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Tribal Benefits Officer Training: Federal Employees Health Benefits Premium Payment


This presentation is an introduction for Tribal
benefit Officers for the billing and payment of premiums under the FEHB Program.
During this presentation we will cover FEHB premiums, enrollment and billing information,
premium collection procedures, adjustments to the monthly bill, non-payment of premiums
and then we will a test your knowledge session and then show you where there are some resources
for you get additional information. The first subject matter is the FEHB premiums.
OPM negotiates benefits and rates on an annual basis with all the different plans that participate
in the FEHB. Now the government contribution is set at 72 percent of the average premium
for Self Only and Self and Family enrollments. The government contribution towards any plan’s
premium will not exceed 75 percent of the plans’ premiums. The contribution that we
have worked out for the tribal employers can be found on our website at www.opm.gov/tribalprograms.
Please remember that these amounts shown on this page do not include the admin fee. Now how did we publish the FEHB premiums?
Rates for the upcoming year are announced in the OPM’s September press release. The
FEHB Guide for Tribal Employees also lists the maximum monthly tribal employee contributions
for all plans. Now, in some cases your tribal employer may decide to pay more than what
is shown in there in which case your part would be less than what is shown as the maximum
monthly tribal. Each FEHB plan’s brochure has the rates
that the Federal and Postal employees pay on the back cover. These do not apply to tribal
employees. Please either look at the tribal employee guide or talk to your HR Officer
to determine just what your portion is. Now how does a tribal employer set its contribution
share? First of all the tribal employer must decide how much to contribute. Now, when figuring
out what the contribution is some things that the tribal employer must do is;
1. They must determine what ever that minimum is that they’re going to pay, that is the
same percentage for each plan. They cannot pay different percentages for different plans.
That’s showing favoritism of one plan over another.
2. Also they must treat all employees in the same category the same. So if they’re going
pay 100% for a Self Only then they have to pay 100% for all Self Onlys. Now the tribal employee will calculate the
tribal employee’s monthly contribution and will publicize how much that you the employee
will pay. The tribal employer will determine your salary deductions based on what your
pay period is and it is also up to the tribal employer to determine whether or not they’re
going to offer premium conversion. Premium conversion is the vehicle by which you can
pay your premiums on a pre-tax basis. However, this is an arrangement that your employer
must make with the IRS. That is something OPM does not have any jurisdiction over. The section that we are going to deal with
is enrollment and the billing information. Now that Standard Form SF 2809 is the form
which everyone employee must complete whether or not you choose to participate in the FEHB
Program. The 2809 is used to process enrollment request, enrollment changes and ay voluntary
cancelation of enrollment. Now the other second form that we have concerning
enrollment is the SF 2810. The SF 2809 is completed by tribal employers for action that
do not require you, the employees signature. It’s used to process terminations, transfer
between tribal employers, reinstatements and name changes. Information about these forms
can found on OPM’s tribal website at www. opm.gov/tribalprograms The
National Finance Center acts as the FEHB payroll
agent paymaster for each tribal employer participating in the FEHB program. NFC is the central location
for collection on enrollment information and the collection of premiums. NFC transmits
enrollment information and premiums information to the FEHB plans. Each month NFC will collect
the premiums the tribal employer owes and send those premiums to the US Treasury. The
US Treasury then sends the premiums to OPM and OPM disburses them among the different
plans. TIPS is the Tribal Insurance Processing System.
This is the electronic system developed by NFC to record all enrollment information for
each tribal employee. Data is entered by the tribal employer and TIPS is maintained by
NFC. The tribal employer review the completed Health Benefits Election Form for its accuracy,
verifies the tribal employees eligibility to enroll or change enrollment and then enter
that SF 2809 into TIPS as soon as possible, preferably with in 24 to 48 hours. TIPS also has a Tribal Desk where you can
go for additional information. Now for the additional setup of the program you would
contact TIPS at [email protected] After your initial set up if you have any additional
inquiries concerning the operation of TIPS you contact NFC at 855-NFC-4GOV or 855- (632-4468) PADS is the Pre-Authorized Debit System that
the tribal employer use to pull the premium from the tribal bank account. PADS will automatically
debit the premium payment on the third business day of each month. Please note that the premium
for the entire billing unit must be available in the bank account on the third business
of each month when PADS pulls the money from the account. What will be included will be
the employers’ share of the premium, the employees’ share of the premium, and the
admin fee. Please note also that NFC does not accept partial payments, the entire amount
of the premiums must be in there. Tribal Employers and Billing Units. A billing
unit is a section of the tribal employer responsible for specific group of tribal employees. For
instance, let’s say tribe A has people that work in their forestry department, people
that work in their hospitality department, and people that work in tribal administration.
