insuring tribal government employees
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Insuring Tribal Government Employees. Federal Employees Health Benefits and Federal Employees Group Life Insurance Program. What to Expect Today. Implementation Process FEHB & FEGLI Program Basics FEHB Employee Enrollment & Eligibility Employer Responsibilities Items to Consider. - PowerPoint PPT PresentationTRANSCRIPT
I n s u r i n g Tr i b a l G o v e r n m e n t E m p l o y e e s
Federal Employees Health Benefits and Federal Employees Group Life Insurance Program
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
What to Expect Today
• Implementation Process• FEHB & FEGLI Program Basics• FEHB Employee Enrollment & Eligibility • Employer Responsibilities• Items to Consider
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
FEHB and FEGLI Implementation• Tribal access to FEHB and FEGLI was authorized through
the Indian Health Care Improvement Act (IHCIA) under the Affordable Care Act (ACA) on March 23, 2010.
• Consultation to implement FEHB and FEGLI in tribal communities began in October 2010.
• Since then the Office of Personnel Management (OPM) has: – collected data from interested tribal governments and urban
Indian organizations; – developed an implementation plan; and – established a tribal-federal workgroup.
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
FEGLI
• FEGLI is the largest group life insurance program in the world, covering over 4 million federal employees and retirees, as well as many of their family members.
• FEGLI includes a basic insurance and three forms of optional insurance.
• Employers pay 1/3 of the total cost, while employees pay the rest.
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FEGLI• Basic Group Life Insurance
– Is equal to the greater of (a) your annual rate of basic pay rounded up to the next $1,000 plus $2,000 or (b) $10,000.
– Accidental Death and Dismemberment (AD&D) coverage included.• Option A (Standard)
– Life insurance amount is $10,000 including AD&D coverage.– The cost of Option A depends on your age.
• Option B (Additional)– You may choose this option in an amount equal to one, two, three,
four or five times your annual basic pay. • Option C (Family)
– Provides life insurance for your spouse and eligible dependent children.
– All eligible family members are automatically covered.
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FEHB• FEHB offers the widest selection of health
insurance plans in the country.• FEHB offers two types of insurance plans:– Fee-for-Service (FFS) plans and their Preferred Provider
Organizations (PPO); and– Health Maintenance Organizations (HMO) for those
who live within the area serviced by the plan.• Program Features– No waiting periods.– No pre-existing condition limitations.
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
FEHB• FEHB provides:– Improved access to health care for employees of
tribes, tribal organizations, and urban Indian health organizations;
– Increased flexibility and variety in choice of plans for employees; and
– Expanded access to health care for tribal employees and their dependents.
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
FEHB Individual Eligibility• Family Members Eligibility– Spouse (as defined in Defense of Marriage Act)– Children under age 26 including:• Married children• Adopted children• Stepchildren• Children who have, or are eligible for, employer-
provided health insurance
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FEHB Individual Eligibility• Family members that are not eligible include: – Grandchildren, unless foster child requirements
are met– Parents– Siblings– In-laws
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
FEHB Individual Eligibility• Tribes may purchase coverage for all tribal
employees meeting the common law employee standard.
• Seasonal employees that work at least six months in the year are eligible for FEHB.
• Part time employees are also eligible for FEHB and must be covered.
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FEHB Enrollment• Enrollment– Coverage is effective on first day of the pay period after
enrollment request is received.– Two enrollment types:
• Self Only• Self and Family
– Employees do not need to reenroll each year.• Open Season– Held annually from mid-November to mid-December.– Enrollments and changes become effective on first day
of first full pay period in January.Materials Provided by the 2012 National Indian Health Outreach and Education Grant
FEHB Tribal Eligibility• Tribes and tribal organizations carrying out
programs under the Indian Self-Determination and Education Assistance Act.
• Urban Indian organizations carrying out programs under title V of IHCIA.
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
Employer Responsibilities• Tribal governments are responsible to:– Pay at 72% of employee premiums.– Insure all of their employees (part-time included).– Pay $15.15 administrative fee to National Finance
Center (NFC) per month per employee.• If interested in FEHB, tribal governments must
sign a statement of intent three months prior to desired enrollment date.
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
Employer Responsibilities• Tribal HR Offices Must:– Validate employee enrollment requests and plan
change requests.– Enter enrollments and plan changes into Tribal
Insurance Program System (TIPS) via online portal.– Address employee questions on program
requirements.– Set up payment account for pre-authorized debits
and funds account monthly.
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
FEHB Coverage Timeline
1. Tribal government notifies OPM of intent to participate in FEHB.
2. Tribal government must agree to follow the guidelines of the FEHB program.
3. Request training if needed.4. Disperse and collect enrollment forms (initial
enrollment period).5. Enter enrollment information in TIPS.
