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While the prospect of a life without pay for 800,000 federal employees and others affected by the ongoing government closure, questions arise about health insurance and other medical benefits – coverage dental and vision and long term care insurance.
Will the closed agencies continue to cover benefits for employees and contractors as usual? We found answers.
Are federal workers and their families still covered by their health plan?
For the most part, federal employees do not have to worry about this, according to the Office of Personnel Management, which has published a FAQ article on the subject.
The online FAQ and the professional association of the health insurance industry confirm that the coverage of the federal employee health protection program will be maintained even though some federal agencies concerned with the closure do not issue these pay checks and / or do not pay insurance premiums.
"The closure should not affect their coverage," said Kristine Grow, spokesperson for America's Health Insurance Plans, the professional group that represents insurers, including those who offer coverage through the federal program. "It's as usual."
At the end of the closure and the resumption of payments, workers should expect that their usual share of premiums plus the accumulated amount that has not been deducted during the missed pay periods be removed.
"The procedures may vary somewhat from one pay office to the other, but the maximum additional deduction allowed by the regulations is equal to a pay period premium (in addition to the premium of the pay period). current payday), "said a spokesperson for OPM.
Is the same thing for contractors?
What is less clear is what will happen to contract workers with the relevant federal agencies – including some people working as analysts, administrative assistants and janitorial staff – who are mostly excluded from the FEHB program.
Many companies that have contracts with the federal government offer insurance to their workers. The Federal Office of Personnel Management recommends that these contractual employees consult their company's human resources office for answers regarding the closure.
"In 95% of cases, even though the law does not require it, I think everyone would like to continue to benefit from this coverage," says Rachel Greszler, Senior Policy Analyst and Research Fellow at the Heritage Foundation who studies economics, budget and work.
Contractors who buy their own health insurance and have trouble paying their bills without their salary may have less recourse, beyond asking insurers a grace period for the payment of premiums. But it is not necessary for insurers to accept such a request.
"We are concerned about the disruption caused by this closure to our members and their families," notes a statement from CareFirst BlueCross BlueShield – one of the insurers near Washington, DC "We are currently studying the best way to remedy this problem if the closure was going on continue. "
Beyond the basic health insurance, what other health benefits could be affected?
Depending on the duration of the closure, dental, vision care and long-term care plans can begin to send bills directly to workers.
Federal workers pay the premiums for these benefits themselves, according to Dan Blair, who was acting director and assistant director of the OPM in the early 2000s. He is now a senior advisor and member of the Bipartisan Policy Center in DC
Since workers' checks are not processed, the amounts usually sent to these carriers at each pay period are also not paid. If the closure lasts more than two or three pay periods, workers will receive premium invoices directly from these companies and will have to pay them "in a timely manner to maintain the coverage," says DFO in its FAQ. Blair agrees.
There may also be a delay in processing claims for flexible expense accounts. These are special accounts in which workers use pre-tax money deducted from their paychecks to cover certain eligible medical expenses – such as eyeglasses, orthopedic appliances, co-payments for doctor visits or drugs, including some over-the-counter products.
In the absence of pay checks, these deductions are not made and transferred to BSOs. Once the paychecks have restarted, the amount deducted will be adjusted so that the worker gets the annual total requested.
When closing, however, claims for reimbursement of these accounts from the FSA will also not be processed, says the OPM. Blair suggests suspending major purchases when closing, if possible, and always keep the documents on purchases.
Another consideration is that people who have changed plans before a leave of absence may find that their paperwork was not processed in time.
In these cases, the OPM recommends to stick to the old health plan until the end of the shutdown and treatment of the new plan. The new plan will cover all claims incurred.
How will workers know if their change has been addressed? The OPM FAQ states that workers who receive an identity card by mail are registered.
"The new policy will apply and pay for the benefits, but the workers could have administrative problems if the closure went on much longer, if the initial bills do not go to the right insurance company," he said. said Greszler.
Overall, Blair said workers should continue to monitor media sites, especially those that focus on workers and federal issues, looking for updates.
"We are entering unexplored territory and there are still things that are not getting ready," said Blair, who has not suffered any interruption during his tenure at OPM.
Kaiser Health News is a non-profit press service, an independent editorial of the Kaiser Family Foundation, and not affiliated with Kaiser Permanente.