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2. Federal Employees Health Benefits for Tribal Employees National Tribal Health Reform Training April 18, 2012 2

3. Agenda Introduction Federal Employees Health Benefits (FEHB) for Tribal Employees Tribal Employer Participation in FEHB Tribal Employee Enrollment in FEHB 3

4. Agenda (cont.) What is OPM Doing for Outreach? What is OPM Doing for Employer Guidance? Questions 4

5. INTRODUCTION 5

6. Law Affordable Care Act (ACA), Section 10221(codified as 25 U.S.C. 1647b) Entitles certain tribal employers to purchase the coverage, rights, and benefits of FEHB for their employees 6

7. Enrollments Effective dates: – May 1 18 tribal employers 2,843 enrollees – June 1 7 tribal employers 1,542 enrollees 7

8. FEHB FOR TRIBAL EMPLOYEES 8

9. FEHB Program 91 available plans (206 choices) with same benefits and same provider networks No waiting periods or pre- existing condition limitations 9

10. FEHB Program (cont.) Temporary Continuation of Coverage 31-day extension Conversion to individual policy 10

11. FEHB Program (cont.) Choices: –Plan Types: Fee-for-service, HMOs, HDHPs and CDHPs ‒ Options: High and Standard ‒ Enrollment types: Self and Self and Family 11

12. FEHB Program (cont.) Other Features of FEHB for tribal employees: Cannot carry FEHB into retirement No spouse equity or survivor enrollments Tribal employer premiums are billed/ paid to the National Finance Center (NFC) on a monthly basis 12

13. TRIBAL EMPLOYER PARTICIPATION IN FEHB FOR TRIBAL EMPLOYEES 13

14. Eligibility Tribes and tribal organizations carrying out programs under the Indian Self- Determination and Education Assistance Act (ISDEAA), and urban Indian Organizations carrying out programs under title V, are eligible to purchase FEHB and FEGLI coverage. Tribes carrying out programs under the ISDEAA and title V may purchase coverage for all tribal employees meeting the common law employee standard. 14

15. Notification of Interest to OPM Signed Application Package Effective Date of coverage 2/1/2012 3/1/20125/1/2012 3/1/20124/1/20126/1/2012 4/1/20125/1/20127/1/2012 5/1/20126/1/20128/1/2012 6/1/20127/1/20129/1/2012 7/1/20128/1/201210/1/2012 8/1/20129/1/201211/1/2012 9/1/201210/1/201212/1/2012 FEHB Coverage Timeline 15

16. Tribal Employer Participation First effective coverage date: May 1, 2012 Enter in any time after that date –Monthly, rolling basis 16

17. Notification of Interest At least 3 months in advance of the effective coverage date Notify OPM by either –Emailing at tribalprograms@opm.govtribalprograms@opm.gov –Calling the Tribal Desk: 202.606.2530 OPM confirms the interest –Sends Expressed Interest Fact Sheet for tribal employer to fill out –Sends application packet 17

18. Signed Agreement At least 2 months in advance of the effective coverage date Application Packet –Agreement –Contact Information –Billing Unit Information –Bank Account Information –Temporary Continuation of Coverage Memorandum of Understanding 18

19. Signed Agreement (cont.) Email tribalprograms@opm.govtribalprograms@opm.gov –Mail to OPM U.S. Office of Personnel Management Federal Employee Insurance Operations Attn: Demi Mozian 1900 E Street NW, Room 3425 Washington, D.C. 20415 Receive Acknowledgement Letter from OPM 19

20. Initial Enrollment Opportunity (IEO) The Initial Enrollment Opportunity (IEO) occurs when a tribal employer begins participating in the FEHB Program and offers FEHB to eligible tribal employees 20

21. Tribal Employer IEO Responsibilities 5. Enter data into Tribal Insurance Processing System (TIPS) 4. Collect and Verify Enrollments 3. Provide Guidance 2. Build Awareness 1. Provide Access to IEO Materials 21

22. Summary 1.Notify OPM of Intent (3 months) 2.Sign Agreement with OPM (2 months) 3.Hold Initial Enrollment Opportunity (prior to coverage) 4.Enter Data Into TIPS 22

