	Introduction

The Federal Employees Health Benefits (FEHB) Program provides private health insurance to federal employees, retirees, and their dependents. In a typical year, FEHB provides health insurance coverage to about 8.2 million federal employees, retirees, and their dependents. FEHBA generally established parameters for eligibility; election of coverage; the types of health plans and benefits that may be offered; and the level of the government's share of premiums. It also established an Employees Health Benefits Fund to pay for program expenses and put forth provisions for studies, reports, and audits. By law, OPM has the authority to contract with insurers and to prescribe regulations to manage FEHB, among other duties. FEHBA has been amended many times since its passage. The general model of FEHB, consisting of enrollees choosing between multiple types of coverage offered by competing private insurers, has not changed. Employees and retirees have always shared the cost of premiums with the federal government, and, in general, they have always had access to the same plans at the same cost. However, many other aspects of FEHB have been modified. Congressional interest in FEHB often extends beyond FEHB's potential applicability as a model for other health care programs or as an avenue to provide coverage. Congress has a financial interest in the program, as the federal government has always paid a portion of FEHB's costs. In addition, Congress has the legislative authority to restructure FEHB to maintain or improve its function. The report includes short discussions of certain changes to the program. It discusses how Congress has conditioned the use of federal funds on policy changes being implemented in FEHB ( Table 1 ); changed the formula for determining the government's share of FEHB premiums ( Table 2 ); modified eligibility for the program ( Table 3 ); and implemented policies that affect the relationship between Medicare and FEHB ( Table 4 ). FEHB Legislative History

The following are detailed summaries of selected laws or provisions of laws that established, amended, or changed the Federal Employees Health Benefits (FEHB) Program. The act established the general parameters for the program, including eligibility and enrollment procedures; the types of benefits that may be provided; the level of the government's share of premiums; and the role of the Office of Personnel Management (OPM). OPM was allowed to contract or approve the following types of health benefit plans to participate in FEHB:
Service Benefit Plan—one government-wide plan (offering two levels of benefits) under which payment is made by an insurer under contracts with providers for the benefits described Indemnity Benefit Plan—one government-wide plan (offering two levels of benefits) under which an insurer agrees to pay certain sums of money for the benefits described Employee Organization Plans—plans providing health benefits to members of the organization as of July 1, 1959, that are sponsored or underwritten and administered, in whole or in part, by employee organizations; employee organization plans are available only to employees and retirees (and members of their families) who at the time of enrollment are members of the organization Comprehensive Medical Plans—either group-practice prepayment plans , which offer benefits on a prepaid basis provided by physicians practicing as a group in a common center or centers, or individual-practice prepayment plans , which offer health services on a prepaid basis provided by individual physicians who agree to accept the payments provided by the plans as full payment for covered services rendered by them
Under P.L. 86-382). 105-33 modified the formula for determining the government's share of FEHB premiums.
For more than 50 years, the Federal Employees Health Benefits (FEHB) Program has been providing health insurance coverage to federal employees, retirees, and their dependents. It is the largest employer-sponsored health insurance program in the country, covering about 8.2 million enrollees each year.
The program was created by the Federal Employees Health Benefits Act of 1959 (FEHBA; P.L. 86-382). FEHBA and its subsequent amendments established the parameters for eligibility; election of coverage; the types of health plans and benefits that may be offered; and the level of the government's share of premiums. They also established an Employees Health Benefits Fund to pay for program expenses and put forth provisions for studies, reports, and audits. In addition, FEHBA outlined the role of the Office of Personnel Management (OPM) in FEHB. By law, OPM has the authority to contract with insurers and to prescribe regulations to manage the program, among other duties.
FEHB's general model has not changed since its inception. The program has always allowed competing private insurers to offer numerous types of coverage to enrollees within broad federal guidelines. The federal government and the employee or retiree have always shared the cost of the premium, and generally employees and retirees have had access to the same plans at the same cost. However, specific features of FEHB have been modified—in some cases, multiple times—by statutory changes, administrative actions, and judicial decisions. For example, through legislation, Congress has modified the formula for determining the government's share of premiums, and both Congress and OPM have broadened the types of health benefits FEHB plans must provide. Additionally, a Supreme Court decision in 2013 expanded FEHB eligibility to include same-sex spouses of FEHB enrollees and the children of same-sex marriages.
Congress has financial and administrative interests in the program, as the government pays for a share of FEHB premiums and Congress has the legislative authority to modify FEHB. Congressional interest in the program also extends to FEHB's potential applicability as a model for other health care programs or as an avenue to provide coverage, such as by extending aspects of FEHB to Medicare.
This report tracks legislative changes to FEHB. The report includes brief discussions of how Congress has changed FEHB through legislative action, including by restricting the use of federal funds; changing the formula for determining the government's share of FEHB premiums; expanding eligibility for the program; and implementing policies that affect the relationship between Medicare and FEHB. The Appendix includes detailed summaries of selected laws or provisions of laws that have amended or changed FEHB.