New Government Plans: Elevate and Elevate PlusawsDONOTREMOVE
The FEHB Program has made the decision to offer out two governmentwide indemnity plans: Elevate Plus and Elevate, which is to be controlled by GEHA. This will be the first move in more than 30 years.
Even though, to say they are ‘indemnity’ plans may not be accurate. Although they do look like typical indemnity plans, these new plans come under a new fee-for-service category. Unlike conventional indemnity plans that don’t use doctors’ networks and pay out set percentages of whatever the insurance company states are ‘reasonable’ expenses for a procedure or a visit, these new fee-for-service plans offer different rates of reimbursement for out-of-network and in-network doctors.
Laurie Bodenheimer, Deputy Director of OPM for insurance and healthcare, says that while the term ‘indemnity benefit plan’ isn’t correct here, they use this word since it is mandated by the statute. It’s really a fee-for-service plan, which come with pharmacy benefits, preferred or participating providers’ networks, and out-of-network healthcare benefits for people who enroll for this plan.
Walton Francis, independent consultant, states that the ‘indemnity’ term was only being used so that OPM could go with a law going back sixty years that established the program and add a new nationwide plan to its list of FEHBP offerings.
He added that back then, the law had only considered 3 categories, which are the same as now. The first category talks about governmentwide plans, which are of two different kinds. One is to be provided by Blue Cross Blue Shield and the other is supposed to be for indemnity benefit plans. The second category is for employee and union association plans. The third one is for specific comprehensive plans or HMOs.
Most of the 200+ insurance policies given by FEHBP happen to be locally or regional based, covering a city’s entire metro area, whereas others cover more than 48-50 states. Aetna ceased offering indemnity plans in 1989, a slot that has remained vacant ever since. Filling it would mean that a new plan covering all federal workers could come into existence, Francis said.
He says that governmentwide plans came with certain legal obligations. Coverage had to be protected in all regions governed by the US government, including federal workers in Guam and Puerto Rico, all fifty states, and civilian personnel living in military bases overseas.
Although overseas federal employees now have access to these new plans, the new Elevate Plus and Elevate plans offered by GEHA is simply another plan that has to be evaluated on the basis of its benefits, premiums, and out-of-pocket expenses. Francis stated that people living outside the US had more or less the same benefits with these new plans.