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Postal Service Health Benefits (PSHB) Program Carriers

 

Overview

The Postal Service Health Benefits (PSHB) Program was established by the Postal Service Reform Act and will offer health benefits coverage to eligible United States Postal Service employees, annuitants, and their eligible family members beginning January 1, 2025.

The PSHB Program will generally require Postal Service annuitants who are newly entitled to Medicare, and their covered family members who are Medicare-eligible, to enroll in Medicare Part B to continue their health benefits coverage into retirement. PSHB plans are required to integrate Medicare Part D, offering prescription drug coverage through an Employer Group Waiver Plan (EGWP).

Guiding Principles for Carriers

All carriers must be committed to:

  1. Ensuring enrollees have access to 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.

Carrier Letters

All PSHB Carriers must adhere to the guiding principles inherent in the FEHB Program, including the FEHB Act, chapter 89 of title 5, United States Code, regulations at 5 CFR part 890 and 48 CFR chapter 16, current standard contract terms except as conformed specifically for the PSHB, and OPM instruction and guidance.

All FEHB Carrier Letters, including archives commencing with calendar year 1999, will be in effect for PSHB Program Carriers effective January 1, 2025, unless otherwise inapplicable.

2024 Carrier Letters

Letter Date Subject
2024-04 02/08/24

Federal Employees Health Benefits and Postal Service Health Benefits Programs Call Letter

2024-05 02/12/24

Consolidated Pharmacy Benefits Guidance for the FEHB Program

2024-06 03/07/2024 Technical Guidance and Instructions for 2024 Benefit Proposals
Addendum to Technical Guidance and Instructions for 2025 Benefit Proposal
Attachment A: 2024 FEHB Formulary Template
Attachment B: 2025 FEHB Formulary Template
Attachment C: Formulary Comparison Between 2024 and 2025 Template
Attachment D: 2025 PSHB Drug List Template
Attachment E: FEHB Benefit Difference Comparison Chart
Attachment F: Formulary Comparison Between CMS Base, Enhanced EGWP, and FEHB Template
2024-08 03/19/2024 Network Provider Data Reporting Requirements
Provider_PSHB_FEHB JSON file
Provider_PSHB_FEHB Example JSON file
2024-09 04/01/2024 Reconciliation Instructions for 2024 Rates - Community Rated Carriers
Part 3 - 2024 Reconciliation Instructions
2024 Reconciliation Tables Attachments III and IIIA*
2024-10 04/30/2024 2025 Rate Instructions - Community-Rated Carriers
Attachment A: Part 1 - 2025 Community Rating Guidelines
Attachment B: Part 2 - 2025 Proposal Instructions
Attachment C: Proposal Tables Attachments I, IA, II, IIB (QG22-QG28), and IIA
2024-11 05/01/2024 Updated Enrollment Data Reporting Requirements
2024-12 05/07/2024 Formulary Reporting Requirements
Attachment A: PSHB Monthly Formulary Update Template
Attachment B: Mid-Year Formulary Changes Template
2024-13 05/10/2024 Auto-Enrollment Process for Postal Service Employees and Annuitants Transitioning from Federal Employees Health Benefits (FEHB) to Postal Service Health Benefits (PSHB)
2024-19 09/23/2024 Postal Service Health Benefits (PSHB) Program Plan Performance Assessment (PPA) Transition Guidance

*This document will be uploaded soon.

2023 Carrier Letters

Letter Date Subject
2023-13 07/19/23

Methodology for Crediting Postal Service Health Benefits (PSHB) Program Plan Reserves and Earned FEHB Medical Loss Ratio Credits

Attachment A - Crediting the PSHB Reserves Example

Carrier Application

Types of carriers that qualify for participation in PSHB Program

  • The PSHB 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.

How to apply

Carriers interested in offering health insurance plans in the PSHB Program should submit an application in Carrier Connect.

  • Applications for the 2026 plan year must be received by January 31, 2025.

 

 

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