GEHA discusses Open Season options

Thursday - 11/4/2010, 3:20pm EDT

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November 8, 2010 -- Open Season began Monday and ends December 13.

For Your Benefit host Tammy Flanagan discussed options for GEHA (Government Employees Health Association) plans and changes in 2011 with Jane Overton, vice-president of claims for GEHA.

Premium changes

  • High option: The premium will increase 2 percent for self-only and 3 percent for self and family in 2011.
  • Standard option: The premium will increase 8 percent in 2011.
  • High-deductible: For the third year in a row, there is no premium increase.

The number of enrollees in the high and standard options are about the same. Most retirees are enrolled in the high option and the standard option is growing the fastest, Overton said.

High-deductible plans
GEHA's high-deductible option, introduced three years ago, now has 4,000 members, Overton said.

During last week's For Your Benefits show, Walton Francis, editor of Checkbook Guide to Health Plans for Federal Employees, explained that a high-deductible plan allows you to open a health care savings account.

The plan is suitable for nearly everyone except for people with high, predictable medical costs, Francis said.

"It is based on your individualized need if this (high-deductible plan) is the right product for you," Overton said.

Flanagan said the health care savings account can be used to cover future medical expenses.

"There no 'use it or lose it' provision," Overton said. "You can carry [the health care savings account] over another year."

Standard vs. High
The biggest difference between the standard and high GEHA options are the prescription drug benefits. The standard plan pays 50 percent of brand-name drugs, while under the high plan, members pay 25 percent of the brand-name drug cost at a retail pharmacy up to a $150 maximum.

One option for feds is to enroll in the standard GEHA option and Medicare Part D, Overton said.

"Between Medicare Part D and GEHA -- high or standard -- you'd probably be able to get most of your prescription drug expenses reimbursed," Overton said.

She added a caveat: "It's very important you choose the right plan because not all Part D plans cover all medications."

Expanded coverage
GEHA is expanding benefits for smoking cessation. There is no cost for counseling sessions for people trying to quit, and this includes all members -- not just those with a medical condition. GEHA will also cover 100 percent of prescription and non-prescription costs for quitting smoking.

"We just want you to quit smoking," Overton said.

Under the health care reform legislation, children up to age 26 can be covered. Members with self and family options do not have to change their plans during Open Season. They can simply go to the GEHA website, call or request an application.

However, members with self-only coverage who want to cover their adult children must change plans during Open Season, Overton said.

Under both high and standard options, preventative care is covered at no cost if members use a preferred provider. All routine vaccines -- such as flu, H1N1 and pneumonia shots -- are covered both in and out of network, Overton said.

Part B Pilot program
"The trend is for new federal retirees not to enroll in Part B," Overton said.

This has a "significant impact" on federal health plans.

Starting in 2011, if you are a high-option member, GEHA will subsidize you $75 a month for self and $150 for self and spouse if you are enrolled in Medicare Part B, as part of a pilot program.

Members who want to join the pilot can also enroll in Part B during Medicare's open enrollment and have Part B effective next July, Overton said. Both the member and spouse must be retired, she added.

Normally if you have both the high option and Medicare Part B, GEHA waives the Medicare deductible and co-insurance.

If you are in the pilot program, GEHA will still waive your deductible and co-insurance on Part A expenses.

But "in return for receiving this reimbursement to help you pay your Part B premium, you won't have the Part B co-insurance or deductible waived," Overton said.

Overton said you must sign up for the pilot program, so if you have both the high plan and Part B, you will not be automatically enrolled in the pilot program.