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Opm Health Plans 2018

The Basics of OPM Health Plans 2018

The Office of Personnel Management (OPM) Health Plans for the year 2018 are comprehensive healthcare coverage options offered to federal employees, retirees, and their dependents. These plans are designed to provide access to quality healthcare services and a wide range of benefits. There are two main types of OPM Health Plans available: Fee-for-Service (FFS) plans and Health Maintenance Organization (HMO) plans.

Fee-for-Service (FFS) Plans:

FFS plans are traditional health insurance plans that offer a greater degree of flexibility and choice when it comes to selecting healthcare providers. These plans allow individuals to visit any doctor, specialist, or hospital without a referral. Under an FFS plan, individuals pay a portion of the costs for each healthcare service they receive. This can include deductibles, co-payments, and coinsurance.

Health Maintenance Organization (HMO) Plans:

HMO plans, on the other hand, provide a more structured approach to healthcare. They typically require individuals to select a primary care physician (PCP) who acts as a gatekeeper for all non-emergency healthcare services. In an HMO plan, individuals generally need a referral from their PCP to see a specialist. Additionally, HMO plans generally have a network of healthcare providers that individuals must use in order to receive the highest level of coverage.

Both FFS and HMO plans offer a variety of benefits, including coverage for hospitalization, prescription drugs, preventive care, and mental health services. The specific benefits and coverage options may vary depending on the plan chosen.

The OPM Health Plans for 2018 are designed to meet the diverse healthcare needs of federal employees and retirees. These plans offer comprehensive coverage, allowing individuals and their dependents to access the necessary medical services needed to maintain their health and well-being. Some plans also offer additional benefits such as dental and vision coverage, allowing individuals to further customize their healthcare plan.

When considering an OPM Health Plan for 2018, it is important to carefully evaluate the different options available. Factors to consider include the monthly premiums, deductibles, co-payments, and coinsurance rates. It is also important to consider the network of healthcare providers and whether they meet your specific healthcare needs. Additionally, individuals should review the prescription drug coverage offered by each plan, especially if they rely on regular medications.

The OPM Health Plans for 2018 offer federal employees, retirees, and their dependents comprehensive healthcare coverage options. These plans provide access to a wide range of benefits, including coverage for hospitalization, prescription drugs, and preventive care. Whether you choose an FFS plan or an HMO plan, it is essential to carefully evaluate the options available to ensure that you select a plan that meets your specific healthcare needs and preferences.

Key changes and updates in OPM Health Plans 2018

In 2018, the Office of Personnel Management (OPM) has introduced several key changes and updates to its Health Plans. These changes aim to enhance the quality and coverage of the OPM Health Plans, ensuring that individuals and their families have access to comprehensive healthcare services. This article will highlight some of the significant updates in OPM Health Plans for the year 2018.

Premiums and cost-sharing adjustments

One of the notable changes in the OPM Health Plans for 2018 is the adjustment in premium rates and cost-sharing requirements. OPM has actively worked to keep premium increases as low as possible while still maintaining quality coverage. Premiums for most plans have experienced modest increases, aligning with the overall trend in healthcare costs. Additionally, OPM has set limits on maximum out-of-pocket expenses for FFS plans and implemented cost-sharing reductions for certain preventive services.

Expanded coverage options

OPM Health Plans for 2018 have expanded coverage options to cater to the diverse needs of federal employees and their families. One significant addition is the inclusion of more comprehensive mental health and substance abuse services, recognizing the importance of holistic well-being. Moreover, OPM has increased coverage for preventive services, such as immunizations, screenings, and wellness programs, to promote early detection and overall health maintenance.

Access to telehealth services

To enhance convenience and improve access to care, OPM Health Plans now offer expanded telehealth services in 2018. Telehealth allows individuals to receive medical consultations, diagnoses, and treatment plans remotely through video visits or phone calls. This feature is particularly beneficial for individuals in rural areas or those with limited mobility, as it eliminates the need for unnecessary travel and reduces wait times for appointments.

