FEHB Plan Options

Section Banner Image

Health Insurance Options for Federal Employees

The FEHB Program offers three primary types of federal health benefit plans. Here is a summary of each type of plan, along with its key features.

Fee-for-Service (FFS) Network Plans

Under the Federal Employees Health Benefits (FEHB) program, an FFS plan offers health insurance for federal employees whereby doctors and other providers receive a fee for each service, such as an office visit, test, procedure or other health care service. FFS plans then reimburse either the federal employee or the health care provider for the allowable cost under the plan for covered services. In most cases, federal employees may choose their own physicians, hospitals and other health care providers.

Most fee-for service plans have provider network arrangements nationwide. If, under the federal health benefits plan, the employee receives services from a network provider, he or she will usually have lower out-of-pocket expenses because of the network discounts and other features, like a smaller copayment and/or a reduced or waived deductible. All fee-for-service plans require precertification of inpatient admissions and may require preauthorization of certain procedures or other services.

Key Features of a FEHB FFS Network Plan

  • No geographic restrictions on doctors or other providers. Some federal employee health insurance plans may also provide overseas coverage.
  • Out-of-network benefits are provided.
  • Referrals are not required to see specialists.
  • See any provider, at any time — no PCP enrollment required.
  • Copayments or coinsurance available at time of care.
  • Certain federal health benefits require that your annual deductible is met first.
  • Preventive care services are covered, but mostly when Network providers are used.

Compare MHBP federal employee health insurance plans

Health Maintenance Organizations (HMO) Plans

As it relates to federal health benefits, HMOs are federal employee health insurance plans that provide care through contracted or employed physicians and hospitals located in particular geographic or service areas. Federal employees are eligible to enroll in an HMO based on where they live or, in some cases, where they work. Many HMOs have network provider restrictions, which means that the employee must use in-network providers for most health care services to be covered.

Out-of-network coverage is typically limited to emergencies. Federal employees participating in an HMO may be required to choose a primary care physician (PCP) and have all health care services coordinated through that physician. The PCP is typically responsible for obtaining any precertification required for inpatient admissions or other services or procedures.

Key Features of an HMO

  • Federal employees with an HMO may have access to a limited number of doctors and other providers — coverage may be restricted to the plan’s service area.
  • No out-of-network benefits, except for emergencies.
  • Referrals to see specialists may be required.
  • Enrollment with a Primary Care Physician (PCP) may be required.
  • Employees usually pay only copayments for care and there may not be a deductible.
  • Comprehensive preventive care benefits are provided.

Compare MHBP federal employee health insurance plans

Dental and Vision

Many federal health benefits plans also offer optional dental and/or vision coverage. For more information on these options, please visit our FEHB Dental and Vision page.

Learn more about MHBP’s federal dental and vision plans

To learn more about the federal health benefits available to you, contact your agency’s human resources (HR) office or retirement system, or visit www.opm.gov/insure.

Locate a Provider

Enter a Zip Code