Last month, the U.S. Office of Personnel Management (OPM) announced new steps to make sure that the family members of federal employees and retirees in the Federal Employees Health Benefits (FEHB) program meet the eligibility criteria.
In a letter about benefits administration dated April 17, OPM outlined rules for federal agencies and carriers to follow regarding enrollment measures. These measures are aimed at ensuring thorough verification and review of the eligibility of family members.
OPM instructed agencies to confirm the relationships of employees with their spouses and family members whenever there’s a change in enrollment during Open Season. Specifically, the letter requires agencies to check a representative sample of family members included in Open Season elections from the previous year.
Additionally, OPM indicated that federal employees will need to provide documentation proving eligibility for all new family member enrollments during Open Season in the following years.
OPM is also taking steps to identify and address improper enrollments. It has developed the FEHB Master Enrollment Index (MEI) to conduct queries that can identify certain irregularities in existing enrollments. If any irregularities are detected that require further investigation, OPM will inform agencies to review those enrollments. Currently, OPM mandates that agencies inform enrollees about the consequences of improper enrollments, which may include fines and imprisonment.
“These actions continue the progress made over the years in addressing issues related to FEHB enrollments,” OPM stated. “Together, these requirements ensure that agencies verify documentation provided during each key period when an employee might make changes.”
