Paul Sanchez
Federal employees in the US are eligible for health insurance through the Federal Employee Health Benefit (FEHB) program, which was established in 1959 by an Act of Congress. The FEHB is the largest employer-sponsored health benefits program, covering nearly 8.3 million federal employees and dependents. Federal employees typically share the cost of their health plan premium with the government, and can choose from a wide range of health plans, including consumer-driven and high-deductible plans, as well as fee-for-service plans. In addition to health insurance, federal employees also have access to other benefits such as dental and vision insurance, life insurance, and long-term care insurance.
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What You'll Learn
Federal Employees Health Benefits (FEHB) Program
The Federal Employees Health Benefits (FEHB) Program provides health care benefits for over eight million federal civilian employees, retirees, and their families. It is the most diverse employer-sponsored health benefits program in the United States, with 276 plan options available in 2021. The actual number of plans available to each federal employee depends on their geographic location.
The FEHB Program offers a wide selection of health plans, including Consumer-Driven, High Deductible, Fee-for-Service (FFS), Preferred Provider Organizations (PPO), and Health Maintenance Organizations (HMO). Federal employees can choose a plan that best suits their needs and the specific plan options available to them. The Consumer-Driven and High Deductible plans offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts, and lower premiums. On the other hand, FFS plans, PPOs, and HMOs are dependent on the employee's location, as they must live (or sometimes work) within the area serviced by the plan.
There are three enrollment types available with each plan option: Self Only, Self Plus One, and Self and Family. As of December 2020, over 492,000 Department of Defense (DoD) employees were enrolled in the FEHB Program, with 36% in Self Only, 14% in Self Plus One, and 50% in Self and Family. The Defense Civilian Personnel Advisory Service (DCPAS) provides resources and guidance on the FEHB Program, including information on enrollment and plan options.
In certain situations, the FEHB Program may ask health plans to demonstrate maximum flexibility to assure benefits coverage. For example, during emergencies, fee-for-service carriers are expected to relax certain provisions, such as pre-certification requirements, and make additional supplies of medications available to members. The FEHB Program also encourages immediate payment for work-related injuries, with subsequent reimbursement from the Office of Workers' Compensation Programs (OWCP).
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Health insurance plans
Federal employees in the US may be eligible for a health insurance plan through the U.S. Office of Personnel Management's Federal Employee Health Benefit (FEHB) program. The FEHB program is the largest employer-sponsored health benefits program, covering nearly 8.3 million federal employees and dependents.
The FEHB program offers federal employees, retirees, and their survivors the widest selection of health plans in the country. These include Consumer-Driven and High Deductible plans, which offer catastrophic risk protection with higher deductibles, health savings/reimbursable accounts, and lower premiums. There are also Fee-for-Service (FFS) plans, and their Preferred Provider Organizations (PPOs), or Health Maintenance Organizations (HMOs) if you live (or sometimes work) within the area serviced by the plan.
Federal employees typically share the cost of their health plan premium with the government. Depending on the plan, employees may also have to pay deductibles, copayments, or coinsurance. The Federal Flexible Spending Account Program (FSAFEDS) can also help federal employees save money by setting aside pre-tax dollars from their paycheck to help pay for eligible healthcare or childcare costs not covered by their health, dental, and vision plans.
The best health insurance plan for a federal employee will depend on factors such as cost, coverage, and in-network providers. It is recommended to consider the total benefit package, service and cost, and provider availability when choosing a health plan. FEHB plan brochures are available and show what services and supplies are covered and the level of coverage.
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Dental and vision insurance plans
Federal employees in the US have access to a wide range of health plans, including dental and vision insurance. The Federal Employees Dental and Vision Program (FEDVIP) is a separate program from the Federal Employee Health Benefits (FEHB) Program. FEDVIP offers supplemental dental and vision insurance coverage to eligible federal and postal employees, retirees, and their eligible family members.
The FEDVIP dental plans provide a comprehensive range of services, while the vision plans cover comprehensive eye examinations, lenses, frames, and contact lenses. Other benefits, such as discounts on Lasik surgery, may also be available. FEDVIP allows for the group purchase of dental and vision insurance, resulting in competitive premiums and no pre-existing condition limitations. Premiums for enrolled federal and postal employees are deducted from their salaries on a pre-tax basis.
