U.S. shut­down spares health cov­er­age but other is­sues loom

The Niagara Falls Review - - Canada & World - JULIE APPLEBY Kaiser Health News

As the par­tial gov­ern­ment shut­down drags on, about 800,000 fed­eral em­ploy­ees who work for the shut­tered agen­cies —and their fam­i­lies —are liv­ing with­out a pay­cheque.

And those work­ers need to con­sider a host of other re­lated is­sues as they at­tempt to make ends meet.

For starters, what will hap­pen to their health in­sur­ance?

For the most part, fed­eral em­ploy­ees needn’t worry about that, ac­cord­ing to the Of­fice of Per­son­nel Man­age­ment (OPM) in an FAQ blog post.

Both the on­line FAQ and the health in­sur­ance in­dus­try’s trade as­so­ci­a­tion con­firm that cov­er­age through the Fed­eral Em­ploy­ees Health Ben­e­fits (FEHB) pro­gram will con­tinue even if some fed­eral agen­cies af­fected by the shut­down aren’t is­su­ing those pay­cheques or pay­ing pre­mi­ums.

“The shut­down should not im­pact their cov­er­age,” said Kris­tine Grow, spokesper­son for Amer­ica’s Health In­sur­ance plans, the trade group that rep­re­sents in­sur­ers, in­clud­ing those that of­fer cov­er­age through the fed­eral pro­gram. “It’s busi­ness as usual.”

Once the shut­down ends and those pay­ments re­sume, work­ers should ex­pect that their usual share of pre­mi­ums plus some of the ac­cu­mu­lated amount that wasn’t de­ducted dur­ing the missed pay pe­ri­ods will be taken out.

“Pro­ce­dures may vary some­what by pay­roll of­fice, but the max­i­mum ad­di­tional de­duc­tion al­lowed un­der reg­u­la­tions is one pay pe­riod’s worth of pre­mi­ums (in ad­di­tion to the cur­rent pay pe­riod’s premium),” said an OPM spokesper­son.

What about gov­ern­ment con­tract work­ers?

Less clear is what hap­pens to work­ers un­der con­tract with the af­fected fed­eral agen­cies —in­clud­ing some peo­ple work­ing as an­a­lysts, ad­min­is­tra­tion as­sis­tants and jan­i­to­rial staff —who are mostly ex­cluded from the FEHB pro­gram.

Many com­pa­nies that con­tract with the fed­eral gov­ern­ment of­fer work­ers in­sur­ance. The fed­eral Of­fice of Per­son­nel Man­age­ment rec­om­mends these con­tracted em­ploy­ees con­sult the hu­man re­sources of­fice at their com­pany for an­swers re­gard­ing the shut­down.

“In 95 per cent of cases, even if it’s not re­quired by law, I would think most ev­ery­one would con­tinue that cov­er­age,” said Rachel Gres­zler, a se­nior pol­icy an­a­lyst and re­search fel­low at the Her­itage Foun­da­tion who stud­ies eco­nomics, bud­get and labour is­sues.

For con­tract work­ers who buy their own cov­er­age and are strug­gling to pay bills with­out their pay­cheques, it’s a dif­fer­ent story. One strat­egy may be to ask their in­sur­ers for a grace pe­riod in pay­ing their pre­mi­ums, sim­i­lar to how the gov­ern­ment has sug­gested work­ers seek ac­com­mo­da­tion from mort­gage lenders and other cred­i­tors. But there is no re­quire­ment that in­sur­ers grant such a re­quest.

“We are con­cerned about the dis­rup­tion that this shut­down has caused our mem­bers and their fam­i­lies,” noted a cor­po­rate state­ment from CareFirst BlueCross BlueShield. “We are cur­rently ex­plor­ing how to best ad­dress this is­sue should the shut­down con­tinue.”

—What else could be af­fected? De­pend­ing on how long the shut­down lasts, den­tal, vi­sion and life in­sur­ance pro­grams may start send­ing bills di­rectly to work­ers. Fed­eral work­ers pay the pre­mi­ums for these ben­e­fits them­selves, ac­cord­ing to Dan Blair, who served as both act­ing di­rec­tor and deputy di­rec­tor of the OPM dur­ing the early 2000s. He is now a se­nior coun­sel­lor and fel­low the Bi­par­ti­san Pol­icy Cen­ter.

Be­cause work­ers’ cheques are not be­ing pro­cessed, the amounts usu­ally sent to these car­ri­ers each pay pe­riod also aren’t be­ing paid. If the shut­down lasts longer than two or three pay pe­ri­ods, work­ers will get premium bills di­rectly from these firms and should pay them “on a timely ba­sis to en­sure con­tin­u­a­tion of cov­er­age,” the OPM says in its FAQ. Blair agrees.

There also may be a de­lay in pro­cess­ing claims for flex­i­ble spend­ing ac­counts. These are spe­cial ac­counts in which work­ers use pre-tax money de­ducted from their pay­cheques to cover cer­tain el­i­gi­ble med­i­cal ex­penses, such as eye­glasses, braces, co-pay­ments for doc­tor vis­its or med­i­ca­tions, in­clud­ing some over-the-counter prod­ucts. With no pay­cheques go­ing out, these de­duc­tions are not be­ing made and trans­ferred into FSAs. Once pay­cheques start up again, the amount de­ducted will be ad­justed so the worker will get the an­nual to­tal they had re­quested.

Dur­ing the shut­down, though, re­im­burse­ment claims to these ac­counts also won’t be pro­cessed, the OPM says. Blair sug­gests hold­ing off on big-ticket pur­chases dur­ing the shut­down, if pos­si­ble, and al­ways keep­ing pa­per­work on the pur­chases.

An­other con­sid­er­a­tion: Those who changed plans be­fore the fur­lough may find their pa­per­work wasn’t pro­cessed in time.

In those cases, the OPM says to stick with the old health plan un­til the shut­down ends and the new plan is pro­cessed. The new plan will pick up any claims in­curred. How will work­ers know if their change was pro­cessed? The OPM’s FAQ says work­ers who re­ceive an ID card in the mail are en­rolled.

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