have ready access to participate in the program, but the underlying legislation prohibits the entry of new national plans. Because OPM requires a plan to offer prices closer to the healthcare cost of the registrant, and to offer comprehensive benefits, there is a broad commonality in the plan's offerings. However, the total premium may vary substantially, and by 2010 the lowest cost option has a premium cost of only about $ 2,800 and the highest cost plan option for self-registration is around $ 7,200. As an example of benefit variations, a limit of about $ 5,000 per year on potential out-of-pocket costs for self-registration is found only in a number of plans, but in some plans the cap may reach $ 15,000 or more (HMOs usually have no limit, but exposure control potential costs by using payment).
The underlying regulations for the FEHB program are minimal and very stable, especially when compared to Medicare. The FEHB Act is only a few dozen pages, and only a few paragraphs are devoted to the structure and function of the program. The rules are minimal; only a few dozen more pages. In contrast, the Medicare legislation found in the 18th title of the Social Security Act is about 400 pages and the accompanying rules spend thousands of pages in US Federal Regulations.
The FEHB program has often been proposed as a model for national health insurance and sometimes as a program that can directly register uninsured patients. This proposal began in the first decade and has continued since then. The renowned economist Alain Enthoven explicitly built a proposal for a "managed competition" system as a national health reform a few decades ago, and has continued to promote the idea ever since. This proposal version was recently adopted by the Netherlands. In the 2004 presidential campaign, Senator John Kerry proposed opening the enrollment in this plan for all Americans. In enacting the Medicare Modernization Act in 2003, Congress explicitly exemplified the reformed Medicare Advantage program and the new Medicare Part D Drug Prescription program after the FEHB program. One of the prominent proposals for health reform in the United States, the proposed bipartisan Wyden-Bennett Act is largely modeled after the FEHB program, such as the recent "Alternative Republican" proposal by Representative Paul Ryan.
See also
- Health insurance in the United States
Note
References
External links
- Insurance programs offered by the Office of Personnel Management, including health, dental, vision, life, flexible account expenses, and long-term care
- The official website of the FEHB program
Source of the article : Wikipedia
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