Devine, Therefore, an individual who was covered under their spouse's PSHB plan would not continue eligibility if they became a former spouse. If an individual is required to enroll in Medicare, they may feel more compelled to utilize the benefits, increasing overall health care consumption. If I move to another part of the country, say Florida (which would be a lower locality pay), does my retirement annuity (locality pay) get adjusted to the area that I am moving to? What are Survivor Benefits on the Death of a Federal Employee. (d) an individual entitled to benefits under Medicare Part A). 8909a(g). Accordingly, 890.1605 establishes that PSHB plans must be available to enroll individuals during the 2024 Open Season, starting on November 11, 2024. It is NARFEs position that the creation of a new program should retain all postal employees and retirees, rather thansinglingout andexcludingretirees without Medicare, a move that could set a dangerous precedent for the future of the FEHB program. The Postal Service is required by law to be self-sufficient, and the Postal Service, along with its employees, pay taxes to fund Medicare each year, but many of its employees do not enroll in Medicare after they retire. About the Federal Register Start Printed Page 20400 All automatic enrollments will be into a PSHB plan of the same enrollment type (self only, self and family, or self plus one) as the 2024 FEHB plan. Section 102 of the PSRA repeals the requirement to pay actuarially determined normal cost and amortization payments into the Postal Service Retiree Health Benefits Fund (PSRHBF) established at 5 U.S.C. Individuals who, as of January 1, 2025, are Postal Service annuitants who are not both entitled to benefits under Medicare Part A and enrolled in Medicare Part B; Individuals who, as of January 1, 2025, are Postal Service employees who are aged 64 and over; Postal Service Medicare covered annuitants and family members residing outside the United States and its territories who demonstrate their residency in accordance with Postal Service regulations; Postal Service Medicare covered annuitants and their family members enrolled in certain VA health care benefits. 5 U.S.C. 8903(4), from the requirement in this paragraph (b). Phnom Penh is 8% more expensive than Ho Chi Minh City. Jul 2023 Cost of Should a Postal Service compensationer who is enrolled in a PSHB plan and entitled to or eligible for Medicare benefits choose to enroll in Medicare, that compensationers' Medicare coverage would be secondary to the PSHB plan coverage. 2003. USPS understands that employees have many questions, so here are a few things to know: As a result, OPM is interpreting the new PSRA provision in section 8909a as applying only to the post-retirement health requirements in 39 U.S.C. the PSHB Program, which will provide health benefits plans to United States Postal Service (Postal Service) employees, Postal Service annuitants, and their eligible family members starting January 1, 2025. The bill would create a new Postal Service Health Benefits (PSHB) program, starting in January 2023, that would provide separate health plans for postal employees and retirees, parallel to current FEHB plans. Subtitle E of the Small Business Regulatory Enforcement Fairness Act of 1996 (also known as the Congressional Review Act) (5 U.S.C. 1005. USPS assumed that 30% of grandfathered annuitants would enroll in Part B during the SEP, resulting in 30,000 new enrollments in 2025. But once a retiree is eligible for Medicare (age 65), enrollment in Medicare would be required upon enrollment in a PSHB plan, and that retiree cannot go back to an FEHB plan. A locked padlock The law maintains the requirement that the Postal Service continue to pay the Government contribution; directly for employees or through the PSRHBF for annuitants. Details on the methods and assumptions utilized by each agency are provided in the Table 3 footnotes. A covered Medicare individual under section 8903c(a)(1) generally means an individual who is entitled to Medicare Part A, but the term excludes an individual who is eligible to enroll under section 1818 or 1818A of the Social Security Act (42 U.S.C. This guidance references OPM's commitment to ensuring that the Federal Government offers competitive, comprehensive health insurance benefits and includes OPM's policy goals and initiatives for the year. The enrollee must make an affirmative enrollment change to remove an ineligible family member and may replace them with an eligible family member or change the enrollment to a self only or to a self and family enrollment type. corresponding official PDF file on govinfo.gov. Postal service reform bill would shift retirees health care costs to This interim final rule includes a process for OPM to provide information to SSA for these purposes. Enrollees in the PSHB Program will be subject to the FEHB Program requirement of maintaining enrollment for 5 years of service before retirement in order to carry that coverage into retirement. (1) Demonstrating qualification to the Postal Service for the exceptions at paragraphs (c)(1)(iii) and (c)(2)(ii) of this section; (2) Documentation from the Department of Veterans Affairs in a form, manner, and frequency as prescribed by OPM demonstrating the individual meets an exception identified in paragraphs (c)(1)(iv) and (c)(2)(iii) of this section; or. The PSHB plan year will run from January 1 to December 31 each year OPM invites comment on this approach. 