Health Care Complications

It's no secret that health insurance plans are complex. Each has fine print on important details such as in-network versus out-of-network benefits, co-pays, deductibles and coverage levels for specialty drugs. And when that fine print is multiplied 269 times across the plans in the Federal Employees Health Benefits Program, the amount of information is hard to fathom.

That's why it's also no surprise that insurers occasionally make changes that catch participants -- or even the Office of Personnel Management, which administers FEHBP - off guard.

For example, an April Government Executive report revealed that 87,000 federal employees were enrolled in health plans that required them to pay more for certain types of specialty drugs than they would under standard co-payments systems. At the time, OPM didn't seem quite sure what to do. Lorraine Dettman, assistant director for insurance services programs at the agency, said she thought the rising costs of those drugs was difficult for insurers and providers to bear.

In a more recent case, a change to the Blue Cross Blue Shield Standard Option would have required participants to pony up $7,500 in co-pays per surgical procedure performed by an out-of-network doctor. The 2009 cost hike would have had broad implications for the 4 million people enrolled in the plan.

OPM took steps to mitigate the damage in both instances.

By the beginning of open season on Nov. 10, OPM officials had negotiated to protect employees from unexpectedly high specialty drug prices. Agency officials later decided to extend open season to allow time to re-examine the Blue Cross Blue Shield issue.

Given the flood of panicked comments on Government Executive stories and blog posts about the cost hikes for out-of-network surgery, OPM's decision was the right one. Federal employees want more time to review their health care options and sort through the thicket of information to decide whether or not to switch plans.

But, this one-time solution doesn't mitigate the constant need to make the details of FEHBP plans clearer and more accessible, so new features don't take enrollees by surprise. When it comes to benefits, there's no such thing as too clear.

Cost-of-Living Changes

In other news, OPM has proposed decreasing cost-of-living allowances in the Pacific and certain parts of Alaska by 1 percentage point, and is accepting comments on the proposal until Feb. 9, 2009. The agency also has published the results of a cost-of-living survey in Hawaii, Guam and Washington conducted in 2007.