Benefits Administration Letter
Number: |
04-404 |
Date: November 5, 2004 |
Subject: |
(UPDATED) 2004 Federal Employees Health Benefits (FEHB) Program Open Season: Significant Plan Changes Note changes that occurred after September 30, 2004. |
PURPOSE
The original Significant Events BAL was issued on September 30, 2004. This letter reflects changes that occurred after September 30, 2004; please make note of the following changes:
- The correct date for the most recent Significant Events BAL is October 25, 2004;
- Table One - In addition to the plans dropping out, Table One now includes plans that are merging with other plans; only the surviving codes will exist, the merged plan codes will no longer exist in 2005;
- Table Five - Universal Care of California will not offer an HDHP for 2005;
- Table Eight - Correct spelling of Strafford County in New Hampshire; and
- Table Eight - Counties were added for Oklahoma City, Oklahoma.
All other information remains the same.
TERMINATIONS
Table 1: Plans Dropping Out of the FEHB Program for 2005
Table 2: Plans Reducing Their Service Areas by Terminating an Enrollment Code
What Must Employees Do?
- Employees in terminating plans (Table 1) or in terminating codes (Table 2) must choose a new health plan during open season.
- New Coverage. Coverage under an enrollee's new health plan will be effective the first day of the pay period beginning on or after January 1, 2005; for most employees this will be January 9, 2005. Enrollees will remain covered and receive benefits under the old plan until coverage under the new plan becomes effective.
What Must You Do?
- You must notify employees in the terminating plans and enrollment codes to select new plans. Advise your employees that if they do not choose new health plans, they will not have coverage in 2005.
- We strongly recommend that you distribute copies of these lists to each employee, along with your agency's notice about open season.
- We also recommend that you follow-up with employees in these plans and remind them to select new plans.
- Belated changes. Some employees still might not get the word to change plans during open season. We encourage you to be liberal in accepting belated open season changes from employees enrolled in terminating plans/enrollment codes.
What Will Health Plans Do?
- Plan Notification: The plans in tables 1 and 2 have been instructed to notify enrollees of the need to select new health plans for 2005. However, because some plans' enrollment and address lists may not be up-to-date, we encourage you to accept belated changes.
SERVICE AREA REDUCTIONS
Table 3: Plans Reducing Their Service Areas Without Terminating an Enrollment Code
What Must Employees Do?
- Enrollees in the service areas being terminated must elect new health plans for 2005. Enrollees who do not choose new health plans will have to travel to their plan's remaining service area to receive full benefits.
OTHER CHANGES
Table 4: New Plans Entering the Program for 2005
Table 5: Existing plans offering a High Deductible Health Plan (HDHP) without new enrollment codes
Table 6: Existing and/or new plans offering HDHP with new enrollment codes
Table 7: Service Area Expansions With New Enrollment Codes
What Must Employees Do?
- Enrollees in these plans must make an enrollment change to enroll in the new code for their service area or elect another health plan during the open season.
What Must You Do?
- We strongly recommend that you distribute a copy of these lists to each employee, along with your agency's notice to employees about open season.
- If you do not distribute the lists, remind employees to check their new health plan brochures carefully to see if there have been any changes to their plans' service areas that will affect them.
Table 8: Service Area Expansions Without New Enrollment Codes
What Must You Do?
- You must include these new plans and expanded service areas when you count the number of eligible employees and place your orders for brochures.
Table 9: Plan Name Changes
Table 10: Plans Adding an Option
Table 11: Plans Adding a Point Of Service Product
Table 12: Plans Renaming an Option
Table 13: Plan Mergers
What Must Employees Do?
- Secret Service is merging with SAMBA for 2005. Enrollees in code Y7 will be enrolled in the new SAMBA standard option, code 444 (self only) or 445 (self and family). Enrollees should read the new SAMBA brochure carefully because there are major benefit changes from the plan they currently have. If enrollees do not want to be in this plan option, they must elect another health plan during the open season.
- Cimarron Health Plan is merging with Lovelace Health Plan. Enrollees in Cimarron (PX) will be automatically transferred into Lovelace Health Plan (Q1) unless they select another health plan during open season.
Table 14: Code Mergers
What Must Employees Do?
- Nothing, unless they want to select another plan during open season. Payroll offices will automatically move enrollees into the surviving code.
Table 15: Plans Splitting a Service Area
Table 16: Service Area Movement
SPECIAL NOTICE
Secret Service (enrollment code Y7) and SAMBA (enrollment code 44), both nationwide fee-for-service plans open to specific groups are merging their plans. Beginning in 2005, SAMBA is the surviving plan and it will have two options. Members of both organizations will be able to join either option. Unless the enrollees switch to another plan or option during open season, current SAMBA enrollees will automatically be enrolled in the high option and current Secret Service enrollees will automatically be enrolled in the standard option.
|
Frank D. Titus
Assistant Director
for Insurance Services
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