Health benefits for federal employees and members of congress : overview, provisions, and fraud issues / Nathaniel Marsh, editor.

Format:

Book

Contributor:

Marsh, Nathaniel, editor.

Series:

Health care in transition series.

Health Care in Transition

Language:

English

Subjects (All):

Federal Employees Health Benefits Program (U.S.).

Government employees' health insurance--United States.

Government employees' health insurance.

Government employees' health insurance--Law and legislation--United States.

Insurance fraud--United States--Prevention.

Insurance fraud.

Physical Description:

1 online resource (149 p.)

Place of Publication:

New York : Nova Publishers, 2015.

Summary:

The federal government is the largest employer in the United States, and the Federal Employees Health Benefits (FEHB) Program is the largest employer-sponsored health insurance program in the country. It provides more than $40 billion in health care benefits annually. This first chapter of this book provides a general overview of FEHB. It describes the structure of FEHB, including eligibility for the program and coverage options available to enrollees, as well as premiums, benefits and cost sharing, and general financing of FEHB. The chapter also describes the role of the Office of Personnel Management (OPM) in administering the program. The second chapter discusses the Patient Protection and Affordable Care Act (ACA) which generally specifies that the only health plans that the federal government may make available to Members and certain congressional staff are either created under ACA or offered through an exchange. The chapter summarizes the provisions of the final rule made me OPM which amends FEHBP eligibility regulations, and describes how it affects current and retired Members and congressional staff. The third chapter in this book provides historical and background information that helps explain how FEHBP has evolved into the program it is today. The fourth and final chapter describes oversight of fraud and abuse programs by OPM's contracting office, and the OPM contracting office's approach to measuring the effectiveness of FEHBP carriers' fraud and abuse programs.

Contents:

HEALTH BENEFITS FOR FEDERAL EMPLOYEES AND MEMBERS OF CONGRESS: OVERVIEW, PROVISIONS, AND FRAUD ISSUES; HEALTH BENEFITS FOR FEDERAL EMPLOYEES AND MEMBERS OF CONGRESS: OVERVIEW, PROVISIONS, AND FRAUD ISSUES; Library of Congress Cataloging-in-Publication Data; CONTENTS; PREFACE; Chapter 1: FEDERAL EMPLOYEES HEALTH BENEFITS (FEHB) PROGRAM:AN OVERVIEW; SUMMARY; BASICS OF THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM; HOW THE USPS INTERACTS WITH THE FEHB PROGRAM; FEHB ENROLLEES AND MEDICARE; IMPACT OF THE AFFORDABLE CARE ACT; APPENDIX. OPM'S ROLE IN ADMINISTERING FEHB

Chapter 2: HEALTH BENEFITS FOR MEMBERS OF CONGRESS AND CERTAIN CONGRESSIONAL STAFFSUMMARY; INTRODUCTION; HEALTH INSURANCE COVERAGE; OTHER HEALTH BENEFITS RELATED TO FEDERAL EMPLOYMENT; MEDICARE; APPENDIX. SELECTED PREMIUMS IN THE D.C. SHOP EXCHANGE; Chapter 3: LAWS AFFECTING THE FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM (FEHBP); SUMMARY; INTRODUCTION; CONDITIONS ON FEHBP USE OF FEDERAL FUNDS; PREMIUM DETERMINATIONS; ELIGIBILITY; MEDICARE AND FEHBP; APPENDIX. FEHBP LEGISLATIVE HISTORY; Chapter 4: FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM: OVERSIGHT OF CARRIERS' FRAUD AND ABUSE PROGRAMS

ABBREVIATIONSWHY GAO DID THIS STUDY; WHAT GAO FOUND; BACKGROUND; OPM'S CONTRACTING OFFICE MONITORS COMPLIANCE WITH FRAUD AND ABUSE PROGRAM REQUIREMENTS AND GUIDANCE BY REVIEWING INFORMATION AND CONDUCTING SITE VISITS; OPM CONTRACTING OFFICE STAFF REVIEW FRAUD AND ABUSE PROGRAM OUTCOMES, BUT SEVERAL FACTORS CONTRIBUTE TO THE CHALLENGE OF ASSESSING PROGRAM EFFECTIVENESS; AGENCY COMMENTS; APPENDIX I: REQUIREMENTS FOR CARRIERS AND ATION ABOUT POTENTIAL FRAUD AND ABUSE; REQUIREMENTS AND PROCEDURES FOR REPORTING BY CARRIERS; REQUIREMENTS AND PROCEDURES FOR REPORTING BY OPM; INDEX

Notes:

Includes index.

Description based on print version record.

ISBN:

1-63483-369-4