WASHINGTON, DC – The Office of Personnel Management has introduced new measures aimed at safeguarding the Federal Employees Health Benefits Program for family members of federal employees and retirees.
The initiative outlined by OPM Associate Director Lore Bodenheimer seeks to enhance the integrity of the FEHBP following reported gaps in determining eligibility and potential improper payments ranging from $500 million to $3 billion annually.
In response to these findings, federal agencies will be required to review the eligibility of family members participating in FEHBP during Open Season elections, with an initial 10% random sample to be expanded in the future. OPM plans to issue further guidance on verification processes in upcoming years.
A newly established “master enrollment index” will be utilized by OPM to detect irregularities and prompt agencies to conduct reviews. Additional guidelines on this process are expected to be released in the coming months.
The agency’s efforts align with a legislative proposal accompanying President Biden’s fiscal 2025 budget, aiming to create a centralized enrollment system for FEHBP similar to the Postal Service Health Benefits Program. This proposed system would streamline enrollment procedures for the program’s over 8 million members and enhance consistency in managing eligibility.
While OPM faces budget constraints on conducting audits recommended by the Government Accountability Office, the House Oversight and Reform Committee has advanced legislation calling for such audits. Committee Republicans have indicated openness to amending the bill to secure funding pending assessment by the Congressional Budget Office.
Overall, the new measures implemented by OPM signal a proactive approach to address vulnerabilities in the FEHBP and ensure the program’s sustainability and integrity for federal employees and retirees and their families.