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, Consultation to implement FEHB and FEGLI in tribal communities began in October 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. Materials Provided by the 2012 National Indian Health Outreach and Education Grant

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. Materials Provided by the 2012 National Indian Health Outreach and Education Grant

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 Materials Provided by the 2012 National Indian Health Outreach and Education Grant

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. Materials Provided by the 2012 National Indian Health Outreach and Education Grant

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 Materials Provided by the 2012 National Indian Health Outreach and Education Grant Signed Statement of Intent Effective Date of Coverage Last Day of Initial Enrollment Opportunity Last Day of data entry into TIPS 4/1/20127/1/20126/5/20126/11/2012 5/1/20128/1/20127/10/20127/16/2012 6/1/20129/1/20128/7/20128/13/2012 7/1/201210/1/20129/4/20129/10/2012 8/1/201211/1/201210/9/201210/15/2012 9/1/201212/1/201211/6/201211/12/2012

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 – Alabama Aetna HealthFundTotal PremiumTribe PaysEmployee Pays CDHP Self CDHP Family HDHP Self HDHP Family Materials Provided by the 2012 National Indian Health Outreach and Education Grant

HMO – Alaska Aetna HealthFundTotal PremiumTribe PaysEmployee Pays CDHP Self CDHP Family HDHP Self HDHP Family Education Materials Provided by the 2012 National Indian Health Outreach and Education Grant

HMO – Arizona Aetna HealthFundTotal PremiumTribe PaysEmployee Pays CDHP Self CDHP Family HDHP Self HDHP Family Aetna Open AccessTotal PremiumTribe PaysEmployee Pays High Self High Family Heal Net of Arizona, IncTotal PremiumTribe PaysEmployee Pays High Self High Family Standard Self Standard Family

HMO – Arkansas Aetna HealthFundTotal PremiumTribe PaysEmployee Pays CDHP Self CDHP Family HDHP Self HDHP Family QualChoiceTotal PremiumTribe PaysEmployee Pays High Self High Family Standard Self Standard Family

HMO – California Aetna HealthFundTotal PremiumTribe PaysEmployee Pays CDHP Self CDHP Family HDHP Self HDHP Family Aetna Open AccessTotal PremiumTribe PaysEmployee Pays High Self High Family Blue Shield of CA Access+Total PremiumTribe PaysEmployee Pays High Self High Family

HMO - California 24 Health Net of CaliforniaTotal PremiumTribe PaysEmployee Pays High Self High Family Standard Self Standard Family Health Net of CaliforniaTotal PremiumTribe PaysEmployee Pays High Self High Family Standard Self Standard Family Kaiser Foundation Health Plan of CA Total PremiumTribe PaysEmployee Pays High Self High Family Standard Self Standard Family

HMO – California Kaiser Foundation Health Plan of CA Total PremiumTribe PaysEmployee Pays High Self High Family Standard Self Standard Family UnitedHealthcare of CATotal PremiumTribe PaysEmployee Pays High Self High Family

Questions For more information: – Contact Me: Insert trainer name and contact information – Contact OPM: Materials Provided by the 2012 National Indian Health Outreach and Education Grant