Enrollment in FEDVIP typically takes place during the annual Federal Benefits Open Season in November and December. For specific questions regarding enrollment and premiums, individuals can contact BENEFEDS at 1-877-888-3337.
It is worth noting that the Federal Flexible Spending Account Program (FSAFEDS) is another option to help federal employees save money on healthcare and childcare costs not covered by their health, dental, or vision plans. FSAFEDS allows eligible employees to set aside pre-tax dollars from their paychecks to cover eligible expenses, such as eyeglasses, prescriptions, and childcare.
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Federal Flexible Spending Account Program (FSAFEDS)
The Federal Flexible Spending Account Program (FSAFEDS) is a program that allows federal employees to save money by setting aside pre-tax dollars from their paychecks to help pay for eligible healthcare or childcare costs not covered by a health, dental, or vision plan. This includes costs such as eyeglasses, some prescriptions, day care, and summer camps. If you are a new or current federal employee, you can set up either a healthcare or dependent care flexible spending account, or both. FSAFEDS is administered by the Office of Personnel Management (OPM), and agencies in the executive branch and a few other agencies offer it.
Eligible employees can enroll in FSAFEDS each year during the Federal Benefits Open Season, typically in November or December. The enrollment deadline for new and newly eligible employees is October 1 of the calendar year, and enrollment must be done within 60 days of becoming eligible. It is important to note that enrollment does not carry forward year to year, so current enrollees must remember to enroll annually to continue participating in the program.
FSAFEDS provides flexibility in managing healthcare and dependent care expenses. It is designed to help cover costs that are typically not covered by other insurance plans, such as the Federal Employees Health Benefits (FEHB) Plan or the Federal Employees Dental and Vision Insurance Program. The minimum election amount for all accounts is $100, and carryover has been adopted for healthcare and limited expense healthcare FSAs.
Additionally, federal employees can also take advantage of other benefits, such as the Federal Employees' Group Life Insurance Program (FEGLI) and federal student loan repayment options. These benefits demonstrate the comprehensive support provided to federal employees and their families to meet their healthcare, financial, and overall well-being needs.
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Federal Long Term Care Insurance Program (FLTCIP)
The Federal Long Term Care Insurance Program (FLTCIP) is administered by Long Term Care Partners and underwritten by John Hancock Life & Health Insurance Company. It is a complex, experience-based product that helps pay for the costs of care when enrollees can no longer perform everyday tasks for themselves due to illness, injury, disability, or aging. This includes situations where the enrollee has a severe cognitive impairment, such as Alzheimer's disease.
When the program is not suspended, most federal and U.S. Postal Service employees and annuitants, active and retired members of the uniformed services, and their qualified relatives are eligible to apply for insurance coverage under the FLTCIP. It is important to note that eligibility for the Federal Health Benefits Program (FEHB) is generally a prerequisite for applying for coverage under the FLTCIP, although annuitants are not required to meet this criterion. Certain medical conditions, or combinations thereof, may prevent some individuals from being approved for coverage.
The FLTCIP offers resources to support caregivers and those who need care throughout the different stages of aging. The LTCFEDS Care Navigator is a resource library that helps assess care needs, communicate with loved ones about those needs, and research different care options.
As of December 19, 2024, the U.S. Office of Personnel Management (OPM) has extended the original application suspension period, during which individuals not already enrolled may not apply for coverage or increase their existing coverage.
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Frequently asked questions
Federal employees may be eligible for a health insurance plan through the U.S. Office of Personnel Management’s Federal Employee Health Benefit program (FEHB). The FEHB program was established in 1959 by an Act of Congress and is the largest employer-sponsored health benefits program.
The Federal Employees Health Benefits (FEHB) Program offers federal employees, retirees, and their survivors a wide selection of health plans to choose from.
There are many types of health insurance plans offered through the FEHB program. These include:
- Consumer-driven plans
- High-deductible plans
- Fee-for-service plans
- Preferred Provider Organizations (PPO)
- Health Maintenance Organizations (HMO)
Federal employees typically share the cost of their health plan premium with the Government. Depending on the plan, employees may also have to pay deductibles, copayments, or coinsurance.
Other benefits available to federal employees include:
- Dental and vision insurance plans
- Federal Flexible Spending Account Program (FSAFEDS)
- Federal Long Term Care Insurance Program (FLTCIP)
- Federal Employees' Group Life Insurance program (FEGLI)
