On December 21, 2011, the Office of Personnel Management (OPM) released a Dear Tribal Leader letter (Letter) regarding the implementation of Section 409 of the Indian Health Care Improvement Act (IHCIA), Access to Federal Insurance. This Memorandum summarizes the contents of the Letter including the following attachments: the Timeline for purchasing Federal Employees Health Benefits (FEHB), the Federal Employees Health Benefits Guide for Tribal Employees, the FEHB FastFacts for Tribal Employees, and the 2012 Tribal Employee Premiums rates tables for HMOs and Fee for Service plans. The Letter along with all attachments discussed below may be viewed at www.opm.gov/tribalprograms.
Section 409 of the IHCIA provides that 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 of the IHCIA, are eligible to purchase Federal Employee Health Benefits and Federal Employees Group Life Insurance (FEGLI) coverage. Implementation of the FEGLI program will follow after implementation of the FEHB Program.
1. Upcoming Deadlines for FEHB Coverage
Tribes carrying out programs under the ISDEAA and Title V may begin to enroll their employees on March 22, 2012, for an effective date of coverage on May 1, 2012. All tribes, tribal organizations, or urban Indian organizations that wish to participate in the FEHB Program with a May 1, 2012, effective date must notify OPM by February 1, 2012. To notify OPM, please email email@example.com. Tribal employers choosing not to purchase coverage during the initial enrollment period may choose to do so at a later date in accordance with the deadlines shown in the Timeline. For example, tribal employers that wish to participate in the FEHB Program with an effective date of June 1, 2012, must notify OPM of their intent to participate by March 1, 2012.
2. Information Released for Tribal Employees
Attached to the Dear Tribal Leader letter is the 2012 FEHB Guide for Tribal Employees as well as a FastFacts sheet for Tribal Employees. The FEHB Guide for Tribal Employees is designed to provide employees with basic information about the benefits offered to the employee of an entitled tribe, tribal organization, or urban Indian organization that has chosen to participate in the FEHB program. The Guide will assist employees with the process of selecting and enrolling in a plan that meets their individual health care needs and explains the initial enrollment process, the FEHB program, the FEHB Program Health Information Technology and Price/Cost Transparency, and the Pre-Existing Condition Insurance Program. The FastFacts sheet is designed to provide answers to basic questions regarding the FEHB Program.
3. Information for Tribal Employers and Notice of Forthcoming Handbook
In the Dear Tribal Leader letter, OPM explained that by electing to purchase FEHB coverage for employees, the tribal employer agrees to use the FEHB coverage as the sole source of employer-sponsored health insurance coverage for all eligible employees and thus a tribal employer may not choose to provide FEHB coverage for some employees while retaining alternative health insurance coverage for other employees. OPM noted that further information for tribal employers will be forthcoming including regulations and a handbook for tribal employers’ human resources offices.
4. Information Regarding Costs and Rates
The Dear Tribal Leader letter explains that tribal employers electing to purchase FEHB for their employees will be responsible for the administrative costs associated with processing enrollments and paying premiums. These administrative fees are considered an employer cost separate from health plan premiums and cannot be passed on to employees. OPM estimates that for 2012, administrative fees will be $15.15 per employee per month based on an estimated enrollment of 25,000 tribal employees but notes that if enrollment reaches 50,000 tribal employees, the administrative fee will be reduced to approximately $9.00.
Tribal employers must also pay, at minimum, the same employer contribution as federal agencies, which is approximately 72 percent of premiums. OPM has provided the 2012 Tribal Employee Premiums rates tables for HMOs and Fee for Service plans. Additionally, tribal employers will be billed by the National Finance Center on a monthly basis for total premiums which include the employer and employee share plus the employer’s administrative fees. Tribal employers are then responsible for collecting the employee share of the premiums.
Please let us know if we may provide additional information or assistance regarding tribal access to the Federal Employee Health Benefit program.