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Agenda

Learn about FEHB enrollment, benefits, and employer participation for tribal employees. Find out about OPM's outreach and guidance efforts. Get answers to common questions.

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Agenda

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  1. Federal Employees Health Benefits for Tribal EmployeesNational Tribal Health Reform Training April 18, 2012

  2. Agenda • Introduction • Federal Employees Health Benefits (FEHB) for Tribal Employees • Tribal Employer Participation in FEHB • Tribal Employee Enrollment in FEHB

  3. Agenda (cont.) • What is OPM Doing for Outreach? • What is OPM Doing for Employer Guidance? • Questions

  4. INTRODUCTION

  5. Law • Affordable Care Act (ACA), Section 10221(codified as 25 U.S.C. 1647b) • Entitles certain tribal employers to purchase the coverage, rights, and benefits of FEHB for their employees

  6. Enrollments Effective dates: • May 1 • 18 tribal employers • 2,843 enrollees • June 1 • 7 tribal employers • 1,542 enrollees

  7. FEHB FOR TRIBAL EMPLOYEES

  8. FEHB Program • 91 available plans (206 choices) with same benefits and same provider networks • No waiting periods or pre-existing condition limitations

  9. FEHB Program (cont.) • Temporary Continuation of Coverage • 31-day extension • Conversion to individual policy

  10. FEHB Program (cont.) • Choices: • Plan Types: Fee-for-service, HMOs, HDHPs and CDHPs • Options: High and Standard • Enrollment types: Self and Self and Family

  11. FEHB Program (cont.) Other Features of FEHB for tribal employees: • Cannot carry FEHB into retirement • No spouse equity or survivor enrollments • Tribal employer premiums are billed/ paid to the National Finance Center (NFC) on a monthly basis

  12. Tribal Employer Participation in fehb for Tribal Employees

  13. Eligibility • Tribes and tribal organizations carrying out programs under the Indian Self-Determination and Education Assistance Act (ISDEAA), and urban Indian Organizations carrying out programs under title V, are eligible to purchase FEHB and FEGLI coverage. • Tribes carrying out programs under the ISDEAA and title V may purchase coverage for all tribal employees meeting the common law employee standard.

  14. FEHB Coverage Timeline

  15. Tribal Employer Participation • First effective coverage date: May 1, 2012 • Enter in any time after that date • Monthly, rolling basis

  16. Notification of Interest • At least 3 months in advance of the effective coverage date • Notify OPM by either • Emailing at tribalprograms@opm.gov • Calling the Tribal Desk: 202.606.2530 • OPM confirms the interest • Sends Expressed Interest Fact Sheet for tribal employer to fill out • Sends application packet

  17. Signed Agreement • At least 2 months in advance of the effective coverage date • Application Packet • Agreement • Contact Information • Billing Unit Information • Bank Account Information • Temporary Continuation of Coverage Memorandum of Understanding

  18. Signed Agreement (cont.) • Email tribalprograms@opm.gov • Mail to OPM U.S. Office of Personnel Management Federal Employee Insurance Operations Attn: Demi Mozian 1900 E Street NW, Room 3425 Washington, D.C. 20415 • Receive Acknowledgement Letter from OPM

  19. Initial Enrollment Opportunity (IEO) The Initial Enrollment Opportunity (IEO) occurs when a tribal employer begins participating in the FEHB Program and offers FEHB to eligible tribal employees

  20. Tribal Employer IEO Responsibilities

  21. Summary • Notify OPM of Intent (3 months) • Sign Agreement with OPM (2 months) • Hold Initial Enrollment Opportunity (prior to coverage) • Enter Data Into TIPS

  22. Tribal Employee Enrollment in fehb

  23. Tribal Employee’s Role During the IEO?

  24. Summary of Enrollment Process • Tribal employee fills out SF 2809 • Tribal employee submits SF 2809 to tribal employer • Tribal employers enter the SF 2809 data for employees into the Tribal Insurance Processing System (TIPS) • National Finance Center maintains TIPS (the online FEHB enrollment portal) • TIPS  Carriers

  25. National Finance Center • Acts as paymaster/payment service provider for tribal employers • Maintains FEHB enrollment system • Collects premium payments • Conducts FEHB enrollment reconciliation

  26. Premium Collection • Collected monthly on retroactive basis • Tribal employer designates a bank account • Total amount of premiums must be in the account at time of collection • NFC collects the money and passes it onto OPM • OPM forwards the money to the carriers

  27. Enrollment After the IEO • After the tribal employer enrolls: • New tribal employee (or newly eligible to enroll) can enroll • Same as Feds • Annual Open Season • Same dates as Feds but January 1st effective date following Open Season • Certain Qualifying Life Events (QLEs) • Same as Feds

  28. What is OPM doing for Outreach?

  29. OPM Outreach • Participation in White House Affordable Care Act outreach calls to provide updates to tribal leaders • Formal Consultative Session • Attended conferences for ANHB, NIHB, NCAI, USET, CRIHB, NNAHRA, Self-Governance Tribes • Federal/Technical Work Group • Open Call

  30. OPM Outreach (cont.) • Dear Tribal Leader Letters • October 5, 2010: Questionnaire • May 2, 2011: Announcing Consultation • December 21, 2011: Coverage Timeline • www.opm.gov/tribalprograms • TribalPrograms@opm.gov • 202.606.2530

  31. Technical/Federal Workgroup (TFW) • Assist with technical and operational detail related to FEHB implementation • Tribal • Knowledgeable individuals familiar with existing tribal healthcare enrollment and payroll systems • From Barrow, Alaska to Hollywood, Florida • Federal • Members of OPM’s Tribal Teams • Director of Healthcare and Insurance

  32. TFW: Results • Ability for a tribal employer to have multiple billing units • Ability for a tribal employer to do an electronic upload of enrollment data into the Tribal Insurance Processing System (TIPS) • Ability to have access to enrollment and eligibility reports from TIPS • Creation of specific billing reports for tribal employers

  33. TFW: Results (cont.) • Frame and give context to the Initial Enrollment Opportunity timeline • Understanding of: • Tribes interaction with carriers • Modes of distributing documentation

  34. What is OPM doing for Employer Guidance?

  35. Tribal Teams • Materials Team • Training Team • Carrier Team • Carrier Workgroup • Technical Team • NFC Teleconference • Technical/Federal Workgroup

  36. Resources • Tribal FEHB Handbook • FEHB Guide for Tribal Employees • Tribal FastFacts • Tribal Quick Guide • Forms Guidance • SF 2809 for Tribal Employees • SF 2809/SF 2810 for Tribal Employers • Training presentations

  37. Resources (cont.) • www.opm.gov/tribalprograms • Tribal Programs Listserv • Tribal Benefit Administration Letters (TBALs) • Tribal Desk • Phone: 202.606.2530 • Email: tribalprograms@opm.gov

  38. Training • Training Modules • FEHB 101, FEHB Enrollment, Eligibility, Guidance to SF 2809 and SF 2810, and Finance • Will be available on website with Speaker’s Notes • Training • 3rd Friday of each month at OPM in DC • Webcasts and teleconferences – notices on tribal listserv • TIPS Training • Done by NFC

  39. Carriers • Carrier workgroup • Carrier Letter • Training and outreach • Ability to create a tribal liaison contact

  40. The End Thank You! Any Questions?

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