Posted on Friday, 17th May 2024 by

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The Office of Personnel Management (OPM) announced a centralized enrollment platform for the postal service last year and they requested funds for FY 2025 to extend this central enrollment system to all Federal Employee Health Benefits (FEHB) enrollments. This would allow OPM to manage and make consistent all FEHB enrollments and remove individuals who cease to be eligible for the program.

Current FEHB eligibility determination and enrollment is highly decentralized and requires cooperation between nearly 100 employing offices responsible for determining eligibility and enrolling more than 8 million members. These benefits are delivered by 68 health insurance carriers in 2024.

Centralized Health Benefits Enrollment

The current FEHB Program’s enrollment functions utilize independent systems at different Federal agencies. For purposes of the Postal Service Health Benefits (PSHB) Program, OPM is shifting certain responsibilities from the employing office to a centralized enrollment system administered by OPM.

This centralized enrollment system will be an electronic enrollment solution for all PSHB stakeholder groups including enrollees, the Postal Service and other employing offices, and PSHB Carriers. The centralized enrollment system will include an online portal to enter and process enrollment transactions, verification of eligibility, decision support tools, and a customer support center to assist enrollees via phone, email, or online chat.

Those unable to access the online portal will be able to enroll through other means such as phone, fax, or mail. OPM will assume responsibility for the following health benefits actions for the PSHB Program: enrollment, changes of enrollment, correction of errors, election not to enroll, and disenrollment of enrollees and removal of family members.

The final rule for the PSHB centralized enrollment was published 5/6/2024 in the Federal Register.

Note: A centralized system for the FEHB program is pending requested funding.

Family Member Eligibility Reviews (On the Horizon)

On April 17, 2024, OPM’s annual Benefits Administration Letter (BAL) was released to Promote the Integrity of the Federal Employees Health Benefits Program.

Employing offices must validate certain Open Season elections starting with the 2024 Open Season.  The Family Member Eligibility Review (FMER) requires a random sampling of FEHB Open Season elections of Self Plus One and Self and Family enrollment types.

This letter outlined requirements for federal agencies and carriers regarding new enrollment actions that will ensure comprehensive verification and review of family member eligibility:

  • Directs agencies to confirm employees’ relationships to spouses and family members when an enrollment change is made during Open Season. Specifically, the BAL requires that agencies verify a meaningful sample of family members included in Open Season elections from the prior year.
  • Federal employees will be required to provide eligibility documentation for all new family member enrollments during Open Season in subsequent years.
  • OPM will use its newly completed FEHB Master Enrollment Index (MEI) to run queries that can spot certain enrollment irregularities in existing enrollments. If irregularities are found that merit further inquiry, OPM will notify agencies to review those enrollments. OPM currently requires all agencies to notify enrollees of the consequences of improper enrollments, including fines and imprisonment.

Health Benefit Program’s Call Letter

Benefit and rate proposals for Federal Employees Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) Program Carriers are due May 31, 2024. Benefit negotiations are expected to be complete by July 31, 2024, and rate negotiations by mid-August for the upcoming open season.

The primary areas of focus for the upcoming plan year for Carriers are:

  • FEHB and PSHB Coordination with Medicare
  • FEHB Prescription Drug Coverage
  • PSHB Prescription Drug Coverage, and
  • Fraud, Waste, and Abuse.

Many providers added Part D Prescription Drug Plans (PDP) that are automatically implemented unless the enrollee opts out.  All Carriers are required to provide guidance to eligible enrollees focused on Medicare coordination, including the potential effects of the Income Related Monthly Adjustment Amount (IRMAA) that applies to both Part B and Part D Medicare plans.

FEHB Prescription Drug Coverage

According to the call letter., “OPM requires FEHB Carriers to provide prescription drug benefits that meet CMS requirements for Creditable Coverage. FEHB Carriers are required to continue offering Creditable Coverage in 2025.”

Any prescription drug benefit changes FEHB Carriers need to make to continue to meet the Creditable Coverage requirements in 2025 do not need to be cost neutral. This means Carriers have the option to change benefits, increase premiums, or a combination of both. We have to wait until negotiations are complete to determine next year’s coverage and premiums.

FEHB and Medicare Part D Coordination

OPM is continuing to consider FEHB proposals that include CMS-approved Medicare Advantage -Prescription Drug (MA-PD) or Prescription Drug Plan (PDP) Employer Group Waiver Plans (EGWPs) for 2025. Many Carriers are offering a (MA-PD EGWP) to FEHB enrollees who are entitled to Medicare Part A and enrolled in Medicare Part B.

Last year Blue Cross Blue Shield and others offered automatic signup for their Part D PDP; enrollees had to opt out of the option if they wanted to retain their original FEHP prescription drug coverage. I wrote two articles on the PDP plans last year that you may find informative:

Be aware that if your Modified Adjusted Gross Income (MAGI) is over certain limits you will be subject to an Income Related Monthly Adjustment Amount (IRMAA) for Part B and D premiums. This is explained in detail in the above two articles.


There is always much to consider when selecting your health care plan during open season. Many things are happening throughout the year that impact plans next year, such as the new Postal Service Benefit Plan with its Part D enrollment requirement.

If your current plan isn’t meeting your needs or if you signed up for a FEHB MA plan last year that isn’t working out for you, open season starts this November. Plus, if you experienced a qualifying life event you can always make changes within specific limits.

For example, you have 31 days before your marriage to 60 days afterward to change to a family health benefits enrollment. You can add a new spouse and convert to a family or the self plus 1 plan during the next open season if you miss this deadline.

Helpful Retirement Planning Tools

Disclaimer: The information provided may not cover all aspect of unique or special circumstances, federal regulations, medical procedures, investment, and benefit information are subject to change. To ensure the accuracy of this information, contact relevant parties for assistance including OPM’s retirement center.

Over time, various dynamic economic factors relied upon as a basis for this article may change. The information contained herein should not be considered investment advice and may not be suitable for your situation. This service is not affiliated with OPM or any federal entity. You should consult with a financial, medical or human resource professional where appropriate. Neither the publisher or author shall be liable for any loss or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

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