The Federal Employees Health Benefits (FEHB) forms part of the Government Health Program. It is a system of managed competition through which employees health benefits are provided to :
Civilian Government employees
Annuitants of the United States Government.
The Government contributes 72% of the weighted average premium of all plans. The FEHB program which forms part of the Government Health Program allows some insurance companies, employee associations and labor unions to market health insurance plans to governmental employees.
“Open Enrollment” period:
In the Government Health Program, the employee will be fully covered in any plan he or she chooses without limitations regarding pre-existing conditions. Upon a life-qualifying event such as marriage, divorce, adoption or the birth of a child, changes may be made, even though open enrollment is closed. Part of the premium is paid for by the U. S. Government Agency the employee works for, but does not exceed 72%.
In 2010 about 250 plans participated in the Government Health Program. Employee unions that offer plans are:
National Association of Letter Carriers.
National Insurance Companies, such as:
Blue Cross and Blue Shield Associations.
Indian Health Services (IHS)
Part of the Government Health Program is the IHS which is responsible for providing medical and public health services to members of federally recognized Tribes and Alaskan Natives. In fact, IHS provides healthcare at 33 hospitals, 59 Health Centers and 50 Health Stations. 34 urban Indian health projects supplement these facilities with a variety of health referral services.
The IHS which forms part of the Government Health Program employs approximately 2, 700 nurse, 900 physicians, 400 engineers, 500 pharmacists and 300 dentists as well as other health professionals totalling more than 15, 000 in all. The IHS is one of two federal agencies mandated to use Indian preference in hiring.
Veterans Health Administration (VHA)
Forming part of the Government Health Program, is Veterans Health Administration. To be eligible for VA care benefit programs you must have served in the active military, naval or air service. Veterans who enlisted after September 7 1980 or who entered active duty after October 16 1981, must have served 24 continuous months or the full period for which they were called to active duty.
Preventive Care Services:
The following is offered in VA care :
Counselling on inheritance of genetically determined disease
Health Care Assessments
Health Education programs
Ambulatory (outpatient) and hospital (inpatient) diagnostic and treatment services:
Surgical (including plastic/reconstructive surgery)
Substance Abuse treatment
Prescription drugs (when prescribed by a VA physician)
The Military Health System
Part of the Government Health Program is the Military Health System that provides healthcare to active duty and retired U. S. Military Personnel and their dependents. Its primary mission is to maintain the health of military personnel so as to enable them to carry out their military missions, and to deliver health care during wartime.
The Military Health System has a $50 billion budget and serves about 9.6 million beneficiaries, including active duty personnel and their families and retirees and their families. MHS employs more than 137, 000 in 65 hospitals, 412 clinics and 414 dental clinics.
The U. S. Patient Protection and Affordable Act, enacted in 2010, has provisions intended to make it easier for uninsured veterans to obtain coverage. Under the Act, veterans with incomes at or below 138% of the Federal Poverty Line ($30, 429 for a family of four in 2010) would qualify for coverage as of January 2014. This group constitutes nearly 50% of veterans who are currently uninsured.
Part of the Government Health Program is Medicare, a national social insurance program administered by the U. S. federal government since 1966. It currently uses 30 private insurance companies across the United States and guarantees health insurance for America’s aged 65 and older who have worked and paid into the system, younger people with disabilities and people with end stage renal disease.
Part A: Hospital Insurance
Part B: Medical Insurance
Part C: is a public supplement option
Part D: covers many prescription drugs
This covers in-patient hospital stays including semi-private room, food and tests. The maximum length of stay is typically 90 days. The first 60 days would be paid by Medicare in full except for one copayment of $1, 216 at the beginning of the 60 days. Days 61-90 require a copayment of $304 per day.
Medicare penalises hospitals for re-admission. Medicare will take back from the hospital these payments, plus a penalty of 4 to 18 times the initial payment. The highest penalties on hospitals are charged after knee or hip replacements, $265, 000 per excess readmission. The goal is to encourage better post-hospital care.
The beneficiary is also allocated “lifetime reserve days” that can be used after 90 days. These lifetime reserve days require a copayment of $592 per day and the beneficiary can only use a total of 60 of these days throughout their lifetime.
Part B of the Government Health Program helps pay for some services and products not covered by Part A, generally on an outpatient basis.
This coverage begins once a patient meets his or her deductible of $147 (2013), then typically Medicare covers 80% of approved services, while the remaining 20% is paid by the patient. This section covers:
physician and nursing services
laboratory and diagnostic tests
influenza and pneumonia vaccinations
outpatient hospital procedures
limited ambulance transportation
durable medical equipment
cataract surgery and spectacles
oxygen for home use
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organisations, Preferred Provider Organisations, Private Fee-for-Service Plans, Special Needs Plans and Medicare Medical Savings Accounts Plans.
Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-For-Service Plans and Medicare Medical Savings Accounts Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.