801 chapter 89. Current employees would be required to enroll in Medicare once they turn age 65 and are retired. For the initial contract year, the weighted average applicable for determining the Government contribution by the Postal Service will be determined using the calculation at 5 U.S.C. 8901 or set forth in other authorizing legislation. Startup Costs: . 486(c); 48 CFR 1.301. (2) If the carrier of the individual's current plan offers more than one health benefits plan or option under this subpart, in the plan and option offered by that carrier that provides coverage with equivalent benefits and cost sharing to the individual's current plan and option, as determined by OPM. Despite the assumption that not all carriers will offer both FEHB plans and PSHB plans, it is likely that the PSRA will increase the total number of plans covering both the Postal and greater FEHB population. Current enrollment type Carriers offering PSHB plans, as part of the FEHB Program, will be subject to the same or similar guidance. The first opportunity to select a PSHB plan will take place during Open Season in late 2024, and coverage under the PSHB health benefits program coverage will begin January 2025, it says. After December 31, 2024, a Postal Service employee or Postal Service annuitant is not eligible to be enrolled in an FEHB plan but may only enroll in a PSHB plan in accordance with subpart P of this part. Postal Service Health Benefits (PSHB) Program A regulatory impact analysis must be prepared for major rules with economically significant effects (annual effect of $100 million or more), and a significant regulatory action is subject to review by the Office of Management and Budget (OMB). An individual can be removed or disenrolled from a PSHB plan if they do not enroll within those enrollment Because H.R. H.R. Cost of living in Mexico City is 40% more expensive than in Bogot. On transfer to or from Postal Service. Postal Service annuitant [FR Doc. (b) For purposes of this subpart, a Postal Service employee includes a Postal Service employee who receives monthly compensation under 5 U.S.C. These tools are designed to help you understand the official document If the Postal Service Medicare covered annuitant or eligible Medicare covered family member does not enroll in Medicare Part B at the next opportunity such as a Medicare General Enrollment Period, they will be disenrolled or removed from a PSHB plan and, in the case of a Postal Service annuitant, will have no further opportunity to re-enroll in a PSHB plan. shall be consistent with the requirements of this chapter for contracts under section 8902 with carriers to offer health benefits plans. Therefore, generally, the requirements of the FEHB Program will apply to the PSHB Program, unless otherwise set forth in the PSRA or in 5 CFR part 890. It is possible that a number of current FEHB Carriers will elect not to participate in the PSHB From a societal perspective, the primary costs associated with the implementation of the PSHB Program will be administrative and operational costs necessary to initiate and maintain the program, including development of information technology (IT) systems, education and outreach, and additional administrative staffing for the design, maintenance, and oversight of the increased quantity of health plans. Application of CMS Employer Group Waiver Authority). In this section. The program would create separate health plans for postal employees and retirees, parallel to current FEHB plans, that would be required to be actuarily equivalent. For example, there would be a Blue Cross Blue Shield Standard plan for Feds and a separate one for postal employees and retirees. 