These will be three separate operations with three separate bank accounts, each maintaining
their own enrollment and their own premium payment. Now the bank account, each billing unit must
have a separate bank account. Bank account must accept automatic clearing house transactions.
The billings unit bank account is where NFC will collect to total premium amount the administrative
fee. Premium Collection Procedures. This section
will provide a broad overview of the premium collection procedure. For more detail guidance
we suggest that you see the TIPS User Manual and the TIPS training modules that will be
provided by NFC. Premium collection. What we need to pull form
the bank account every month is the tribal employee’s contribution plus the tribal
employer’s contribution plus the NFC administrative fee which is paid totally by the tribal employer.
The funds are deposited with the monthly PADS withdrawal. The tribal monthly bill is posted on TIPS.
NFC will post the billing unit monthly statement on the TIPS system. The tribal employer can
view the billing statement throughout the month making changes that are necessary or
any additions or retroactive adjustments which we will discuss at a later time. The third step in the process is Bill Review.
Now the tribal employer is responsible for reviewing each unit’s billing statement
and making any necessary changes all the way up to the last calendar day of the month.
Changes make by 11:59 mountain time on the last calendar day of the month will be reflected
when the current bill is posted. We suggest that you do not stack your changes and wait
until the last moment to try to get them into the system. We strongly suggest that you put
them in as you receive them so at the end of the month you already have your changes
in the system. Any enrollments or enrollment changes entered into TIPS after the cutoff
date of the last calendar day of the month will be reflected on the following months
billing. Step four is the Bill Payment. PADS will collect
the billed payment amount from the tribal employer’s bank account on the third business
day of the next month. So for instance, May’s premiums will be collected on the third business
day of June. Now tribal employers are strongly encouraged to prefund your account with at
least additional months’ premium funding. Now we’ll talk about the Adjustments to
the Monthly Bill. The first one we are going to discuss is Prospective
Actions. This is an enrollment action with a future effective date that can be added
to TIPS. The FEHB plans will not change the coverage until that effective date and premiums
will not change to reflect the change until the effective date. The second type is a Retroactive Adjustment.
In these cases, the circumstances have already occurred and you’re playing catch up in
the system. Enrollments changes with a retroactive effective date can be made in the TIPS system.
NFC will adjust, either credit or debit, the current month billing to reflect the change
if it is entered into TIPS prior to the last calendar day of the month. Retroactive changes
entered on or after the last day of the month will be adjusted on the next month’s bill.
Now, one thing that you have to remember is that the tribal employer is responsible for
refunding the member any amounts or collecting from the member any amounts that would be
due for the employee part to f the premium as a result of doing these adjustments. Next is prorated premiums. Premiums need to
be prorated when there is an enrollment change before the end of the month. So for instance,
somebody terminates their employment on the 25. TIPS will calculate the premiums based
on the number of days covered in that month. And then the tribal employer will calculate
the salary deductions. The next section we’re going to discuss
is What Happens with Non-Payment of Premiums. What will happen if there’s not enough funds
to pay the billed amount when NFC attempts to withdraw the premiums from the tribal employers
bank account? This slide will show you the insufficient funds payment procedures. If
the total billed premium is not available when PADS attempts the initial withdrawal
on the third business day of the month these steps will occur.
OPM will receive notification that sufficient funds were not available to pay the full amount
of the premium. The OPM tribal Liaison will contact the tribal
employer by phone within one business day to determine why the funds were not available.
During the call we will ask to identify the reason for the under payment, discuss the
insufficient funds process and the final consequences. If sufficient are now available OPM will then
Advise NFC. NFC will make a second attempt to withdraw the entire amount through the
PADS. If OPM cannot confirm that sufficient funds are available we will determine whether
there are mitigating circumstances that should delay a second attempt and there weren’t
a delay in terminating the FEHB enrollments as a result of having insufficient funds.
OPM hold the authority to decide whether or not the circumstances would warn a delay in
the second attempt to withdraw the premium from the bank account. Termination of Coverage. All tribal employees
in the billing unit will be terminated if there is not sufficient funds to pay the premiums.