Improvements in prescription drug benefits

OPM Health Plans have also made improvements in their prescription drug benefits for 2018. They have worked closely with pharmacy benefit managers to negotiate lower prices for commonly prescribed medications, making them more affordable for plan members. Additionally, OPM has expanded its coverage for certain specialty drugs, ensuring that individuals with complex or chronic conditions can access vital medications without undue financial burden.

Enhanced consumer tools and resources

Recognizing the importance of informed decision-making, OPM has introduced enhanced consumer tools and resources to help individuals navigate the complexities of choosing and managing their OPM Health Plans. These tools provide access to detailed information about plan benefits, coverage options, and provider networks. Consumers can compare plan costs and estimate their out-of-pocket expenses, enabling them to make well-informed decisions that best suit their healthcare needs.

The key changes and updates in OPM Health Plans for 2018 aim to provide federal employees and their families with improved coverage and access to high-quality healthcare services. Through adjustments in premiums and cost-sharing, expanded coverage options, access to telehealth services, improvements in prescription drug benefits, and enhanced consumer tools and resources, OPM continues to prioritize the overall well-being of its plan members. Individuals can now make more informed decisions, maximize their benefits, and ensure they receive the care they need when they need it.

Understanding the Enrollment Process for OPM Health Plans 2018

Eligibility Criteria for OPM Health Plans 2018

To enroll in OPM Health Plans for the year 2018, individuals must meet certain eligibility criteria. Typically, federal employees, retirees, and their families are eligible to participate in these plans. Temporary employees, members of the House of Representatives, congressional staff, and other specific groups may also be eligible.

Enrollment Periods for OPM Health Plans 2018

It is important to be aware of the enrollment periods for OPM Health Plans in 2018. The Open Season, which is the primary enrollment period, usually takes place in the fall. During this time, eligible individuals can choose a plan or make changes to their existing coverage. The exact dates for Open Season are determined by the Office of Personnel Management (OPM) and are typically announced well in advance.

There may be other special enrollment periods throughout the year, such as when individuals experience qualifying life events like marriage, birth, adoption, or the loss of other healthcare coverage. It is important to stay informed about these special periods to ensure timely enrollment.

Steps to Enroll in OPM Health Plans 2018

Enrolling in OPM Health Plans for 2018 involves a series of steps to follow. Here is a general outline of the process:

  1. Research and Compare Plans: Before enrolling, individuals should research and compare the available plans to determine which one best meets their healthcare needs and preferences. This includes considering factors such as coverage options, network of providers, costs, and prescription drug benefits.
  2. Review Plan Documents: Once a suitable plan has been identified, it is essential to review the plan documents, such as the brochure and Summary of Benefits and Coverage (SBC). These documents provide detailed information about the plan’s coverage, costs, and limitations, helping individuals make an informed decision.
  3. Enroll Online or by Phone: Most OPM Health Plans in 2018 allow for online enrollment through a secure website. Alternatively, individuals can also enroll by phone, following the instructions provided by the plan. It is essential to have all necessary information, such as Social Security numbers and dependent details, readily available when enrolling.
  4. Select Coverage Options: During the enrollment process, individuals will need to choose their coverage options, such as selecting the type of plan (e.g., Fee-for-Service or Health Maintenance Organization) and the specific benefits they wish to include.
  5. Submit Enrollment Forms: Once the choices have been made, individuals will need to submit the necessary enrollment forms to the OPM or the specific plan’s administrator. It is important to complete the process within the designated enrollment period to ensure coverage starts on time.

Deadlines and Important Dates for OPM Health Plans 2018

To ensure a smooth enrollment process, it is crucial to be aware of the deadlines and important dates for OPM Health Plans in 2018. The Open Season typically has a set timeframe, and enrollment forms must be submitted within this period to be valid. Missing the enrollment deadline could result in a delay in coverage or even the inability to enroll until the next Open Season.

Additionally, it is essential to understand any other applicable deadlines, such as those related to special enrollment periods. These dates may vary depending on the circumstances, so individuals should contact the OPM or the specific plan’s administrator for accurate information.

