Special health coverage extended to ‘underserved’ federal workers

Federal employees and retirees in 14 states qualify for special treatment under the Federal Employees Health Benefits Program, the Office of Personnel Management announced Wednesday.

OPM released its annual list of states that qualify as "medically underserved" areas under the FEHBP. The designation gives FEHBP members who live in the states more flexibility in choosing medical providers.

For calendar year 2002, the underserved states are: Alabama, Georgia, Idaho, Kentucky, Mississippi, Missouri, Montana, New Mexico, North Dakota, South Carolina, South Dakota, Texas, Utah and Wyoming. More than 500,000 federal employees work in those states, according to 1998 OPM statistics.

Georgia, Montana, North Dakota and Texas are new to the list. Louisiana was removed from the list.

To be a medically underserved area, 25 percent or more of the population must live in a "medical care manpower shortage area" as designated by the Department of Health and Human Services. "The law requires non-HMO FEHB plans to reimburse beneficiaries, subject to their contract terms, for covered services obtained from any licensed provider in these states," OPM's announcement said.

If, under the terms of an FEHBP plan, the carrier will only pay for a particular medical service if it is performed by a certain category of practitioner, then the plan must pay for the same service performed by any other licensed practitioner if the member lives in a medically underserved state.

For example, if your health plan says that sprained ankles must be treated by licensed physical therapists, but you live in Utah, a licensed family practitioner could provide the treatment and your plan would still have to cover the cost.

OPM pointed out that the designation applies to entire states, not just counties. The announcement was published in the Sept. 26 Federal Register.