OPM has finalized rules tightening the scrutiny of coverage of family members under the FEHB and PSHB program, including by imposing new requirements for proof of eligibility, and reinforcing policies on removing persons found to be ineligible.
Final rules in the June 2 Federal Register do not change who is eligible to be covered as a family member but represent the latest in a series of steps over a decade by OPM and Congress against coverage of ineligible persons. Both the GAO and the inspector general’s office at OPM have repeatedly said that such persons are adding costs—which the GAO estimated to be $1 billion annually for the FEHB, before the PSHB was split off—which are shared by the government and enrollees in the form of higher premiums.
In its notice, OPM estimated that 2 percent of all family members in the program are ineligible and that more than another 2 percent could be deemed ineligible due to lack of acceptable proof. “The incentives are stronger to fraudulently cover ineligible individuals when their health care needs and costs are higher,” it added, but said there are no specific data on that effect.
Add your first comment to this post