By understanding the eligibility criteria, enrollment periods, and steps involved in enrolling for OPM Health Plans in 2018, individuals can navigate the process smoothly and select the best coverage for their healthcare needs. It is crucial to be proactive, stay informed about deadlines, and seek assistance when needed to ensure a successful enrollment experience.

Comparing Different OPM Health Plans for 2018

Understanding the Available Options

When it comes to OPM Health Plans for the year 2018, it’s important to understand the different options available. OPM offers a range of plans, including both Fee-for-Service (FFS) and Health Maintenance Organization (HMO) plans. Each type of plan has its own unique features and benefits, making it essential to compare and evaluate them based on your individual needs.

Fee-for-Service (FFS) Plans

FFS plans provide individuals with the freedom to choose their healthcare providers without a primary care physician referral. These plans typically offer a wide network of doctors, hospitals, and specialists. They often have higher premiums compared to HMO plans but also provide greater flexibility in terms of selecting healthcare providers.

Health Maintenance Organization (HMO) Plans

HMO plans, on the other hand, require individuals to choose a primary care physician who manages their healthcare and provides referrals to specialists. These plans usually have lower premiums compared to FFS plans but have a narrower network of providers. However, HMO plans often emphasize preventive care and coordination of healthcare services.

Key Factors to Consider

When comparing different OPM Health Plans for 2018, there are several key factors to consider to make an informed decision:

Coverage Options

Evaluate the coverage options offered by each plan. This includes benefits such as hospital stays, doctor visits, prescription drugs, and preventive care. Look for plans that align with your specific healthcare needs, ensuring that essential services and treatments are covered.


Consider the costs associated with each plan, including premiums, deductibles, co-pays, and coinsurance. Compare the overall cost of each plan and determine which one fits your budget. It’s important to strike a balance between affordability and coverage.

Network of Providers

Examine the network of healthcare providers associated with each plan. Determine if your preferred doctors, specialists, and hospitals are in-network. It’s crucial to choose a plan that allows you to access the healthcare providers you trust and are comfortable with.

Prescription Drug Benefits

If you regularly require prescription medications, carefully review the prescription drug benefits offered by each plan. Look for plans that cover the medications you currently take and inquire about pharmacy options, such as mail-order programs or preferred networks.

Making an Informed Decision

To make the best decision when selecting an OPM Health Plan for 2018, it’s important to gather all the necessary information and weigh your options. Here are a few tips to help you make an informed decision:

  • Research and compare the plans. Visit the OPM website or contact their customer service to obtain detailed information on each plan.
  • Consider your healthcare needs. Assess your current health status, any ongoing treatments or conditions, and estimate your healthcare needs for the upcoming year.
  • Seek advice from others. Reach out to friends, family, or colleagues who have experience with OPM Health Plans. They may offer insights and recommendations based on their own experiences.
  • Review plan materials carefully. Carefully read the plan documents, such as the Summary of Benefits and Coverage (SBC) and the plan brochure. Pay attention to the fine print, including cost-sharing details and limitations.
  • Use online tools and resources. Many online tools and resources are available to help you compare and evaluate OPM Health Plans. Utilize these tools to simplify your research and decision-making process.

By taking the time to compare and evaluate the different OPM Health Plans for 2018, you can choose the one that best suits your healthcare needs and budget. Remember to consider coverage options, costs, network of providers, and prescription drug benefits to ensure you make an informed decision.

Tips for Maximizing Benefits and Utilizing Resources in OPM Health Plans 2018

Managing Healthcare Costs

When it comes to OPM Health Plans 2018, one of the key concerns for many individuals is managing healthcare costs. To maximize your benefits and minimize out-of-pocket expenses, there are several strategies you can employ. Firstly, take the time to review your plan’s benefits, including any deductibles, copayments, and coinsurance amounts. Understanding these costs will help you plan and budget accordingly. Additionally, consider using generic medications when possible, as they tend to be more cost-effective compared to brand-name drugs. You can also explore the option of mail-order pharmacies, which often offer discounted prices on prescription medications. Lastly, take advantage of any preventative services covered by your plan, as early detection and prevention can help save on future healthcare costs.