23. TRIBAL EMPLOYEE ENROLLMENT IN FEHB 23

24. Tribal Employee’s Role During the IEO? 4. Submit the SF 2809 to your tribal employer 3. Complete the Health Benefits Election Form - Standard Form (SF 2809) 2. Choose the best FEHB plan for you 1. Review the plans available in your area 24

25. Summary of Enrollment Process Tribal employee fills out SF 2809 Tribal employee submits SF 2809 to tribal employer Tribal employers enter the SF 2809 data for employees into the Tribal Insurance Processing System (TIPS) –National Finance Center maintains TIPS (the online FEHB enrollment portal) TIPS  Carriers 25

26. National Finance Center Acts as paymaster/payment service provider for tribal employers Maintains FEHB enrollment system Collects premium payments Conducts FEHB enrollment reconciliation 26

27. Premium Collection Collected monthly on retroactive basis Tribal employer designates a bank account Total amount of premiums must be in the account at time of collection NFC collects the money and passes it onto OPM OPM forwards the money to the carriers 27

28. Enrollment After the IEO After the tribal employer enrolls: –New tribal employee (or newly eligible to enroll) can enroll ‒ Same as Feds –Annual Open Season ‒ Same dates as Feds but January 1 st effective date following Open Season ‒ Certain Qualifying Life Events (QLEs) ‒ Same as Feds 28

29. WHAT IS OPM DOING FOR OUTREACH? 29

30. OPM Outreach –Participation in White House Affordable Care Act outreach calls to provide updates to tribal leaders –Formal Consultative Session –Attended conferences for ANHB, NIHB, NCAI, USET, CRIHB, NNAHRA, Self-Governance Tribes –Federal/Technical Work Group –Open Call 30

31. OPM Outreach (cont.) Dear Tribal Leader Letters –October 5, 2010: Questionnaire –May 2, 2011: Announcing Consultation –December 21, 2011: Coverage Timeline www.opm.gov/tribalprograms TribalPrograms@opm.gov 202.606.2530 31

32. Technical/Federal Workgroup (TFW) Assist with technical and operational detail related to FEHB implementation Tribal –Knowledgeable individuals familiar with existing tribal healthcare enrollment and payroll systems –From Barrow, Alaska to Hollywood, Florida Federal –Members of OPM’s Tribal Teams –Director of Healthcare and Insurance 32

33. TFW: Results Ability for a tribal employer to have multiple billing units Ability for a tribal employer to do an electronic upload of enrollment data into the Tribal Insurance Processing System (TIPS) Ability to have access to enrollment and eligibility reports from TIPS –Creation of specific billing reports for tribal employers 33

34. TFW: Results (cont.) Frame and give context to the Initial Enrollment Opportunity timeline Understanding of: –Tribes interaction with carriers –Modes of distributing documentation 34

35. WHAT IS OPM DOING FOR EMPLOYER GUIDANCE? 35

36. Tribal Teams Materials Team Training Team Carrier Team –Carrier Workgroup Technical Team –NFC Teleconference Technical/Federal Workgroup 36

37. Resources Tribal FEHB Handbook FEHB Guide for Tribal Employees Tribal FastFacts Tribal Quick Guide Forms Guidance –SF 2809 for Tribal Employees –SF 2809/SF 2810 for Tribal Employers Training presentations 37

38. Resources (cont.) www.opm.gov/tribalprograms Tribal Programs Listserv –Tribal Benefit Administration Letters (TBALs) Tribal Desk –Phone: 202.606.2530 –Email: tribalprograms@opm.gov 38

39. Training Training Modules –FEHB 101, FEHB Enrollment, Eligibility, Guidance to SF 2809 and SF 2810, and Finance –Will be available on website with Speaker’s Notes Training –3rd Friday of each month at OPM in DC –Webcasts and teleconferences – notices on tribal listserv TIPS Training –Done by NFC 39

40. Carriers Carrier workgroup Carrier Letter Training and outreach Ability to create a tribal liaison contact 40

41. The End Thank You! Any Questions? 41