It specifies that the federal government and the employee or retiree will share the cost of health insurance, with the federal government contributing 72% of the weighted average premium of all plans but no more than 75% of any given plan's premium, with the exception of employees of the USPS, whose share of the premium is collectively bargained. The Office of Personnel Management (OPM) administers the program. Eligibility

Eligible enrollees include federal employees, retirees, and their dependent family members. New federal employees have 60 days from their start date to sign up for an FEHB plan, or they can wait to enroll until the next open season (the period each year during which individuals can enroll or change health plans). Enrollees can choose either individual or family coverage. Starting in calendar year 2016, a self plus one coverage option is also available to enrollees. Members of Congress and Certain Congressional Staff

Members of Congress and certain congressional staff no longer receive health benefits through FEHB as a benefit of their employment but may be eligible to enroll in FEHB in retirement. The Patient Protection and Affordable Care Act (ACA; P.L. For information on Medicare coverage for FEHB retirees, see " FEHB Enrollees and Medicare ." Generally, health insurance carriers and their health plans fall into two broad categories: fee-for-service (FFS) plans or health maintenance organizations (HMOs). FFS plans are generally available nationwide, and HMOs tend to be locally available. These limits include deductibles, co-payments, and coinsurance and cannot exceed $6,550 for self-only coverage and $13,100 for family coverage in calendar year 2016. Premium costs are shared between the federal government and the employee or retiree. Benefits and cost sharing vary among FEHB plans. For some services, such as the preventive care services outlined in the ACA, plans are not allowed to impose cost sharing. In general, contingency reserves are used to offset unexpected increases in spending or premium increases in later years. How the USPS Interacts with the FEHB Program

Similar to most other federal agencies, the USPS offers health care benefits to its employees, retirees, and their dependents through FEHB. Several coverage options are available through the Medicare program: the Hospital Insurance (HI) program in Medicare Part A, the Supplementary Medical Insurance (SMI) program in Medicare Part B, and prescription drug coverage in Medicare Part D.

		Eligibility for Medicare

Most FEHB enrollees (retirees and employees) aged 65 or older are entitled to Medicare Part A because they or their spouse paid Medicare payroll taxes for at least 40 quarters. When FEHB is the primary payer, the FEHB plan pays hospitals and physicians based on Medicare rates. For example, the new law allowed all adult children (including those who are married) to enroll in or remain on their parents' plan until the age of 26. However, many ACA provisions had no meaningful effect on FEHB because many FEHB plans already met the requirements established under the law, such as the provision that people with preexisting conditions cannot be denied health coverage. OPM is authorized to contract with health insurance carriers; approve health plans for participation in the program; negotiate with carriers about benefit and premium levels; determine the times and conditions for open seasons during which eligible individuals may elect coverage or change plans; make information available to employees concerning plan options; apply administrative sanctions to health care providers that have committed certain violations; and administer the program's financing. All plans also must complete quality-assurance reports as well as fraud and abuse case reports and submit these reports to OPM.
The Federal Employees Health Benefits (FEHB) Program provides health insurance to federal employees, retirees, and their dependents. This report provides a general overview of FEHB. It describes the structure of FEHB, including eligibility for the program and coverage options available to enrollees, as well as premiums, benefits and cost sharing, and general financing of FEHB. The report also describes the role of the Office of Personnel Management (OPM) in administering the program.
Eligible individuals include federal employees, retirees, and their family members. As of calendar year 2014, Members of Congress and certain congressional staff are no longer eligible to enroll in plans offered under FEHB as employees but may be eligible to enroll in retirement. Coverage options available to eligible individuals include individual or family coverage in an approved health benefits plan. Beginning in calendar year 2016, individuals have a third coverage option: self plus one coverage for themselves and one eligible family member. Generally, available health benefits plans fall into two broad categories: fee-for-service (FFS) or health maintenance organizations (HMOs). FFS plans tend to be available nationwide, and HMOs tend to be locally available. Premiums are shared between the federal government and the employee or retiree. Benefits and cost sharing vary among FEHB plans, but all plans must cover basic services such as hospital and physician care and may require cost sharing in the form of deductibles, co-payments, or coinsurance. FEHB financing includes government contributions to premiums, contingency reserves in the U.S. Treasury to offset unexpected increases in costs, and administrative expenses incurred by OPM.
The report also discusses how FEHB interacts with the United States Postal Service (USPS) and with Medicare as well as the impact of the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) on FEHB. Like most federal agencies, the USPS offers health insurance to its employees through FEHB. However, collective bargaining rights and prefunding obligations for retiree health costs make the USPS unique among federal agencies with regard to health benefits. Most federal employees or retirees aged 65 or older are automatically entitled to Medicare Part A (Hospital Insurance, or HI). They also may choose to enroll in Medicare Part B (Supplementary Medical Insurance, or SMI) and Part D (prescription drug coverage). For individuals covered under an FEHB plan, Medicare is the primary payer, meaning it pays for benefits first, and FEHB is the secondary payer. The ACA established new requirements for FEHB plans in some cases. In others, it had no meaningful effect. For example, the requirement to provide coverage to children up to the age of 26 on their parent's plan was a new requirement for plans, but many plans were already meeting the ACA requirement not to deny coverage based on preexisting conditions.
For information on the current plan year, such as premiums and cost sharing in FEHB and the most recent open season (the period each year during which individuals can enroll or change health plans), see CRS In Focus IF10324, The Federal Employees Health Benefits (FEHB) Program: Open Season for the 2016 Plan Year.