A Closer Look at Health Plan Changes

May 16, 2018

health

A few posts back, we looked at the fact that there will be more choices for FEHB participants. Now, there is more information about some more health plan changes on the horizon for the 2018 insurance Open Season, which runs from November 12, 2018-December 10, 2018.

Supplemental Dental Insurance

This health plan change will affect military retirees and family members. The bad news is Delta Dental will no longer be available for military retirees under the TRICARE Retiree Dental Program after December 31, 2018. The good news is that retired service members and their families will be eligible to participate in FEDVIP.

Delta Dental is available under FEDVIP in a high and standard option. The cost and benefits of Delta Dental under the TRDP program and the plan offered under FEDVIP differ. Here are some of the main differences.

  • The monthly premium for TRDP is priced regionally, like FEDVIP. The TRDP 2018 premium along the Gulf Coast in Florida is $32.25 for self only, while in Washington, DC, it’s $40.60.
  • Monthly premiums, for FEDVIP Delta Dental Standard Option PPO, range from $18.81-$26.59 (self only), $37.59-$53.17 (self plus one), and $56.40-$79.76 (self and family), depending on where you live.
  • Monthly premiums, for FEDVIP Delta Dental High Option PPO, range from $36.27-$53.95 (self only), $72.54-$107.92 (self plus one), and $108.81-$161.87 (self and family), depending on your region.
  • Both TRDP and FEDVIP plans provide 100% in-network coverage for preventative and diagnostic dental exams and x-rays.
  • The FEDVIP High Option plan has a $30,000 maximum in-network allowance while the standard option only allows $1,500 per person with no in-network deductible. The TRDP plan has more allowance of $1,300 per person with a $50 deductible.
  • The TRDP plan covers 80%of basic restorative services (i.e. fillings) and the FEDVIP plan covers 55%, with the High option covering 70%.
  • Major dental expenses such as crowns, bridges, and implants are covered at 50% in-network for both the TRDP and FEDVIP High options, while the standard option FEDVIP covers 35%.
  • TRDP provides only a $1,750 lifetime orthodontic maximum while the FEDVIP standard allows a $2,000 max, and the High option has a $3,500 allowance.

There are 9 other FEDVIP plans to choose from. Check out Benefeds.com for plan comparison tools.

The new 2019 premiums won’t be announced until October and coverage will be effective on January 1, 2019, for military and civilian retirees and on January 6, 2019, for most civilian federal employees.

Health Plan Options

This health plan change allows all FEHB plans to offer 3 plan options (high, standard, and value), or 2 plan options and a high deductible option.

To further understand the impact of this change, let’s look at the 4 types of FEHBP plans: service benefit, indemnity benefit, employee organization, and comprehensive medical. Here’s how each is defined in Section 8903 of the U.S. Code:

Service Benefit Plan

“One government-wide plan, which may be underwritten by participating affiliates licensed in any number of states, offering 2 levels of benefits, under which payment is made by a carrier under contracts with physicians, hospitals, or other providers of health services.”

Indemnity Benefit Plan

“One government-wide plan, offering 2 levels of benefits, under which a carrier agrees to pay certain sums of money not in excess of the actual expenses incurred, for benefits.”

Employee Organization Plan

“Employee organization plans which offer benefits…which are sponsored or underwritten, and are administered, in whole or substantial part, by employee organizations…which are only available to individuals, and members of their families, who at the time of enrollment are members of the organization.”

Comprehensive Medical Plans

“Group-practice prepayment plans offer health benefits of the types in whole or in substantial part on a prepaid basis, with professional services provided by physicians practicing as a group in a common center or centers.”

“Individual-practice prepayment plans offer health services in whole or in substantial part or a prepaid basis with professional services provided by individual physicians who agree to accept the payments provided by the plans as full payment for covered services given by them.”

“Mixed model prepayment plans which are a combination of the above plans.”

Each healthcare company has its own options and regulations. The Office of Personnel Management had a response to all the comments on the rule, “All carriers have the ability to adjust their premiums, focus on quality, recruit providers, and promote their brand to compete with the largest insurer in the FEHB program. That some carriers attract more enrollment than others is not evidence of an anti-competitive environment.”

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