Each tribal employee will receive a 31 day extension of coverage and the tribal employer
will be responsible for paying the entire premium that’s due. Now, should you decide that you want to reenter
into the FEHB Program there are certain restrictions on this. First of all the billing unit will
not be allowed to enter the program until the Open Season following one calendar year.
So for instance, if a billing unit is terminated for non-sufficient funds in May of 1 year
they cannot come back in, in the Open Season in November. They have to wait until the following
Open Season in the following calendar year. And that tribe must clearly demonstrate the
ability pay those premiums. We will suggest by having, at this point, at least two months’
worth of premiums in the bank account. Now we’re going to do a “Test Your Knowledge”
to see if you were actually paying attention through this presentation. Michael, is a tribal employee and tells you
he will be married next month and wants to cover his soon-to-be wife under his enrollment.
Can Michael’s enrollment be changed to Self and Family before his marriage date? Yes. If Michael wants immediate coverage for
his new wife, he will submit the SF 2809 during the pay period before the anticipated marriage
(it will be effective the first day of the next pay period) after the marriage occurs.
If the effective date is before the marriage, then the new spouse does not become eligible
until the actual marriage date. So for instance if your pay period starts
on the third, you get married on the seventh, the coverage for the spouse is not going to
start until the seventh. When will the Tribal Employer’s monthly
bill reflect the change to Self & Family coverage? The month the change to Self & Family coverage
is effective. So if Michael changed before the anticipated
marriage date and does not get married, the tribal employer must void the request and
adjust premium withholdings accordingly. If the tribal employee changed plans and the
marriage does not take place the tribal employee must notify both the old a new plan that the
tribal change was voided. Second Senario.
Terry, who is a new employee, turns in his SF 2809 on the 29th day of the month. He tells
the Tribal Benefit Officer that he would like to have his effective date be the next day.
Can we do this for him? Check the calendar.
Yes, Terry’s enrollment can be effective on the 30th but only if that is the first
day of the next pay period. The tribal employer will prorate the monthly premium contribution
to reflect that he only had coverage for the one or two days at the end of the month. Tom brings in a divorce decree showing that
he divorced his wife 6 months ago. Since Tom and his wife were the only people covered,
he wants to change his coverage retroactively and be reimbursed for the 6 months of Self
& Family premiums he has paid. Can this be done? Yes
The Tribal Benefits Officer enters the effective date of change in TIPS.
NFC will calculate the amount of premium the tribal employer has overpaid and posts a credit
on the bill. The Tribal Benefit Officer will calculate
the amount owed to Tom and refund him accordingly. Please note that the ex-spouse is not entitled
to FEHB benefits upon the final divorce decree even if the tribal employee did not timely
notify the tribal employer or FEHB plan. It is important to advise the employee that
the FEHB plan has the right to request a refund of benefits paid to the ex-wife during the
time when she was no longer eligible for coverage. There are additional resources that are provided
so that you may get additional information about anything we discussed in this presentation. The TIPS Tribal Desk for all TIPS inquiries
you can contact, and again we give you this number 855-NFC-4GOV or 855- (632-4468). Email
address for setup information on TIPS is [email protected] So if you have any question about your initial
set up of TIPS and how you are using it this is the email address that you would use. Here at OPM we’ve also established what
we call the OPM Tribal Desk. This is staffed with experienced people who are there to help
you answer any questions that you would have, or to be able to refer you to people who can
answer your questions. Tribal Benefit Officers only may make inquiries to the Tribal Desk
at 202-606-2530 or you may email [email protected] The tribal employee should take their question
directly to tribal employing office. Their tribal employer if they do need help or assistance
with answering the question, they will contact either NFC or OPM accordingly. Additional Resources is at www.opm.gov/tribalprograms.
We’ve provided this website a number of times during this presentation. All the information
that you could possibly want to know about this program, premiums, plans, availability,
is available on this website. Also chapter 11 Financials in the FEHB Handbook for Tribal
Employers a very specific and detailed description of the processes that we’ve discussed here.
www.opm.gov/tribalprograms There is also the FEHB Guide for Tribal Employees,
the Tribal FastFacts and the Tribal Quick Guide.
The tribal quick guide provides answers to over thirty common questions about the FEHB
Program. We also have other FEHB training modules. We have FEHB Program Features (known
as FEHB 101), we have presentations on Enrollment, Eligibility and Guidance on FEHB Forms both
the 2809 and the 2810.

Stephen Childs

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