Healthy Choices

As participants in the Federal Employees Health Benefits Program brace for the biggest premium hikes since 2005, many will be weighing their out-of-pocket costs. Come Nov. 10, when open season begins, employees will have 269 plans to choose from. But before deciding whether to switch or stay put, be sure to consider benefit changes.

In late September, the Office of Personnel Management announced that premiums for FEHB will increase an average of 7 percent in 2009. The government's portion of the overall premium will rise 6.5 percent, while the increase for employees will average 7.9 percent.

The premium hike is significantly higher than the previous year's average of 2.1 percent, but lower than increases for most large health care programs in the private sector.

"There are definitely choices," said Nancy Kichak, associate director for strategic human resources policy at OPM. "It's definitely important, as we say every year, for employees to shop around and get the coverage that is most important to the them and best meets their needs." Open season runs from Nov. 10 to Dec. 8.

Most plans will retain their benefits, but co-pays for office visits and prescriptions will go up. For example, Blue Cross Blue Shield standard, the most popular federal plan, will increase office visit co-pays from $15 to $20.

Blue Cross' changes in prescription co-pays encourage federal employees to use generic medications. For example, out-of-pocket rates for brand-name drugs purchased from retail outlets will increase from 25 percent to 30 percent.

But for members who opt for generic drugs, the plan will waive the first four mail-order co-pays. After that the cost will be $10, the same as in 2008. Blue Cross participants will save 5 percent on co-pays for generic drugs purchased from retail outlets.

Co-pays for 90-day supplies of mail-order brand-name drugs will increase sharply under Blue Cross Blue Shield, from $35 to $65 for the first 30 prescriptions. After that, co-pays will decrease to $50 for a 90-day supply. "We are fully aware of people who need more drugs than average, and we're trying to afford them a little extra protection," Kichak said.

Additions to the plan's standard and basic options include an online fitness tracking program, an interactive health assessment tool and a directory of participating providers, all of which can be found on the plan's Web site.

"This year's new online tools … will enable all members -- singles, families and retirees -- to better customize their health care profile to suit their needs, regardless of which plan they choose," said Jena Estes, vice president of the Blue Cross Blue Shield federal program.

Premiums for the plan's standard and basic options will be among the steepest hikes in 2009. The employee share for the standard option will increase by 12.9 percent for singles, to $70.17 biweekly, and family coverage will rise 13.4 percent, to $164.58 biweekly. The basic option for singles will increase by 9 percent, to $42.66, and family coverage will increase by 9 percent, to $99.91 biweekly.

Nearly 60 percent of FEHB participants are in Blue Cross Blue Shield; 50 percent are in the carrier's standard plan, with 10 percent enrolled in the basic plan.

Premiums for the Government Employees Health Association, another popular FEHB carrier, will set minimal increases next year. The employee share of premiums for the standard option will increase 99 cents for singles, to $34.27 biweekly, while family coverage will rise $2.27, to $77.89 biweekly. Single coverage in GEHA's high option is up just a few pennies, to $43.94 biweekly, and family coverage will actually decrease in 2009, to $100.36 biweekly.

GEHA's plans offer full coverage on in-network preventive care, such as colonoscopies, mammograms and immunizations, with no deductible. Benefits also include vision coverage, discounts on gym memberships, workout equipment and NutriSystem meal plans, and access to professional health coaches.

Twenty-seven carriers, including GEHA, will offer high-deductible health plans next year. The plans include health savings accounts and feature lower monthly premiums than traditional options, in exchange for higher annual deductibles.

Ten fee-for-service carriers, including Blue Cross Blue Shield, and some health maintenance organizations will expand hearing benefits for adults in 2009. Most plans will offer up to a set dollar limit, such as $1,000 per hearing aid per year. Some carriers added hearing benefits for children up to age 22 in 2008.

"Federal employees will know … when they go to the doctor, they will be able to receive with assurance the benefits described in the brochure," Kichak said. "Our plans are financially solvent, and we work very hard to keep them that way."