Laws Affecting the Federal Employees Health Benefits (FEHB) Program (CRS Report for Congress)
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| Release Date |
Revised July 22, 2015 |
| Report Number |
R42741 |
| Report Type |
Report |
| Authors |
Kirstin B. Blom, Analyst in Health Care Financing; Ada S. Cornell, Information Research Specialist |
| Source Agency |
Congressional Research Service |
| Older Revisions |
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Summary:
For more than 50 years, the Federal Employees Health Benefits (FEHB) Program has been providing health insurance coverage to federal employees, retirees, and their dependents. It is the largest employer-sponsored health insurance program in the country, covering about 8.2 million enrollees each year.
The program was created by the Federal Employees Health Benefits Act of 1959 (FEHBA; P.L. 86-382). FEHBA and its subsequent amendments established the parameters for eligibility; election of coverage; the types of health plans and benefits that may be offered; and the level of the government's share of premiums. They also established an Employees Health Benefits Fund to pay for program expenses and put forth provisions for studies, reports, and audits. In addition, FEHBA outlined the role of the Office of Personnel Management (OPM) in FEHB. By law, OPM has the authority to contract with insurers and to prescribe regulations to manage the program, among other duties.
FEHB's general model has not changed since its inception. The program has always allowed competing private insurers to offer numerous types of coverage to enrollees within broad federal guidelines. The federal government and the employee or retiree have always shared the cost of the premium, and generally employees and retirees have had access to the same plans at the same cost. However, specific features of FEHB have been modifiedâin some cases, multiple timesâby statutory changes, administrative actions, and judicial decisions. For example, through legislation, Congress has modified the formula for determining the government's share of premiums, and both Congress and OPM have broadened the types of health benefits FEHB plans must provide. Additionally, a Supreme Court decision in 2013 expanded FEHB eligibility to include same-sex spouses of FEHB enrollees and the children of same-sex marriages.
Congress has financial and administrative interests in the program, as the government pays for a share of FEHB premiums and Congress has the legislative authority to modify FEHB. Congressional interest in the program also extends to FEHB's potential applicability as a model for other health care programs or as an avenue to provide coverage, such as by extending aspects of FEHB to Medicare.
This report tracks legislative changes to FEHB. The report includes brief discussions of how Congress has changed FEHB through legislative action, including by restricting the use of federal funds; changing the formula for determining the government's share of FEHB premiums; expanding eligibility for the program; and implementing policies that affect the relationship between Medicare and FEHB. The Appendix includes detailed summaries of selected laws or provisions of laws that have amended or changed FEHB.