3076 / S. 1720 ), would create a new Postal Service Health Benefits (PSHB) program, starting in January 2023, that would provide separate health plans for postal employees and retirees, parallel to current FEHB plans. Start Printed Page 20396. While specific information such as rates and benefits will not be available until later in 2024, the Postal Service will structure this Education Program based on the requirements for the PSHB Program as set forth in this rule. (b) OPM shall identify Postal Service annuitants and their eligible family members who may be covered Medicare individuals from OPM's stored enrollment data. FEHB enrollments and FEHB plan eligibility will terminate at the end of 2024 for all Postal Service employees. Kerners term at OSC expired last year, but he is currently serving a one-year holdover period until October. v. Under the statute, OPM must establish a PSHB Program for Postal Service employees, Postal Service annuitants, and their eligible family members, and not later than one year after the date of enactment, the OPM Director must issue regulations to carry out the statute. (3) A Postal Service Medicare covered annuitant will not be disenrolled and a Medicare covered member of family will not be removed from PSHB coverage due to not being enrolled in Medicare Part B if such individual qualifies for one of the exceptions in 890.1604(c). This payment replaces the previously required actuarially determined pre-funding payments (normal cost and amortization) calculated annually by OPM from 2017 through 2021. These periodic agreements will specify the data elements that will be shared, the process for information sharing, the frequency of information sharing, and how that data can be used and disclosed. Medicare covered member of family Medicare covered annuitants may be eligible, depending on whether they meet statutory income and resource thresholds, for the low-income cost-sharing subsidies and premium subsidies that are part of the Medicare part D program, under section 1860D14 of the Social Security Act. The Office of Personnel Management (OPM) is issuing an interim final rule with comment period to establish and administer the Postal Service Health Benefits (PSHB) Program pursuant to the Postal Service Reform Act of 2022 (PSRA). Register documents. (d) To qualify for an exception under paragraph (c) of this section, a Postal Service Medicare covered annuitant or a Medicare covered member of family must meet one of the following documentation requirements: 486(c); 48 CFR 1.301. Not immediately. The CBO has estimated that premium rates will be lower than in parallel FEHB plans, largely due to shifting more costs of retiree claims onto Medicare; about a quarter of postal retirees currently . Section 890.1611 describes OPM's right to withdraw approval of any PSHB plan or carrier, and to give notice of non-renewal of any health benefits plan contract for failure to meet applicable standards. Election not to enroll FEHB and Medicare Part D Prescription Drug Coordination Startup Costs: 8905(h) cannot be fully and properly applied with respect to Postal Service annuitants for whom a court order continues from when they were an employee. This will result in smaller risk pools within each plan, which could lead to greater uncertainty with respect to costs. These industry discounts are in addition to the discounts negotiated with individual FEHB plans, resulting in lower per-member payments for the subset of current and future Postal Service annuitants who would have otherwise elected not to enroll in Part D. It is important to note, however, that all estimates related to Part D savings were conducted prior to the enactment of the Inflation Reduction Act (Pub. Although recruitment, onboarding, and development costs will gradually ramp up preceding implementation, the ongoing costs are expected to become fully realized beginning in FY25 and will likely persist for a period of 510 years following implementation, at which point the Postal Service will reevaluate resourcing needs. Ultimately, this would increase the average risk and costs within the PSHB enrolled population, creating upward pressure on premiums. August 29, 2022 USPS and the Office of Personnel Management (OPM) have published online FAQs about the new Postal Service Health Benefits Program. If PSHB plans are not available, those individuals may experience a gap in health insurance coverage, and people without insurance coverage have worse access to care and experience worse health outcomes than people who are insured. In short, the FEHB Program offers FEHB plans, and the PSHB Program within the FEHB Program offers PSHB plans. Generally, unless an individual qualifies for an exception from the Medicare enrollment requirement, the individual will be disenrolled or removed from coverage from a PSHB plan if they have not enrolled in Medicare Part B (for example, during their seven-month Medicare Initial Enrollment Period (IEP), or applicable Medicare SEP). v. Last week, President Biden nominated Henry Kerner, the current head of the Office of Special Counsel (OSC), to the serve on the Merit Systems Protection Board (MSPB). Follow the instructions for submitting comments. Section 102 of the PSRA (The USPS Fairness Act) amends 5 U.S.C. are not part of the published document itself. It will be critical during the initial implementation of the Program and for the subsequent 510 years to send constant communications regarding plan options and healthcare costs, along with information about Medicare Part B eligibility periods and how and when to enroll. The Department of Labor's Office of Workers' Compensation Programs is the employing office for compensationers. 