[vc_row][vc_column width=”2/3″ el_class=”section section1″][vc_column_text]In an attempt to ensure that providers are getting paid, and that recipients are paying the correct amount regardless of the varying benefits the members might receive, The National Association of Insurance Commissioners has enacted standardized coordination of benefits that carriers in the Federal Employees Health Benefits (FEHB) program are obliged to follow.
If one is eligible, the OPM permits a retired person to forego the FEHB premiums by putting a hold on their coverage and enrolling in any of the following programs: Tricare or CHAMPVA, Medicaid, or a Medicare HMO. There will be no contributions on premiums that are applicable to OPM. Unless a previously-covered person has had their coverage revoked against their will, they are free to enroll again the FEHB program at the next open season.
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Military retirees and their eligible dependents are the recipients of Tricare. The same is true of CHAMPVA with disabled veterans and their dependents too. Tricare and CHAMPVA benefits will be coordinated according to status by FEHB carriers. FEHB will always pay first when FEHB and Tricare or CHAMPVA cover the person who is enrolled.
The same can also be said of Medicaid. Once again, with the first payouts coming from the FEHB.
After 65, retirees can begin to receive Medicare. Medicare and FEHB carriers will coordinate, with Medicare in charge of deciding who is the primary provider. If a Medicare-aged person is still working or a federal employee, then the primary payments come from the FEHB. Adversely, Medicare pays first if the enrolled person is already retired.
NAIC guideline – the guidelines that are universal to all health care plans – state that if a person is enrolled in the FEHB and a spouse’s private employer, the two providers will have to coordinate to make sure all benefits are paid. Generally, a person’s own coverage would be the primary provider of that of their partner.
NAIC guidelines also state that if a person has coverage from their own private employment, then the person’s current active plan will payout before the plan that covers them as a retiree.
And NAIC guidelines say that FEHB carriers must also coordinate when the payout of medical coverage is through a no-fault or a different automobile insurance plan that also pays benefits without fault.[/vc_column_text][/vc_column][vc_column width=”1/3″][vc_single_image image=”36171″ img_size=”292×285″ style=”vc_box_shadow”][/vc_column][/vc_row]
