Government Closure: What Happens to Health Insurance for Federal Employees?


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As the partial closure of the government continues, about 800,000 federal employees who work for sold-out agencies – and their families – face the reality of living without pay.

And these workers have to take into account a host of other related problems when they are trying to make ends meet.

For starters, what will happen to their health insurance?

In general, federal employees do not have to worry about this, according to the Office of Personnel Management (OPM) in a report FAQ blog post.

The online FAQ and the professional association of the health insurance sector confirm that the protection offered by the federal employee health benefits program (FEHB) will be maintained even though some federal agencies affected by the closure do not issue these benefits. pay checks and their premiums.

"The closure should not affect their coverage," said Kristine Grow, spokesman for the US health insurance plans, the professional group that represents insurers, including those who provide coverage through the federal program. "It's as usual.

At the end of the closure and the resumption of payments, workers should expect their regular portion of premiums plus a portion of the accumulated amount that has not been deducted in the missed pay periods to be removed.

"The procedures may vary slightly from one pay office to another, but the maximum additional deduction allowed by regulation is equal to a pay period premium (in addition to the premium for the current pay period)," said a spokesman for the OPM.

What about government contract workers?

What is less clear is what happens to contract workers with the relevant federal agencies – including some people working as analysts, administrative assistants and janitorial staff – who are mainly excluded of the FEHB program.

Many companies that have contracts with the federal government offer insurance to workers. The Federal Office of Personnel Management recommends that these contractual employees consult their company's human resources office for answers regarding the closure.

"In 95% of cases, even though it was not required by law, I thought everyone would continue with this coverage," said Rachel Greszler, Senior Policy Analyst and Research Fellow at the Heritage Foundation, who studies economy, budget and labor issues.

For contractors who subscribe to their own cover and who struggle to pay their bills without their salary, that's another story. One strategy may be to ask their insurers for a grace period for paying their premiums, as the government has suggested to workers to request accommodation from mortgage lenders and other creditors. But it is not necessary for insurers to accept such a request.

"We are concerned about the disruption this closure has caused to our members and their families," said a statement by CareFirst BlueCross BlueShield. "We are currently studying the best way to solve this problem should closure continue."

What else could be affected?

Depending on the duration of the shutdown, dental insurance, vision care and life insurance plans can start sending bills directly to workers.

Federal workers pay premiums for these benefits themselves, according to Dan Blair, who was acting director and assistant director of the OPM in the early 2000s. He is now a senior advisor and member of the Bipartisan Policy Center.

Since workers' checks are not processed, the amounts usually sent to these carriers at each pay period are also not paid. If the closure lasts more than two or three pay periods, workers will receive their invoices directly from these companies and will have to pay them "in a timely manner to ensure continuity of coverage," says DFO in its FAQ. Blair agrees.

There may also be a delay in processing claims for flexible expense accounts. These are special accounts in which workers use pre-tax money deducted from their pay check to cover certain eligible medical expenses, such as glasses, orthopedic appliances, co-payments for doctor visits or medicines, including some over-the-counter products. In the absence of pay checks, these deductions are not made and transferred to BSOs. Once the paychecks have restarted, the amount deducted will be adjusted so that the worker gets the annual total requested.

However, at the time of closure, claims for these accounts will not be processed either, says the OPM. Blair suggests suspending major purchases when closing, if possible, and always keep the documents on purchases.

Another consideration: those who have changed plans before the obligation to leave may find that their documents have not been processed in time.

In these cases, the OPM recommends to stick to the old health plan until the end of the shutdown and treatment of the new plan. The new plan will cover all claims incurred.

How will workers know if their change has been addressed? The OPM FAQ states that workers who receive an ID card by mail are registered.

"The new policy will apply and pay for the benefits, but the workers could have administrative problems if the closure went on much longer, if the initial bills do not go to the right insurance company," he said. said Greszler.

Overall, Blair said workers should continue to monitor media sites, especially those that focus on workers and federal issues, looking for updates.

"We are entering unexplored territory and there are still things that are not getting ready," said Blair, who has not faced any blockage during his tenure at OPM.

Kaiser Health News is a non-profit news service covering health issues. It is an independent editorial program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.