AnnieL. Mach
Analyst in Health Care Financing
Ada S. Cornell
Information Research Specialist
TheFederal Employees Health Benefits Program (FEHBP) has been in existence forover 50 years. Since its creation, it has provided private healthinsurance coverage to federal employees, annuitants, and their dependents.It is the largest employer-sponsored health insurance program in thecountry; in 2010, nearly 8 million individuals were covered under FEHBP.
The program was created by the Federal Employees Health Benefits Act of 1959(FEHBA, P.L. 86-382). FEHBA and its subsequent amendments established theparameters for eligibility and the election of coverage; the types ofhealth plans and benefits that may be offered; the level of the government’sshare of premiums; the Employees Health Benefits Fund to pay for program expenses;and provisions for studies, reports, and audits. FEHBA also outlined the roleof the Office of Personnel Management (OPM). By law, OPM is given theauthority to contract with insurers and to prescribe regulations to manageFEHBP, among other duties.
The general model of FEHBP has not changed since its inception in 1959. FEHBPwas and is a program that allows competing private insurers to offernumerous types of coverage to enrollees within broad federal guidelines.The federal government and the employee/annuitant have always shared thecost of the premium, and generally, employees and annuitants have always hadaccess to the same plans at the same cost. However, specific features ofFEHBP have been modified, in some cases multiple times, by Congress andOPM. For example, eligibility has been expanded to include additionaltypes of federal employees and dependents, the formula for determining the government’sshare of premiums has changed, and the types of health benefits offered through FEHBPplans have been broadened.
Congressional policymakers share responsibility with OPM for the program’sviability and sustainability. Congress has financial and administrativeinterest in the program, as the government pays for a share of FEHBPpremiums and Congress has legislative authority to modify FEHBP.Congressional interest in FEHBP also extends to FEHBP’s potential applicability asa model for other health care programs or as an avenue to provide coverage,such as extending aspects of FEHBP to Medicare, or using it as one of themodels for the state exchanges under the Patient Protection and AffordableCare Act (ACA, P.L. 111-148, as amended).
The purpose of the report is to provide historical and background informationthat helps explain how FEHBP has evolved into the program it is today.Policymakers may use this report to understand how Congress has interactedwith FEHBP in the past, and to inform its future interactions with FEHBP.Specifically, the report includes short discussions of how Congress has effectedand maintained policy changes to FEHBP by restricting the use of federal funds;changed the formula for determining the government’s share of FEHBPpremiums; expanded eligibility for the program; and implemented policiesthat affect the relationship between Medicare and FEHBP. The Appendix includesdetailed summaries of selected laws or provisions of laws that have directlyamended or otherwise changed FEHBP.
Date of Report: September 19, 2012
Number of Pages: 42
Order Number: R42741
Price: $29.95
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