MEDICAL PLANS AVAILABLE
Doyon Government Group offers medical plans through the Federal Employee Health Benefits (FEHB) program for tribal employees. The FEHB plans give you and your family choices so you can choose the plan that works best for healthcare needs.
OPEN ENROLLMENT
Open enrollment begins November 14, 2022, and concludes December 12, 2022. Enrollment for all benefits is available through PlanSource.
During open enrollment, you can add or change dependents, and enroll (or decline coverage) for the following benefits:
Medical plans through FEHB
Dental and vision coverage
Health care flexible spending account
Dependent care flexible spending account
Transportation Reimbursement Account
Voluntary employee, spouse, and child life insurance
Upcoming FEHB Educational Webinars
October 24 at 4 p.m. PDT/7 p.m. EDT
October 25 at 9 a.m. PDT/12 p.m. EDT
October 26 at 12 p.m. PDT/3 p.m. EDT
October 27 at 12 p.m. PDT/3 p.m. EDT
NEW EMPLOYEES
You can add or change dependents and enroll (or decline) for the following benefits during your initial enrollment period and annual open enrollment period:
• FEHB Medical Plan
• Dental and Vision Coverage
• Health and Dependent Care Flexible Spending Accounts
• Transportation Reimbursement Account
• Voluntary Life and AD&D Insurance for Self, Spouse, and Child
• Basic Life Insurance
You must re-enroll in all your benefits for the 2023 plan year.
CHOOSING A PLAN
Every family’s needs are different. Choose a plan that matches the way you use medical services. For example, if you have a lot of doctor visits, you may want a plan with lower out-of-pocket expenses. Or, if you have a prescription drug you take every day, choose a plan that covers those drugs at the lowest cost.
Decide who to cover
The FEHB plans are available for:
Employee only
Employee + 1
Employee + family
Look at provider networks
Your costs are lower when you use providers who are part of the plan; these are “in-network” providers. If you have doctors or other health care providers that you like, call their office to see if they are in-network for the plans you are considering. This means that they have an agreement with that plan’s insurance company to provide service to you at a lower price.
In general, plans with a bigger network of healthcare providers will give you more choices. If you use providers that are not in your plan’s network, you may pay much more.
Some of the FEHB plan providers use the same networks as Aetna and Cigna:
• APWU – 471 plan uses Cigna/ 474 plan uses United Healthcare
• GEHA – uses Aetna’s network
• MHBP – uses Aetna’s network
• NALC – uses Cigna’s network
• SAMBA – uses Cigna’s network
Think about your budget
With many health plan choices, you can find a premium cost that fits your budget. Your total cost of health care also includes out-of-pocket expenses, so you need to compare those costs as well as the premium cost.
Some FEHB plans put part of your premium in a medical reimbursement account (HSA or HRA) for your use – consider this when comparing plan premium costs.
You can choose a plan in the state where you live OR the state where you work. Use the tool to compare features of the plans available to you. You can compare up to four plans at a time.
COMPARE FEHB PLANS
The Compare Plans Tool shows a monthly premium cost for each plan. This is the employee premium most tribal employees pay for each FEHB plan. However, Doyon has chosen a different contribution strategy. Please use this chart for your premium cost for each FEHB plan available to you.
HEALTH CARE DEFINITIONS
PREMIUM
The amount paid for your health insurance every month. You and Doyon share in the cost of this premium, with Doyon paying the majority of the cost.
DEDUCTIBLE
The amount you pay for health care services before your insurance plan starts to pay.
CO-PAYMENT
A fixed payment for a service, paid at the time of service. Not usually subject to a deductible.
COINSURANCE
The percentage of the cost you pay for health services after you have paid your deductible.
OUT OF POCKET COSTS
Costs for medical care that are not paid by insurance. This includes deductibles, co-payments and coinsurance for covered services and all costs for services that are not covered. Once you reach your out-of-pocket maximum, the insurance plan will pay 100% of eligible costs for the rest of the calendar year.
