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OPM sets new process for FEHB rates
OPM releases a new interim rule regarding how FEHB group insurance rates are determined
By Vyomika Jairam
Federal News Radio
The Office of Personnel Management is changing how Federal Employees Health Benefits carriers determine their group rates.
The new interim rule replaces the current system in which “premiums for community rated FEHB carriers are compared with the rates charged to a carrier’s similarly sized subscriber groups (SSSGs).”
Under the interim rule, a medical loss ratio (MLR) threshold will be incorporated into the methodology in determining rates, and will apply to all community rated plans, except traditional community rating (TCR) plans. The new methodology will be phased in over the next two years.
The interim rule also notes that under current regulations, “the premiums for community rated FEHB plans are negotiated with OPM the August before the plan year begins on January 1.”
The full interim rule can be found here.
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