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
FEHB Coverage Timeline
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Signed Statement of Intent
Effective Date of Coverage
Last Day of Initial Enrollment
OpportunityLast Day of data entry into TIPS
4/1/2012 7/1/2012 6/5/2012 6/11/2012
5/1/2012 8/1/2012 7/10/2012 7/16/2012
6/1/2012 9/1/2012 8/7/2012 8/13/2012
7/1/2012 10/1/2012 9/4/2012 9/10/2012
8/1/2012 11/1/2012 10/9/2012 10/15/2012
9/1/2012 12/1/2012 11/6/2012 11/12/2012
Some Items to Consider• Total number of eligible employees.– This will set a baseline for administrative costs and allow
you to estimate costs.• Health insurance options provided through FEHB.– Are they better choices that what you have now?
• Potential associated costs:– NFC administrative fees– Premiums– Tribal administrative cost (coordinating HR offices,
training staff, etc)
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
HMO – AlabamaAetna HealthFund Total Premium Tribe Pays Employee Pays
CDHP Self 558.50 402.46 156.04
CDHP Family 1268.32 897.76 370.56
HDHP Self 376.48 282.36 94.12
HDHP Family 824.53 618.40 206.13
Materials Provided by the 2012 National Indian Health Outreach and Education Grant
HMO – AlaskaAetna HealthFund Total Premium Tribe Pays Employee Pays
CDHP Self 558.50 402.46 156.04
CDHP Family 1268.32 897.76 370.56
HDHP Self 376.48 282.36 94.12
HDHP Family 824.53 618.40 206.13
Education Materials Provided by the 2012 National Indian Health Outreach and Education Grant
HMO – ArizonaAetna HealthFund Total Premium Tribe Pays Employee Pays
CDHP Self 558.50 402.46 156.04
CDHP Family 1268.32 897.76 370.56
HDHP Self 376.48 282.36 94.12
HDHP Family 824.53 618.40 206.13
Aetna Open Access Total Premium Tribe Pays Employee Pays
High Self 634.83 402.46 232.37
High Family 1535.11 897.76 637.35
Heal Net of Arizona, Inc Total Premium Tribe Pays Employee Pays
High Self 552.65 402.46 151.19
High Family 1401.57 897.76 503.81
Standard Self 494.80 371.10 123.70
Standard Family 1252.59 897.76 354.83
HMO – ArkansasAetna HealthFund Total Premium Tribe Pays Employee Pays
CDHP Self 558.50 402.46 156.04
CDHP Family 1268.32 897.76 370.56
HDHP Self 376.48 282.36 94.12
HDHP Family 824.53 618.40 206.13
QualChoice Total Premium Tribe Pays Employee Pays
High Self 571.03 402.46 168.57
High Family 1337.22 897.76 439.46
Standard Self 445.36 334.02 111.34
Standard Family 1042.93 782.20 260.73
HMO – CaliforniaAetna HealthFund Total Premium Tribe Pays Employee Pays
CDHP Self 558.50 402.46 156.04
CDHP Family 1268.32 897.76 370.56
HDHP Self 376.48 282.36 94.12
HDHP Family 824.53 618.40 206.13
Aetna Open Access Total Premium Tribe Pays Employee Pays
High Self 492.27 369.20 123.07
High Family 1212.62 897.76 314.86
Blue Shield of CA Access+ Total Premium Tribe Pays Employee Pays
High Self 536.55 402.41 134.14
High Family 1212.64 897.76 314.86
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HMO - CaliforniaHealth Net of California Total Premium Tribe Pays Employee Pays
High Self 929.61 402.46 527.15
High Family 2149.33 897.76 1251.57
Standard Self 886.93 402.46 484.47
Standard Family 2050.64 897.76 1152.88
Health Net of California Total Premium Tribe Pays Employee Pays
High Self 595.23 402.46 192.77
High Family 1376.20 897.76 478.44
Standard Self 559.07 402.46 156.61
Standard Family 1292.63 897.76 394.87
Kaiser Foundation Health Plan of CA
Total Premium Tribe Pays Employee Pays
High Self 661.90 402.46 259.44
High Family 1579.96 897.76 682.20
Standard Self 554.41 402.46 151.95
Standard Family 1297.29 897.76 399.53
HMO – CaliforniaKaiser Foundation Health Plan of CA
Total Premium Tribe Pays Employee Pays
High Self 504.31 378.23 126.08
High Family 1165.58 874.19 291.39
Standard Self 323.03 242.27 80.76
Standard Family 746.59 559.94 186.65
UnitedHealthcare of CA Total Premium Tribe Pays Employee Pays
High Self 512.42 384.32 128.10
High Family 1171.39 878.54 292.85
Questions• For more information:– Contact Me:• Insert trainer name and contact information
– Contact OPM:• [email protected]• 202-606-2530
Materials Provided by the 2012 National Indian Health Outreach and Education Grant