Health reform alters FEHBP plan coverage

Before changing health insurance plans this open season, federal employees should know how new reform provisions affect their benefits.

The Office of Personnel Management this fall released regulations detailing the effects of the Affordable Care Act President Obama signed in March on the Federal Employees Health Benefits Program. OPM Director John Berry last month attributed the 7.2 percent increase in employee premiums in part to expanded benefits in 2011, including those required under health reform.

"They are marginal changes for most people, but for the people whom they affect, they matter," said Walton Francis, author of the Consumers' Checkbook 2011 Guide to Health Plans for Federal Employees.

One key change allows children to stay on their parents' health plans until age 26. Previously, coverage expired at age 22 for dependents, except for those unable to support themselves due to a mental or physical disability. According to OPM, adult children will receive benefits regardless of dependency, residency, current coverage, or student status.

Plans now broadly cover kids up to age 26, including married children (but not their spouses or dependents); stepchildren and foster children; those who are eligible for or currently have their own employer-provided health insurance; and children incapable of self-support.

FEHBP participants must be enrolled in a self-and-family plan to extend coverage to eligible children. Those who have elected self-and-family enrollment must contact their plan provider to supply information on the children to be covered. Those in self-only plans and anyone not currently enrolled in FEHBP must switch to the self-and-family option. Retirees, former spouses and U.S. Postal Service employees also can take advantage of the new rule. Children added to their parents' plan will receive coverage effective Jan. 2, 2011, the first day of the pay period. Children who lose FEHBP coverage when they turn 26 are eligible for temporary continuation of coverage for up to 36 months.

In addition, health reform expands reimbursement for children's expenses through flexible spending accounts. Children are no longer required to live with the FEHBP enrollee, or to be his or her dependent. Expenses are covered until age 27.

Health savings accounts and health reimbursement accounts, along with FSAs, no longer can be used to pay for over-the-counter medicines and drugs unless accompanied by a prescription. The only exception is insulin.

FEHBP participants will see a few additional changes outside of health reform. Plans in 2011 are required to eliminate cost sharing for preventive care, such as immunizations, tobacco cessation and health screenings. Five plans have increased benefits for hearing devices and 16 have expanded coverage for bone marrow and stem cell donor testing. And for the first time, Mail Handlers and Government Employees Health Association will pick up part of enrollees' Medicare Part B premium.

Open season for electing 2011 benefits started Nov. 8 and will run through Dec. 13.