What flexibilities are in place under the Federal Employees Health Benefits Program (FEHB) for employees affected by a disaster?

The Office of Personnel Management (OPM) has procedures in place to respond to a disaster or emergency situation to ensure continued coverage for affected enrollees. OPM may contact or issue a blanket request to all FEHB carriers to ask them to demonstrate maximum flexibility under their OPM contract to include the following:

  • Request that fee-for-service carriers relax certain provisions such as their pre-certification requirement that the plan must be notified within two business days of an emergency admission.
  • Request fee-for-service and HMOs to relax requirements about notification and levels of benefit payment when those needing medical attention due to a disaster or emergency situation are taken to non-plan and/or non-PPO hospitals or other treatment centers.
  • Depending on the area that is affected and the HMO's covering the areas, OPM may encourage HMOs to be lenient and flexible when accepting claims filed by those in the disaster area.  If an employee requires medical care, s/he should use the HMO's regular procedures for obtaining health care and filing claims if s/he has evacuated to a location outside the HMO's service area.
  • OPM expects plans to make certain that FEHB members can get additional supplies of medications as backup for emergency situations if necessary.
  • Though charges for work-related injuries sustained by Federal workers are payable by the Office of Workers' Compensation Programs (OWCP), OPM may encourage FEHB plans to provide immediate payment and seek subsequent reimbursement from OWCP.