COVERED SERVICES
Services covered by your health insurance plan, listed in the plan’s Summary of Benefits.
Frequently asked questions
Below is a list of top and general frequently asked questions. For frequently asked questions regarding eligibility, Flexible Spending Accounts, enrollment, and more, click here.
This year we experienced a 41% premium increase in the United Healthcare medical plan. We determined that our health plans is no longer sustainable and began exploring other options to reduce our cost. We will now offer medical plans through the Federal Employee Health Benefits (FEHB) program for tribal employers. Eligible employees will now be able to buy the same health insurance offered to U.S. federal government employees. The federal plan gives you and your family more choices and better pricing. Movement to the FEHB will help reduce our company’s health care costs on an on-going basis.
- A spouse (including a same-sex spouse)You must provide proof that you are legally married to your spouse.
- Common Law Spouse. You may cover your common law spouse under the FEHB Program only if your marriage was initiated within a State that recognizes such a marriage. The National Conference of State Legislatures lists the states that recognize common law marriages.
+ You must provide all of the following information:
+ A court order or judgment recognizing the marriage; orYour declaration indicating:
– The date on which and the state in which you and your spouse mutually agreed to become married.
– The length of time you and your spouse have lived together.
– All address or addresses at which you and your spouse have lived together.Whether you and your spouse have been regarded among neighbors, friends, and relatives as being married spouses.
– If you or your spouse were previously married, the declaration must indicate date and place of each previous marriage as well as the date, place, and manner of termination (i.e., death, divorce, or annulment).
– Your signature underneath the following statement: Any intentionally false statement or willful misrepresentation relative thereto is a violation of the law punishable by a >fine of not more than $10,000 or imprisonment of not more than 5 years, or both. (18 U.S.C. 1001)
In addition to the above, you must provide any one of the following documents listing you and your spouse:
- Front page of most recent tax year’s Federal or State tax return; orProof of common residency (e.g., utility bill, other household bill, auto registration); and proof of financial interdependency (e.g., shared bank statement, credit card statement, life or auto insurance policy).
- Children under age 26, including adopted children, recognized natural children or stepchildren (including children of same-sex domestic partners in certain states); or foster children living with the employee in regular parent/child relationship.
- Children age 26 or older incapable of self-support, if the disabling condition began before age 26 (medical documentation required).
To learn more about eligibility requirements visit https://www.opm.gov/healthcare-insurance/healthcare/eligibility/.
All regular full time and part time employees are eligible to participate in this plan. You can enroll in an FEHB plan even if you did not enroll in a plan for 2022.
Yes, with some exceptions. You are not eligible for an FEHB plan if you have existing Federal Employee Health Benefits (FEHB) coverage. This does not include other federally managed/funded plans like Medicare, VA, or Indian Health Services.
However, if you have Tricare Reserve Select (not TriCare or TriCare Prime – only Tricare Reserve Select), you are no longer eligible for Tricare Reserve Select coverage now that you are eligible for FEHB. If you want to enroll in a FEHB plan, you must immediately notify Tricare to terminate your Tricare Reserve Select coverage effective January 1, 2023.
November 14 to December 12, 2022.
The FEHB will be effective January 1, 2023.
After the open enrollment period ends, you should receive insurance cards and other information within about two weeks. This information will come from the insurance carrier you selected. If you do not receive your information by December 31, call the toll-free telephone number listed for that carrier. You can use the “Compare Plans Tool” on the https://www.doyon.com/fehb/ website to find the contact information for your insurance carrier.
Your current medical plan will end on December 31, 2022. If you do not enroll in an FEHB plan, you will not have medical coverage in 2023.
APWU Health Plan – CDHP (Plan code 474, 475, 476) is an HRA plan the uses United Healthcare’s network. It is the plan that is most similar to the current HRA plan offered to you by United Healthcare. This plan is available in all states.
UnitedHealthcare Choice HDHP (Plan code LU1, LU2, LU3) is an HRA/HSA plan that also uses United Healthcare’s network. This plan may not be available in all states.
