Weekend Update

On Friday OPM issued a benefits administration letter to government payroll offices with an attachment that explain Affordable Care Act driven changes to the FEHB Program for 2011. The guidance focuses on how to add dependent children between age 22 and 26  (and married children under age 26) to self and family FEHB coverage. Here are two important points made in the letter:

First point

Be aware: The effective date of coverage for your newly eligible children depends upon the event used to enroll or change enrollment.

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If you are an employee who gets paid biweekly (this applies to most Federal employees) or you are an Office of Workers’ Compensation (OWCP) recipient, and you want you child covered on January 1, 2011, then you must enroll or change your enrollment as a “change in family status” – qualifying life event (QLE). The qualifying life event code to use on the SF 2809 is ‘1C’ for employees and ‘2B’ for OWCP recipients.

You may change your enrollment from 31 days before to 60 days after January 1, 2011. Your change to Self and Family will take effect on the first day of the pay period that includes January 1, 2011. Your child will be covered on January 1, 2011. If you make your QLE change after January 1st, your child will be covered retroactively to January 1, 2011 and you will pay retroactive premiums back to the effective date of the enrollment or change.

If you enroll or change your enrollment as an Open Season change, it will take effect on the first day of the first pay period that begins in 2011. For most employees, this will be January 2, 2011. For the Office of Workers’ Compensation, this will be January 16, 2011. For a few other agencies, the date may be different.

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For United States Postal Service employees, CSRS/FERS annuitants, Temporary Continuation of Coverage (TCC) enrollees and former spouses, an enrollment or change in enrollment made either as a “change in family status” QLE or as an Open Season change will provide coverage of eligible children on January 1, 2011. This is also true for other agencies and other retirement systems with a pay period that begins on January 1, 2011.

If you have a Self Only enrollment and would like your newly eligible child to be covered, you must change to a Self and Family enrollment. If you do not change to a Self and Family enrollment as a “change in family status” QLE or an Open Season change then your child will not be covered.

Read the letter and its attachments for the complete details

Second point

The [Affordable Care Act]  Act has made no changes to the Federal Employees Dental and Vision Insurance Program (FEDVIP), the Federal Employees’ Group Life Insurance Program (FEGLI) or the Federal Long Term Care Insurance Program (FLTCIP). Health care reform does not extend coverage for children until age 26 or provide coverage for married dependent children under these programs.

Thanks for the guidance, OPM.

Congress resumes its work this week following the August recess. As previously discussed in the FEHBlog, Congress is expected to vote on modifying or repealing the expanded IRS Form 1099 reporting requirement included in the Affordable Care Act. The Federal Times reports that Congress is not expected to tackle 2011 fiscal year appropriations before the mid-term election recess at the beginning of October.

“I’m expecting very little action on the appropriations bills because Congress simply won’t be in long enough to make significant progress,” said Brian Riedl of the Heritage Foundation think tank. Like other analysts, Riedl thinks the Defense appropriations bill stands the best chance of winning final approval in the next few weeks. Otherwise, he predicts most agencies will be saddled with stopgap continuing resolutions that keep federal spending at 2010 levels at least into November. And many experts expect that the spending bills will be bundled into a massive omnibus appropriations package that will be approved in a lame-duck session before year’s end.

FEHB Program appropriations are included in the financial services appropriations bill (S. 3677).

Finally, Kaiser Health News reports that

A study released Thursday [by Dartmouth researchers] challenges two widely-held assumptions about medical care: that people who see a primary care physician will end up healthier than those who don’t, and that having more primary care doctors in an area guarantees better access for patients.