1 Federal Employees Health Benefits for Tribal

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Federal Employees Health Benefits for Tribal Employees National 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. 1647 b) • 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 preexisting 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 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 Notification of Signed Interest to Application OPM Package 2/1/2012 3/1/2012 4/1/2012 5/1/2012 6/1/2012 7/1/2012 8/1/2012 9/1/2012 3/1/2012 4/1/2012 5/1/2012 6/1/2012 7/1/2012 8/1/2012 9/1/2012 10/1/2012 Effective Date of coverage 5/1/2012 6/1/2012 7/1/2012 8/1/2012 9/1/2012 10/1/2012 11/1/2012 12/1/2012 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 1. Provide Access to IEO Materials 2. Build Awareness 3. Provide Guidance 4. Collect and Verify Enrollments 5. Enter data into Tribal Insurance Processing System (TIPS) 21

Summary 1. Notify OPM of Intent (3 months) 2. Sign Agreement with OPM (2 months) 3. Hold Initial Enrollment Opportunity (prior to coverage) 4. Enter Data Into TIPS 22

TRIBAL EMPLOYEE ENROLLMENT IN FEHB 23

Tribal Employee’s Role During the IEO? 1. Review the plans available in your area 2. Choose the best FEHB plan for you 3. Complete the Health Benefits Election Form - Standard Form (SF 2809) 4. Submit the SF 2809 to your tribal employer 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 1 st 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 • Tribal. Programs@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 Fast. Facts 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 – 3 rd 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? 41