Our deep dive into the Federal Employee Health Benefits (FEHB) program continues with a look the types of health plans available.
OPM’s FEHB Handbook is a dense digital document that details all the technicalities around health insurance for active and retired federal workers and their family members. In this series, we’re attempting to summarize the government’s guide in more digestible chunks. In the first article, we provided a general overview of the handbook and its introduction. The second article looked at the legal responsibilities of the parties involved while the third piece focused on FEHB premiums and the tax implications of premium conversion. And the fourth part was about FEHB withholdings, contributions, and how to calculate the daily rate. This part is looking at the types of health plans available in the FEHB program.
The two main types of health plans are national plans and HMO (Health Maintenance Organization) plans. The national plans include Fee-for-Service (FFS) plans and consumer driven health plans (CDHP). Then, there are three types of HMO plans: group practice plans, individual practice plans, and mixed model plans. Both HMO and FFS plan types offer High Deductible Health Plans (HDHP) and plans with POS (point-of-service) features.
The description of a specific plan can be found in the brochures provided by federal agencies and the insurance carriers. These pamphlets are supposed to include descriptions of a plan’s costs, benefits, exclusions, limitations, and other important provisions. OPM provides agencies with a list of the upcoming year’s participating plans prior to each year’s open season.
With an HMO health plan, most covered medical services have to be provided with a specific health organization, although POS benefits in some plans will cover select out-of-network services. A primary care physician (PCP) is an important aspect of HMOs. Here’s a summary of the three types of HMO plans:
-Group Practice Plan: Includes groups of doctors that work at medical centers.
–Individual Practice Plan: Includes participating doctors who work their own offices.
–Mixed Group Plans: A combination of the above two.
With FFS and CDHP plans, there’s usually a bigger selection of available health providers to choose from, both locally and nationally, although with FFS plans, there can be a preferred provider organization (PPO). FFS plans come in two varieties as well: those known as federal employee programs (an FEP) and the plans that are sponsored by unions or other employee organizations.
Upcoming articles in this FEHB series will be focusing on health plan coordination, eligibility, and enrollment. In the meantime, don’t forget to register for our next FEHB Webinar!
The information has been obtained from sources considered reliable but we do not guarantee that the foregoing material is accurate or complete. Any opinions are those of Serving Those Who Serve writers and not necessarily those of RJFS or Raymond James. Any information is not a complete summary or statement of all available data necessary for making an investment decision and does not constitute a recommendation. Investing involves risk and you may incur a profit or loss regardless of strategy suggested. Every investor’s situation is unique and you should consider your investment goals, risk tolerance, and time horizon before making any investment or financial decision. Prior to making an investment decision, please consult with your financial advisor about your individual situation. While we are familiar with the tax provisions of the issues presented herein, as Financial Advisors of RJFS, we are not qualified to render advice on tax or legal matters. You should discuss tax or legal matters with the appropriate professional. **
The FedLife Podcast is your in-depth, biweekly deep dive into the world of federal benefits and retirement planning. Hosted by federal benefits expert Ed Zurndorfer and Dan Sipe of Serving Those Who Serve, each 30-minute episode unpacks the complexities of FERS and CSRS retirement, FEHB and Medicare, survivor benefits, tax planning, and more. Designed for federal employees and retirees who want more than just the basics, FedLife goes beyond the headlines to explore the rules, nuances, and strategies that can make a meaningful difference in your retirement. Remember: it’s your Fed life, make it a great one.
The Fed15 Podcast is your weekly 15(ish)-minute briefing on federal benefits and financial planning, built specifically for federal employees and retirees. Hosted by Dan Sipe and Katelyn Murray of Serving Those Who Serve, each episode delivers clear, actionable guidance on topics like FERS and CSRS retirement, TSP strategies, FEHB, survivor benefits, tax planning, and more! Whether you’re five years from retirement or already there, The Fed15 helps you cut through the noise, avoid costly mistakes, and make confident decisions about your federal benefits.