8903c(e)(3)(B) that OPM promulgate regulations to implement the VA and IHS coverage exceptions. b. New Postal Reform Bill Threatens FEHB - NARFE 8904 and include hospital benefits, surgical benefits, medical care and treatment, and obstetrical benefits, among others. May 18, 2021 Postal reform legislation recently introduced in the House of Representatives has the potential to increase health care premiums for federal employees and retirees enrolled in Federal Employees Health Benefits (FEHB) plans. Postal Service contribution. Secure .gov websites use HTTPS They further make no mention of coverage term requirements or participation requirements for plans meeting the enrollment criterion for years after 2025. Enrollment in a PSHB plan will not disrupt enrollment in other insurance and benefits programs, including: Signup to stay on top of the latest postal news. Postal retirees younger than 65 would have the option to enroll in either an FEHB or PSHB plan. Util. means coverage that meets the requirements of 890.1604. for better understanding how a document is structured but Start Printed Page 20401 Whether the split would increase premiums, and to what extent, is still unclear. is responsible for processing appropriate requests for FEHB enrollment or changes in enrollment. 3. While PSHB enrollment is suspended, no PSHB premiums would be required. See In rural and remote communities especially, many of which lack adequate broadband access and rely heavily on mail service, the Postal Service's universal service mandate ensures crucial access to essentials including medicine and food.[10]. As required by 5 U.S.C. This is based upon the assumption that self-attestation will be utilized for Postal Service annuitants and family members to provide proof of eligibility for IHS health services for purposes of an exception to the Medicare Part B requirement. (f) Ongoing Costs: Cost of living in New York City is 13% more expensive than in London. (5) Disenrollment of a Postal Service Medicare covered annuitant from a PSHB plan under this section shall be considered a termination with entitlement of the enrollee and PSHB covered family members to a 31-day temporary extension of coverage and the right of conversion under 890.401. and PSHB coverage will replace existing FEHB Program coverage for these groups. Indian Health Service (IHS) estimates de minimis costs for PSHB implementation. All other provisions. OPM may also issue guidance to further delineate responsibilities regarding PSHB enrollment. This rule is effective on June 5, 2023. PSHB is a new program within the Federal Employees Health Benefits (FEHB) Program. These correction of errors provisions will apply in the PSHB Program, as laid out in 890.1614. A Postal Service employee, Postal Service annuitant, or their covered family member whose enrollment or coverage is terminated other than by cancellation of the enrollment or discontinuance of the plan, in whole or part, is entitled to a 31-day temporary extension of coverage and right of conversion in accordance with 890.401. Since the inception of the FEHB Program in 1960, OPM has prescribed regulations over time that place responsibility for health benefits actions on to an employing office, as defined at 5 CFR 890.101, an employing agency, or an agency. Consequently, the FEHB Program's enrollment functions are not handled by OPM but are dependent on decentralized processes that utilize independent systems at different Federal agencies. PSHB preview | USPS News Link The standards for requesting reconsideration of an initial decision affecting enrollment in the PSHB Program will be the same as current FEHB standards at 5 CFR 890.104 and 890.308. OPM anticipates that this rule is likely to have economic impacts of $100 million or more in at least 1 year, meeting the definition of a significant rule under Executive Order 12866. e.g., Start Printed Page 20384 8903c, the provisions of chapter 89 applicable to health benefits plans offered by carriers under section 8903 or 8903a shall apply to plans offered under the [PSHB] Program.. Salaries and burden were based on 2022 pay tables and Washington, DC metro area locality adjustment, a burden percentage of 34%, and award and transit subsidies. L. 117169), which contained significant prescription drug provisions including, for example, a provision that sunsets the Coverage Gap Discount