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There's Still Time to Start, Change Health Plan

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Nov. 17, 1998 – Federal civilian employees have until Dec. 14 to enroll in a health plan for 1999. That's when the annual open season ends.

If you already are enrolled in one of the hundreds of plans available under the Federal Employees Health Benefits Program, your provider should have sent you a brochure and renewal form. If you're not currently in a plan, your personnel office should have provided you a guide to the 1999 program and enrollment forms.

The guide, forms and other information, including answers to frequently asked questions, are also available on the Office of Personnel Management Web site at www.opm.gov/insure/html/about.html.

Federal employees, retirees and their survivors can choose from a nationwide selection of plans. Options include health maintenance organizations, point-of-service plans and managed fee-for-service plans.

Health maintenance organizations typically provide broad coverage for a premium and small, fixed copayments. In return, you select a participating doctor to be your primary care provider and to refer you to participating specialists. Other than for emergency care, HMOs usually won't pay for health care you receive from nonmember doctors.

Point-of-service plans are cheapest when you use doctors in the plan's network. On those occasions you're willing to pay more, however, you can use any doctor you like and see specialists without referrals.

Fee-for-service plans provide you the widest choice of doctors -- you choose the ones you want and see specialists without referrals. They charge a premium and, after an annual deductible, cover a percentage of your costs -- usually 75 percent to 80 percent. Many also offer a preferred provider organization that can cut your out-of- pocket expenses. Some plans require that you join the sponsoring organization. Others limit enrollment to certain employee groups.

Some things to consider when exploring the available plans include:

  • Cost. How much is the premium and how often is it due? How much are "extras" -- emergency room visits, well-child care and deductibles, for example? Does the plan feature a mail-order pharmacy option, which usually cuts prescription costs significantly? Does the fee-for-service plan you want include a network of preferred providers?
  • Coverage. Make sure the plan meets your and your family's needs. For example, if you are over 65 does the plan coordinate with Medicare? If you're planning to have children, does it have a prenatal program? What and how much catastrophic coverage does the plan provide? Does the plan cover dentistry and, if so, to what extent?
  • Quality. The Office of Personnel Management recommends you learn as much as possible about a health plan before enrolling. Talk to plan administrators and providers. If you're considering a health maintenance organization, is it nationally accredited? Find out from co-workers what they like and dislike about their plans. Use the comparison chart at your personnel office and on the Internet at www.opm.gov/insure/99/states/index.html for information about each plan and its performance and management.

All plans under the federal program contain improvements for 1999. These include direct access to women's health care providers for nonemergency services, and frequent specialist care for persons with complex or serious medical conditions.

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