OPM renegotiates out-of-network health benefits

The Office of Personnel Management announced on Friday that it is working with insurance carriers in the Federal Employee Health Benefits Program to reevaluate certain out-of-network benefits for nonemergency surgeries, a move that will extend enrollment until the end of January for federal employees who wish to change their plans.

OPM on Friday asked the 269 insurance carriers in FEHBP to propose changes to their out-of-network surgery benefits by Dec. 8, the official close of federal benefits open season. The move was fueled by concerns over a change in coverage in the Blue Cross Blue Shield Standard Option -- the most popular federal employee plan -- that would have substantially increased the fees in 2009 paid by federal employees who have surgeries performed by out-of-network doctors.

The issue was the subject of a Dec. 3 hearing before the House Oversight and Government Reform Federal Workforce subcommittee, at which lawmakers urged OPM to renegotiate the Blue Cross benefit and extend open season to federal employees who were unaware of the plan change.

The 2009 benefit change, affecting more than 4 million current Blue Cross Standard enrollees, would have required enrollees to pay a deductible of up to $7,500 for each procedure or surgery performed by a nonparticipating physician. Previously, enrollees paid 25 percent of the plan allowance for an out-of-network procedure, plus any difference between the allowance and the billed amount.

OPM noted Friday that it originally negotiated the change with Blue Cross to address situations where enrollees could be billed tens of thousands of dollars for nonemergency surgeries performed by out-of-network providers, a practice known as balanced billing.

The agency said it will work with insurance carriers, including Blue Cross Blue Shield, to take a second look at how to address out-of-network benefits for 2009. OPM will not allow carriers to change premiums or other types of benefits for 2009.

In the meantime, federal employees who want to switch carriers must go to their individual personnel office, complete an enrollment request form and note the belated change to their enrollment by the end of next month.

"When Chairman Danny Davis [D-Ill.] flew here to hold a hearing on the huge $7,500 per surgery increase, the subcommittee signaled that transparency, not hidden costs, was expected from both OPM and Blue Cross Blue Shield," said Del. Eleanor Holmes Norton, D-D.C. "Although OPM appeared reluctant to embrace the obvious remedy of an extension of the open season for subscribers, I applaud Associate Director Nancy Kichak for apparently being willing to agree to an extension and a review of the underlying issue of extra costs to subscribers."

Colleen Kelley, president of the National Treasury Employees Union, said on Friday that she also was pleased that employees would have extra time to select a health plan.

"There have been some confusing changes this year and it is hard for federal employees and their families to absorb these complex changes," she said. "It is important that members and retirees will have the opportunity to take more time to study the changes in the plan. I also urge federal employees to look carefully at the various brochures on their health insurance plans posted to OPM's Web site."