Program at the end of 2024, and establishes a new Manufacturer Discount Program, beginning Jan. 1, 2025, at section 1860D14C of the Social Security Act. These regulatory provisions implement the statutory requirements, and without these provisions, it will be impossible for OPM to comply with its own obligations under the PSRA, and PSHB Carriers, other agencies, and Postal Service employees and annuitants will be uncertain about how the PSHB Program will operate. This could create additional burden and confusion for participants and may result in suboptimal enrollment decisions. Starting January 1, 2025, PSHB plans will replace FEHB plans for Postal Service retirees and, to qualify, they must enroll in Medicare Part B. Automatic pre-enrollment could relieve these Postal annuitants from making two separate enrollment decisions. For 2023, these goals included advancing health equity, providing gender affirming care and services, and addressing obesity. 15. As this timeline makes clear, there are numerous operational interdependenciesbeginning with carriers submitting applications to participate in the PSHB Program by August 2023that necessitate the immediate effectiveness of this regulation. FEHB plan Pay/Benefit Help 890.102 also issued under sections 11202(f), 11232(e), and 11246 (b) of Pub. This exemption is derived from, Postal Service Medicare covered annuitants and family members eligible for health services provided by the Indian Health Service; and. As such, NARFE has urged the committee to obtain analysis from the Office of Personnel Management (OPM) regarding the bills likely effect on FEHB plan premiums. As envisioned, the centralized enrollment system will be an electronic enrollment solution for all PSHB stakeholder groups including 8901(1) includes Federal employees and other categories of statutorily eligible individuals. This could potentially result in adverse selection within the PSHB plans, referring to the tendency for individuals with higher health risks to disproportionately elect more generous coverage. All benefits, costs, and transfers summarized above are based on baseline assumptions that plan enrollment, carrier participation, and healthcare utilization will remain consistent following implementation of the PSHB Program. This new section adds a clause to state except that retroactive corrections to an enrollment under this subpart may not go further back than the initial contract year. This is to establish that there cannot be a retroactive correction to a PSHB enrollment before the initial contract year of the PSHB Program. OPM Establishing New Postal Service Health Benefits Program Beginning in 2025, OWCP estimates an additional $2,000 of annual, recurring costs for the creation and distribution of mailing announcements and customer service response letters related to the PSHB Open Season. OPM is adding a new paragraph (l) to 890.303 to indicate that a Postal Service employee eligible to enroll in a PSHB plan who moves to a Federal agency, without a break in service of more than three days, cannot continue in PSHB plan enrollment but may be eligible for FEHB plan enrollment if their position conveys eligibility. 1108 and 25 U.S.C. Subject to limited exceptions, Postal Service annuitants who retire and become Medicare-eligible after December 31, 2024, and their Medicare-eligible family members will be required to enroll in Medicare Part B as a condition of eligibility to enroll in the PSHB Program. The broad umbrella of the FEHB Program comprises both FEHB plans and PSHB plans. This implements section 8903c(e) of the PSRA and is a unique requirement as a condition of participation in a health benefits program under chapter 89 of title 5, U.S.C. Individuals eligible to enroll under 1818A are disabled individuals who lose Medicare coverage solely because of substantial gainful work. Some Postal Service Medicare covered annuitants and/or their Medicare covered members of family who enroll in Medicare during the SEP beginning April 1, 2024, may be subject to a Medicare Part B late enrollment penalty. Eligibility & Enrollment Eligible for FEHB Losing & Ineligible for FEHB Members of Congress/Staff FEHB Eligibility & Enrollment As a Federal employee, you are eligible to elect Federal Employee Health Benefits (FEHB) coverage, unless your position is excluded by law or regulation. The VA anticipates startup costs for system updates and development to meet the information sharing requirements outlined in 890.1612 of the regulation. The PSRA includes the following requirements for consultation between OPM and several other Federal agencies: This interim final rule amends subparts A, C, and E of 5 CFR part 890 related to the FEHB Program and 48 CFR chapter 16, the Federal Employees Health Benefits Program Acquisition Regulation (FEHBAR).
