Article from Fedweek is linked below – here are a couple of excerpts you need to read:

Federal Employees Health Benefits Program Enrollment and Eligibility

Ineligible family members receiving FEHBP benefits remains a Top Management Challenge for OPM. This issue has been reported on by both the OPM OIG and the U.S. Government Accountability Office (GAO). OPM has taken or has plans to take appreciable steps towards addressing this issue, including issuing further and more robust guidance in Benefit Administration Letters as well as monitoring recommendations from GAO. However, ineligible member enrollment in the FEHBP remains an ongoing difficulty for the agency.

Primarily, OPM hopes to use a centralized enrollment portal that will allow a federal employee or annuitant to submit valid documents (e.g., birth certificates, adoption certificates, marriage certificates) proving that family members are eligible for FEHBP benefits. A smaller-scale version of this centralized enrollment portal is already under development for the PSHBS. However, when and at what cost OPM will be able to implement a centralized enrollment portal is not clear.

Also of concern, related to FEHBP program enrollment and eligibility, is that the initial transfer of members from the FEHBP to the PSHBP is planned to occur without a centralized enrollment portal being active. This “lift-and-shift” strategy will move more than a million members to the new program, including an unquantified number of fraudulent family member enrollments.

Once OPM has a centralized enrollment portal, the agency would need to apply the portal to these debut members. Not doing so—and not being prepared to do so at some point with any similar FEHBP centralized enrollment portal—would allow existing undiscovered fraud to continue and some federal employees may go decades before retirement without being required to use the centralized enrollment portal. For the initial PSHBP open season, OPM is planning on collecting enrollment verification documentation for new family members. Also, starting on January 1, 2025, OPM will require member eligibility verification documents for any new Postal employee and for Qualifying Life Events. While these are positive steps going forward to provide a better control environment, the majority of the population in the PSHBP will be at a higher risk level since the membership will not have been validated. OPM recognizes this issue, but the agency has said it would need further funding to verify enrollment on the over 700,000 members that will transfer from the FEHBP to the PSHBP.

PEN: OPM says they need more money…. hell, we need more money and more affordable health insurance. 

Read Fedweek article ‘Drug Costs, Ineligible Enrollees Named as among Top Issues in FEHB ‘ here.