Talk:Federal Employees Health Benefits Program

There is a comment that "opening enrollment in this plan to all Americans, which would certainly have changed it drastically." I'm wondering if someone can clarify how it would be changed/what would change about it? It seems like this approach may be proposed again soon, so if there's a downside, it'd be a good idea to know what that is.Wiki15rich (talk) 18:12, 21 June 2009 (UTC)

Criticism of the FEHBP

The article includes criticisms that may be opinions rather than facts.

1.

A chief criticism of this program's legislation and management is that the purchasing power of the Federal Government is not utilized to draw down premiums and expand coverage.

Presumably the competition between approved plans for a larger share of the huge Federal work force causes some price pressure. Also, the insurance providers presumably have savings due to automatic premium deductions, and savings from not having to research preexisting conditions and general health status of their customers.

2.

In the FEHBP, the Federal Government sets standards that, if met by an insurance company, allows them to participate in the program. The result is numerous competing insurance plans that are available to Federal Employees, but which vary only marginally in price and coverage, and which results in choice overload.

True, it does take some effort to sort out which plan will be best for your existing and anticipated health conditions. However, assistance in making these decisions can be had by reviewing Checkbook Magazine's or other annual comparison guides. HM plan usually are rated as lest costly in these evaluations, but also usually have the most restrictions on the patients choice of health care providers and the freedom to go to a specialist or out-of-plan hospital. Some plans charge co-pays of as much as 50% of a brand name drug's cost, while others may charge a relatively small (e.g., $35) fixed co-pay for brand name prescription drugs. The list of participating physicians and hospitals can also affect the choice of insurance plan, although usually doctors are either enrolled in all plans or take no insurance. The OPM standards ensure that many of the most important points of health insurance, such as a limit on a patient's out of pocket expenses, are included in all the plans. The OPM also acts as an arbitrator in disagreements between a plan administrator and an employee over coverage.

3.

... it has been proposed that the Federal Government give notice that it is interested in only offering a few plans for Federal employees to choose from, and that it would accept bids from companies for the best proposals possible. The benefits of such a process would be lower costs to the Federal Government and employee, and greater health coverage under the plans.

The current plans are in competition for enrolling employees in their plans. They thus already have an inducement to offer the best plans possible. After each year's experience the plans make adjustments to their terms, some times because they were too generous with some provision and attracted to many employees who knew they would utilize that particular service. On the other hand, the terms that the plans can afford to offer depend on how successful they are in their negotiations with health care providers over the how much the plan will have to pay for health care for its insured. Larger insurers may have greater bargaining clout than than smaller ones, so one might expect some cost reduction if there were fewer plans. However, whether or not this would happen needs to consider that many of the small plans are managed by a small number of very large health insurers, such as Wellpoint and CIGNA. Most plans offer reduced prescription drug co-pays if ordered from their mail pharmacy. All the plans I am familiar with have used one of two major mail pharmacies, Caremark or Medco.

Btm1 (talk) 20:06, 24 October 2009 (UTC)

I am brand new to Wikipedia and haven't mastered most of the techniques and protocols. Apologies in advance for any errors. I have quite substantially edited, expanded, revised, footnoted, and otherwise improved the subject article. I've removed a number of mostly minor inaccuracies as well (for example, it used to say that the program was only available for full-time employees and only after a probationary period; both false).

The first talk page criticism says that the article had criticisms that were opinions rather than facts. Indeed it did. I have removed or very substantially edited these. In a couple of cases I left in a criticism simply to rebut it. Some of my rebuttals may arguably commit the same sin, but sometime there is no other convenient way to respond to such criticisms. And it is hard to prove a negative. If hard pressed, I can modify, eliminate, or find written support.

Some of the material that a previous editor removed was essentially accurate but simply not well worded or documented. I may later put some of it back, suitably edited. The edits I have made so far represent only the minimum to get the article into a semblance of accuracy; many more pages of info could be added, along with dozens of other references, and I will probably do a bit of that from time to time.

I am apparently supposed to sign off with a bunch of tildes that look to me like they leave code, so I will do this hoping it is helpful. My "name" for Wiki purposes is Publiusprimo and I have entered some info on my background. Unstated there, but in fact the case, I am one of the handful most knowledgeable people about the FEHBP in the world.

Publiusprimo (talk) 03:13, 29 January 2010 (UTC)

Infobox Too low and incorrect

Can we move that contents box up and fix it? Its too low and does not work well at all.

98.110.157.174 (talk) 20:48, 5 April 2010 (UTC)

Structure

This is hard to read. I've placed some subtitles there to try to help readers, but a lor more structure is needed. Sounds like gobbledegook. Maybe it's just too much at one time. Structure would help leaven what the reader sees at one gulp. Student7 (talk) 00:41, 25 April 2010 (UTC)

Updated Article

I updated the article to correct the error that all federal employees are eligible for FEHB. This has changed due to the Affordable Care Act. Under the Affordable Care Act, at least members of congress and their staff are no longer eligible for FEHB. I think this applies to the executive branch as well (I know it applies to the president), but I am not sure and therefore did not put it into the article. — Preceding unsigned comment added by 159.118.66.116 (talk) 17:35, 1 January 2014 (UTC)