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Belated Open Season Enrollment

Background

Each year, the Office of Personnel Management (OPM) works with Federal Employees Health Benefits (FEHB) carriers to provide protection against catastrophic events without shifting a high-premium burden to enrollees. OPM is taking steps to provide additional protections for Federal employees participating in the FEHB Program who have non-emergency surgeries performed by out-of-network physicians. They have asked FEHB carriers to re-evaluate their benefits for non-emergency surgeries; and will communicate any benefit changes to you as they become available.

OPM is taking this action in response to concerns over a change in coverage in the Blue Cross Blue Shield out-of-network reimbursement that would have established a $7,500 co-pay for out-of-network surgeries. They negotiated this change to address situations where enrollees could be billed tens of thousands of dollars for non-emergency surgeries performed by out-of-network providers, a practice known as balance billing.

What This Means to You

You may make belated Open Season enrollment changes to your FEHB Program, Federal Employees Dental and Vision Insurance Program (FEDVIP) and the Federal Flexible Spending Account Program (FSAFEDS) if FEHB benefit changes affect your enrollment decisions in these programs. You now have an extended enrollment opportunity through January 31, 2009, to make any enrollment changes in these programs.

Also, if you make a belated Open Season change to your enrollment in these programs, the effective dates of the belated change will vary among the programs. Depending on the timing of your change and your pay periods, it may take one or more pay periods for your Federal Benefits deductions/allotments to be adjusted to match your new election. If you make a belated Open Season change and in 2009 you incur claims for services under your former plan, you and/or your provider may be responsible for reimbursing the former plan for any benefits paid.

Effective Dates

Belated changes to FEHB, regardless of the date the change was made, will take effect the first day of the pay period that starts on or after January 1, 2009. Belated changes to FEDVIP, regardless of the date the change was made, will take effect January 1, 2009. Belated change to FSAFEDS, regardless of the date change was made, will take effect on January 1, 2009, or the day after the change is received, whichever is later.