Navigating the Network of Providers

Another important aspect of maximizing your OPM Health Plan is navigating the network of providers. Most plans have a network of doctors, specialists, and hospitals that offer preferential rates for plan participants. It is crucial to carefully review the provider directory and ensure that your preferred healthcare providers are part of the network. This will help you avoid higher out-of-network costs. Additionally, if you need a specialist or have a specific healthcare need, consider reaching out to your plan’s customer service for assistance in finding an in-network provider that meets your requirements.

Taking Advantage of Additional Resources and Programs

OPM Health Plans often offer additional resources and programs to promote overall health and wellbeing. These resources may include telehealth services, wellness programs, and discounts on alternative therapies, such as acupuncture or chiropractic care. To maximize your benefits, be sure to explore these additional offerings. Telehealth services, for example, allow you to consult with a healthcare professional remotely, saving you time and potentially reducing the need for in-person visits. Wellness programs may include incentives for completing certain health activities, such as smoking cessation programs or weight management initiatives. By actively engaging in these resources and programs, you can take proactive steps towards improving your health and potentially reducing healthcare costs.

Staying Informed and Proactive

To make the most of your OPM Health Plan in 2018, it is essential to stay informed and proactive. Regularly review your plan documentation, including the Summary of Benefits and Coverage, to understand your coverage and any updates or changes that may occur throughout the year. Additionally, stay up to date with your plan’s communications, such as newsletters or member portals, as they often provide valuable information regarding new services, benefits, or cost-saving opportunities. Lastly, don’t hesitate to contact your plan’s customer service if you have any questions or concerns. They are there to assist you and provide guidance on utilizing your benefits effectively.

By implementing these tips, you can maximize your benefits and make the most of your OPM Health Plan in 2018. Managing healthcare costs, navigating the network of providers, taking advantage of additional resources and programs, and staying informed and proactive are all essential strategies to optimize your healthcare experience. Remember, your health is invaluable, and by making informed decisions and proactive choices, you can ensure you receive the best possible care while optimizing your benefits and keeping expenses under control.


In conclusion, OPM Health Plans for 2018 offer a range of options and benefits for individuals looking for comprehensive healthcare coverage. These plans are designed to cater to the diverse needs of different individuals and provide access to a wide network of healthcare providers. From Fee-for-Service plans to Health Maintenance Organization plans, there is a plan to suit every preference and requirement.

It is important for individuals to stay informed about the key changes and updates in OPM Health Plans for 2018. These updates can include improvements in coverage, changes in premiums, deductibles, and co-pays, as well as the introduction of new services or benefits. By staying up-to-date with these changes, individuals can make informed decisions about their healthcare coverage and ensure that they are maximizing their benefits.

Enrolling in OPM Health Plans for 2018 requires an understanding of the enrollment process. Eligibility criteria, enrollment periods, and steps involved in selecting and enrolling in a plan need to be carefully considered. It is important to keep track of any deadlines or important dates to ensure a smooth enrollment process and avoid any gaps in coverage.

When comparing different OPM Health Plans for 2018, individuals should consider various factors such as coverage options, costs, network of providers, and prescription drug benefits. By carefully evaluating these factors, individuals can make an informed decision that aligns with their specific healthcare needs and preferences.

To maximize benefits and make the most of OPM Health Plans for 2018, individuals can follow certain tips and strategies. By effectively utilizing preventive services, managing healthcare costs, and navigating the network of providers, individuals can optimize their healthcare experience. Additionally, taking advantage of resources such as telehealth services, wellness programs, and other services offered through the plans can contribute to overall health and wellbeing.

In conclusion, OPM Health Plans for 2018 provide a comprehensive and flexible healthcare coverage option for individuals. By understanding the basics of these plans, staying informed about changes and updates, and carefully comparing different options, individuals can make the most of their healthcare benefits. By utilizing resources and following practical tips, individuals can ensure a positive healthcare experience and prioritize their overall health and wellbeing.