Midweek update

The Office of Personnel Management (“OPM”) issued two FEHBP-related proposed rules this week.  The FEHBlog discusses the first proposed rule, which concerns extension of FEHB coverage while an employee is on leave without pay, in this Govexec.com article. In short, the proposed rule permits agencies to require LWOP employees to pay as they go for FEHBP coverage except in certain circumstance such as Family and Medical Leave or workers compensation. A friend of the FEHBlog pointed out to him that “The USPS has had a process in place for many years that automatically bills for the employee share of FEHB premiums after an employee has been in LWOP for six pay periods [/ twelve weeks].” That’s a sensible approach.

Today, OPM promulgated proposed rules governing the ACA created program that makes FEHBP coverage available to Native American tribal employers.  OPM rolled out this program a few years ago relying on subregulatory guidance.  A major difference between the federal employee program and the tribal employee program is that

Section 890.1417 [of the proposed rules] states that an FEHB enrollment cannot be continued into retirement from employment with a tribal employer. This is a statutory requirement as the law entitles tribal employers to purchase FEHB for employees but it does not extend that entitlement to permit tribal employers to purchase FEHB for retirees.

The public comments deadline for both proposed rules is Halloween, October 31, 2016.

Earlier this week the Health and Human Services Department issued its proposed 2018 Notice of Benefit and Payment Parameters, a major annual ACA issuance.  Professor Timothy Jost requires two articles in the Health Affairs Blog to discuss it.  If you are glutton for punishment here is a link to the notice which will be published in the Federal Register on September 6.  As noted in CMS’s three page long fact sheet on the notice,

Annual Limitation on Cost Sharing: The maximum annual limitation on [in-network] cost sharing [for group health plans other than high deductible plans with health savings accounts] is the product of the dollar limit for calendar year 2014 ($6,350 for self-only coverage) and the premium adjustment percentage for 2018, rounded down to the next lower $50. We are proposing a maximum annual limitation on cost sharing for 2018 of $7,350 for individual coverage and $14,700 for family coverage.

This is the principal provision that applies to the FEHBP.  (There used to be more.)  For those interested here is a link to a handy dandy list of the out of pocket maximums for high deductible plans and other group health plans next year. 

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