Special Initiatives Self Plus One

A Self Only enrollment covers only the enrollee. A Self and Family enrollment covers the enrollee and all eligible family members. The new Self Plus One enrollment type covers the enrollee and one eligible family member you designate to be covered.

A Self Plus One enrollment covers the enrollee and one designated eligible family member. The definition of eligible family  members has not changed. Your eligible family member can include either a spouse OR a child up to age 26. A child age 26 or over who is incapable of self-support because of a mental or physical disability that existed before age 26 is also an eligible family member.

Yes. You can always make changes to your plan during Open Season. In addition, you can make changes if you experience a Qualifying Life Event. For example, if you are currently married and chose a Self Plus One enrollment, in the event you divorce,  you can make a change to Self Only. Alternatively, you can change to Self and Family if you have an eligible child. Other QLEs allow you to make changes as well. You can see a list of all your QLE opportunities on the SF 2809.

The Limited Enrollment Period (February 1-February 29, 2016) allows individuals participating in premium conversion (pre-tax deduction of premiums from paycheck) to decrease enrollment from Self and Family to Self Plus One. Individuals who do not participate in premium conversion ( such as annuitants) can decrease enrollment at any time. No other enrollment changes will be allowed   Contact your Human Resources office for additional information.

No. Only legally married spouses are considered eligible family members under any FEHB enrollment, including Self Plus One.  This has not changed with the addition of the new Self Plus One enrollment type.

You will be able to increase or decrease your enrollment type during the annual Open Season, or outside of Open Season if you experience a QLE that is consistent with current FEHB guidelines. A full list of QLE codes and their definitions will be outlined in the updated SF2809, which will be available soon.   Note: individuals who do not participate in premium conversion, including annuitants, may decrease their enrollment at any time.

To switch a covered family member you must complete a Standard Form 2809. You will not be able to directly contact your carrier to make this change. Contact your agency benefits officer for more information.

No, you do not have to be enrolled in Self Plus One for the five years before you retire to meet the five-year requirement. You need to be enrolled in FEHB for five years before you retire, or for the entire time for which you were eligible to be enrolled, and retire on an immediate annuity  to be eligible to continue coverage into retirement.

Benefits do not differ between enrollment types. However, there may be a difference in cost-sharing for some plans. For example, deductible amounts and out of pocket expenses may differ between enrollment types. Please review your plan brochure available at www.opm.gov/fehbbrochures for details.

You are able to switch a covered family member during the annual Open Season and outside of Open Season upon experiencing a change in family status, a change in coverage, or a change in eligibility, as long as switching the family member is consistent with the QLE experienced. For example, if an enrollee has a spouse and a child, but only covers their spouse with a Self Plus One enrollment, in the event that the enrollee and spouse are divorced, the enrollee may choose to stay in Self Plus One and switch their covered family member to terminate their spouse’s coverage and add their eligible child to the enrollment. However, if an enrollee covers a spouse under a Self Plus One enrollment and then has a child, the enrollee would be allowed to increase to Self and Family to cover all of their eligible family members, but not to switch from covering their spouse to covering their new child under a Self Plus One enrollment. A full list of QLE codes and their definitions will be outlined in the updated SF2809, which will be available soon.

Total premiums for Self Plus One will be less than or equal to total premiums for Self and Family for all plan options available in plan year 2016. However, after the Government Contribution is applied, it is possible that some plans will have higher enrollee shares for Self Plus One enrollments than for Self and Family enrollments.

 OPM, your agency, and your carrier cannot make enrollment decisions for you. However, for 95% of FEHB enrollees currently in Self and Family with only one eligible family member, it makes financial sense to decrease your enrollment to Self Plus One as your premium will be lower. It is important to take a look at your plan details, including premiums and benefits, before making an enrollment decision. If you do not change your enrollment to Self Plus One during Open Season, you will remain in Self and Family and will not be able to change your enrollment until either next year’s Open Season or if you experience a Qualifying Life Event (QLE) throughout the year.

As long as your spouse has a Self Plus One enrollment, you are still married to your spouse, and you are listed as the designated covered family member, you will be covered under the enrollment. Your eligibility for coverage under your spouse's Self Plus One enrollment will cease after a divorce or annulment. You may, however, be eligible for FEHB coverage under either the Spouse Equity provisions or the Temporary Continuation of Coverage provisions of the law. If so, you would be enrolled in your own right and would pay both the Government and employee shares of the premium yourself.

For most enrollees (95%), the enrollee share for Self Plus One will be lower than the enrollee share for Self and Family. However, it is possible that some plans will have higher enrollee shares for Self Plus One enrollments than for Self and Family enrollments. The statutory formula that is used to calculate the Government Contribution is based on the average of all plan premiums and requires that OPM calculate a maximum contribution for each enrollment type. In other words, there is a limit to how much the government will contribute towards the cost of a Self Only, Self Plus One, or Self and Family enrollment. The government contributes the lesser of the maximum contribution or 75% of the total premium. The remaining amount is the enrollee share (how much the enrollee must pay). In some cases, such as plans with a premium cost that is above the program average, this calculation may result in a higher enrollee share for a Self Plus One enrollment than a Self and Family enrollment.

 Premiums vary based on the claims experience of each carrier. For the 2016 plan year, OPM required that Self Plus One total premiums be less than or equal to Self and Family premiums.  For the 2017 plan year, OPM will consider the claims experience in the new Self Plus One enrollment type.

No, you do not have to be enrolled in a Self Plus One plan option for the five years before you retire to meet the five-year requirement. As a retiree who does not participate in premium conversion, you can enroll decrease your enrollment from Self and Family to Self Plus One at any time. If you wish to increase your enrollment from Self Only to Self Plus One, you may do so during Open Season or when if you experience a Qualifying Life Event.

If you are an annuitant or an employee who waived premium conversion, you can decrease enrollment at any time. If you are an employee who participates in premium conversion, your youngest child turning age 26 is a qualifying life event (QLE) permitting you to change your FEHB enrollment outside of Open Season.  With this QLE, you can decrease your enrollment. You do not need to wait until the next Open Season to make this change; however, you need to request the change to decrease your enrollment within 60 days of your child turning 26

An enrollee is not required to enroll in Self Plus One. If an enrollee wants to stay in his or her current plan and enrollment type, the enrollee may remain in Self and Family and does not need to do anything during Open Season. Alternatively, the enrollee may select a new plan option with a lower enrollee share. OPM encourages enrollees to review their enrollment options each Open Season before making an enrollment decision.

Yes, there are nationwide plans available with lower enrollee shares for Self Plus One than Self and Family.