Kaiser Mid-Atlantic States Prosper (Plan code T71, T72, T73) is a Kaiser Permanente plan. It is most similar to the current Kaiser plan. This plan is in Maryland, Virginia, and Washington, DC.
FEHB is the Federal Employee Health Benefits (FEHB) program. This is the same insurance offered to U.S. federal government employees. FEHB is the largest group health insurance program in the world, with more than 8 million members. This health insurance is also available to employees of approved tribal employers. DGG and Design Data can now offer FEHB benefits to employees.
No, but you need to log in to PlanSource and “decline” coverage. We want to make sure that every employee knows about the new health plans and understands that if you do not enroll in an FEHB plan, you will not have medical coverage in 2023 (unless you have a qualified life event).
See “Choosing a Plan” for information about choosing a plan. You need to decide who to cover, think about your medical needs, look at provider networks, and think about your budget.
The FEHB has an online tool, the Compare Plans Tool, that can help you narrow down your choices within the plans. The tool allows you to choose specific plans and compare them side by side. Always refer to the plan brochures before making a final decision.
If you are enrolled in the HRA plan, the APWU CDHP Health plan (474, 475, 476) is most comparable to your existing plan. This is a plan available in all states and utilizes United Healthcare’s network. It has a $2,200 individual deductible with a $1,200 HRA contribution, reducing the overall deductible to $1,000.
If you are enrolled in the HSA plan, the most equivalent plan is the United Healthcare HDHP plan (LU1, L2, LU3). This plan is only available in Washington, Arizona, Colorado, Nevada and Oregon. It has a $1,500 annual deductible. If you are not eligible for an HSA, you can enroll in the HRA option of this plan which provides a $750 annual credit for individual coverage.
If you are enrolled in the Design Data Kaiser plan, the most equivalent plan is the Kaiser Permanente Mid-Atlantic State Prosper In-Network (T71, T72, T73). It is available in Maryland, Virginia, and Washington DC. It has a $100 individual and $200 family annual deductible. $30 Primary care office visit. Preventative care you pay nothing.
The federal government plans include:
- Fee for Service with Preferred Provider Organization (PPO)
- Health Maintenance Organizations (HMO)
- Consumer Driven High Deductible plans (CDHP)
- High Deductible Plans (HDHP) with a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA)
Different plans are available in different states. PlanSource will only allow you to enroll in a plan in the state you live in. For more information on available plans, use the Compare Plans Tool.
You’ll need to do the comparison using one zip code, and then the same using the other zip code. You can’t compare plans for more than one zip code at a time.
The company will continue to offer vision coverage. See your benefit guide for more information.
Some FEHB plans may offer emergency vision coverage so check the plan documents when reviewing plan options.
The company will continue to offer dental coverage. See your benefit guide for more information.
Some FEHB plans may offer emergency dental coverage so check the plan documents when reviewing plan options.
If you have a “qualifying life event (QLE),” you may be able to add a medical plan or change your coverage. Some examples are:
Your family changes through marriage, divorce, birth, death or for other reasons
Your employment changes, for example from on-call to regular
You lose coverage under a spouse’s insurance plan
You become entitled to Medicare
You will have coverage for 31 days at no cost. Then you have several options:
You can enroll in “Temporary Continuation of Coverage” for up to 18 months. You will pay the entire premium plus 2% administrative fee.
You can convert to an individual medical policy.
You can get other coverage inside or outside of the health insurance exchanges.
If you have a “qualifying life event (QLE),” you may be able to cancel your health plan. Some examples are:
Your family changes through marriage, divorce, birth, death or for other reasons
Your employment status changes
You gain coverage under a spouse’s insurance plan
You become entitled to Medicare
Variable Hour Employees who are not expected to work 130 hours per month
Seasonal Employees
Contract Employees
Tribal Retirees
Volunteers
Non-Citizens working outside of the US
If you are unsure of your employment status, contact Human Resources.
For more information contact Paty Delgadillo at 253-344-5319, Crystal Myers at 253-344-5315, or dgghr@doyongovgrp.com.