Typical Federal Employees Health Benefits Programs
The Federal Employees' Health Benefit program is a vast private group insurance offered to anyone working for or under the federal government. According to the Annenberg Public Policy Center, over eight million people utilize the program. Although there is only one FEHB program, it is comprised of over 300 different plans that vary by the plan offerings, the federal employer offering the insurance and private company providing the insurance coverage. Despite all of the variation, the FEHB has three basic program plans that employees can choose from: fee-for-service plans, health maintenance organization plans, and point of service plans. These three plans are typical for all of the providers insuring federal employees under the program.
Fee for Service Plans
The FEHB allows its eight million program participants to choose the most traditional form of insurance, the fee-for-service plan. Under such a plan, the insured employees pay a deductible or co-pay for medical services. After the medical visit, the insured submits a claim for reimbursement to the FEHB insurance provider. The medical service provider (the doctor) usually submits the claim and receives payment, however. Insured employees on this program can receive treatment at any hospital or medical center; from any doctor as well. The fee-for-service plans are the lowest maintenance of the three typical FEHB plans offered.
Health Maintenance Organization (HMO)
The health maintenance organization or HMO is a cheaper plan than the fee-for-service FEHB plan. The HMO is established by the insurance company as an agreement with medical providers in the area. The HMO will cover certain types of services without charging a co-pay, deductible, or co-insurance, if the treatment comes from a doctor in the area. In return for the business, the medical providers offer a discount to the HMO for those services. Additional treatments and medical services not covered under the list are not excluded. The HMO will cover them, but charge the insured a co-pay, co-insurance, and/or a deductible. The HMO plan is much more restrictive than the fee-for-service plans.
Point of Service Plan
The point of service plan is often tacked onto the HMO and fee-for-service plans. The insurance provider has a network of physicians, hospitals, and medical centers that are willing to treat the insured employees. These in-network medical providers usually agree to a specific rate for services that the insurance company will pay. In return, the employees using in-network medical providers can do so without a deductible or con-insurance payment (the share of the bill left after the insurance has made payment on their agreed upon share). This plan is often cheaper than the fee-for-service, and it is also more restrictive than HMO. Using an out-of-network doctor can lead to co-insurance fees and a deductible. The employee may even have to pay the bill for treatment and submit a reimbursement claim to the insurance company later.
Choosing the best FEHB plan requires research and knowledge of a family's health needs. Employees are allowed to change their policy each year under the Open Enrollment period offered by each insurance provider. Otherwise, each employee must adhere to the rules of the individual plans.
