The Federal Employees Health Benefits (FEHB) Program is the largest employer sponsored health benefits program of its kind. Established by an Act of Congress in 1959, the FEHB Program began covering employees on July 1, 1960. FEHB Program carriers cover most active, full-time civilian employees and retirees of the U.S. government and their families. The Program now provides benefits to nearly 8.3 million federal enrollees and dependents and offers our 180 health plan choices to federal members.

Guiding Principles for Carriers

All carriers must be committed to:

1. Ensuring enrollees have access to good healthcare benefits;
2. Striving to keep premiums affordable;
3. Ensuring enrollees have access to quality provider networks;
4. Providing competitive healthcare choices for consumers;
5. Strengthening information for consumers so they can be more involved and responsible for their own healthcare decisions;
6. Being well managed and financially secure;
7. Providing efficient and effective contract administration;
8. Ensuring the timely and accurate submission of actuarial data and financial accounting information;
9. Maintaining compliance with laws, regulations, contract requirements and administrative guidance at all times; and
10. Guaranteeing that enrollee and Government resources are protected.

*This Letter was rescinded.  It will be revised and reposted.

**This document will be uploaded soon.

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Types of carriers that qualify for participation in FEHB Program

• The FEHB Program will only consider applications from comprehensive, prepaid medical plans.
• Carriers must offer a complete line of medical services, such as doctor's office visits, hospitalization, emergency care, prescription drug coverage, and treatment of mental conditions and substance abuse.
• We do not have the authority to contract with companies that offer limited services, such as dental and/or vision plans, prescription drug plans, supplemental insurance and disability insurance.
• We cannot consider applications from fee-for-service carriers.

We especially invite qualified applicants from the states that the Department of Health and Human Services (HHS) has determined to be medically underserved: Alabama, Arizona, Idaho, Illinois, Louisiana, Mississippi, Missouri, Montana, New Mexico, North Dakota, Oklahoma, South Carolina, South Dakota, and Wyoming.

We also encourage applicants that HHS, Centers for Medicare and Medicaid Services (CMS), determines to be Federally qualified or that are an approved Competitive Medical Plan (CMP).

How to apply

1. Submit the Carrier Application Information Form on this page.
2. Complete the following documents and return them to OPM by January 31:

• Application for FEHB
• Drug Free Workplace Certification
• Sample Experience-Rated HMO Contract
• Sample Community-Rated HMO Contract
• Anti-lobbying form

If you have a question, please call our HMO contracts office at 202-606-0755 or 202-606-0737 and ask to speak with a contract specialist.

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• Directory of Headquarters Level Agency Benefits Officers
• Tests and Procedures Identified in the Choosing Wisely Campaign
• Carrier Handbook
• Benefits Administration Letters
• Tribal Benefits Administration Letters
• Indian Tribes Reference Materials
• Medicare
• Title 5, United States Code, Chapter 89 - Health Insurance
• FEHB Regulations - Part 890 of CFR Title 5
• Federal Acquisition Regulation (FAR)
• OPM Federal Employees Health Benefits Acquisition Regulation (FEHBAR)
• FEHB Enrollment Through Tribal Employees
• FedScope
• Federal Employees Health Benefits Program Call Letter

Performance Assessment

• FAQs on Carrier Letter 2014-19 FEHB Health Plan Performance Assessment
• FAQs Carrier Letter 2014-28 Additional Information on the Performance Areas for the FEHB Plan Performance Assessment
• FAQS Measures and Framework Design
• Reporting HEDIS Metrics to the National Committee Quality for Assurance (NCQA) 

Health Information Technology References

Health & Human Services

• Office of the National Coordinator for Health Information Technology (ONCHIT)
• National Health Information Infrastructure (NHII) Home Page
• CMS DOQ-IT Project
• CMS QIO Program (Quality Improvement Organizations)
• The Health Information Technology Leadership Panel: Final Report (Press Release)
• The Health Information Technology Leadership Panel: Final Report

Executive Branch/Congressionally Appointed Commission

• Certification Commission for HIT

Regional Health Organizations (focusing on the States with which HHS-AHRQ has contracts on HIT demos)

• Indiana Health Information Exchange
• Utah Health Information Network
• Blue Cross $50 Million for Massachusetts HIT 
• Information on Rhode Island HIT efforts

Technology Groups

• Health Information and Management Systems Society
• HL-7 (Health Level 7) Home Page
• Webgroup for Electronic Data Interchange (WEDI) Health Data

• 2022-01 Health Matters Newsletter - Telehealth
• 2022-02 Health Matters Newsletter - Adult Immunization Status
• 2023-01 Health Matters Newsletter: Opioid Stewardship

Federal Employees Health Benefit (FEHB) Program Plan Performance Assessment

The Office of Personnel Management’s (OPM) goal is to improve the health of the populations we serve, ensure the delivery of high quality consumer focused health care, and provide Federal employees and retirees with affordable insurance benefits. We evaluate FEHB Carriers on key parameters of clinical quality, customer service, resource use, and contract oversight.

Many aspects of our performance assessment framework rely on measures from the Healthcare Effectiveness Data and Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS). Scoring measures against national benchmarks help OPM recognize top performing health insurance carriers in the program, inform enrollee choice, and link objective performance to profit.

FEHB Carriers are encouraged to join the National Committee for Quality Assurance's Digital Measurement Community to learn about the implementation of digital performance measures. FEHB Carriers may also find the Health Care Payment Learning and Action Network, managed by the Department of Health and Human Services, as a source of proven value-based payment models utilized among commercial carriers. OPM also encourages FEHB Carriers to join the PPA Best Practices Workgroup. Details can be found in Carrier Letter 2017-10, "Plan Performance Assessment Best Practices Workgroup." Carriers interested in joining the FEHB Program should carefully review materials listed under the subject areas on this page.

Below are links to more FEHB Plan Performance Assessment Information: