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Health Benefits Open Season Marked by Higher Premiums

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Sept. 22, 1998 – Premiums for federal health benefits will increase by an average 10.2 percent in 1999, but with the higher costs will come improvements dictated by President Clinton's Patients' Bill of Rights.

Federal civilian employees enrolling in the government's health plan during the upcoming open season, Nov. 9-Dec. 14, will feel the effects of rising costs nationwide of prescription drugs and other health services. They'll pay about $3.39 more every two weeks than in 1998. Average biweekly premiums that cost $27.27 for individuals this year will cost $30.43 in 1999.

The 1999 increases are actually smaller than this year's, according to Janice Lachance, director of the Office of Personnel Management, which administers the Federal Employee Health Benefits Program. That's because agencies will pay a higher percentage of the total cost, she said. Government (agency) costs for individual plans will average $70.01 in 1999, an average of $12.07 more than in 1998.

Employees kept increases down last year and could do the same this year, Lachance said. If they select less costly plans, she said, the average increase could drop to under 7.4 percent.

During 1998, prescription drug costs rose 22 percent nationwide. About one in five dollars expended in the federal health plan goes to pay for prescription medicine.

An aging population nationally and within the federal work force requires more medical services, thereby raising health costs. Other contributing factors include lower fiscal reserves; new, more expensive medical technologies; and managed care savings reaching a saturation point in many areas.

Consolidations and other changes in managed care and point-of- service health plans have reduced the number of health plans open to federal employees from 350 this year to 285 in 1999.

Despite higher costs and fewer options in 1999, next year's health benefits contain several improvements, Lachance said. Most notably, she said, the program will incorporate the Patients' Bill of Rights, which provides:

  • Direct access to women's health care providers for routine and preventive services;
  • Use of the "prudent lay person" (a person who possesses an average knowledge of health and medicine) standard when reviewing emergency care visits for coverage;
  • Direct access to a qualified specialist for persons with complex or serious medical conditions requiring frequent special care;
  • Detailed information about the plan's performance, provider network characteristics and management; and
  • A prohibition against gag clauses in provider contracts that could limit communication about medically necessary treatment.

Without reducing existing mental health services, plans now will also cover the management of mental therapy medications in the same way they cover the medical and pharmaceutical management of any other disease.

"The hallmark of the [Federal Health Benefits Program] is quality and choice," Lachance said. "Those who take the time to review their options will find the program offers something for everyone. Federal employees will continue to enjoy lower health care premiums than most covered employees in the United States."

Details of the 1999 Federal Health Benefits Program are available at civilian personnel offices and on the Internet at http://www.opm.gov/insure/98/html/index.htm.

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