FEHB plans you may not be allowed to join

The three categories

Every FEHB plan sets out who may enroll in the eligibility section of its brochure. In practice they fall into three groups:

• Open to all eligible federal employees and annuitants.
• Open subject to membership in a sponsoring association, which you can usually join for a modest annual fee.
• Restricted to people in a particular service, agency or job, with no way in otherwise.

The sting is that all three appear side by side in the same comparison tables and in our own estimator. The premium is shown; the eligibility is not.

Open to everyone

The large nationwide fee-for-service plans, including the Blue Cross and Blue Shield Service Benefit Plan options and the GEHA plans, are open to any eligible federal employee or annuitant. If you want to keep the decision simple, these are where most people land.

Open, once you join something

Several plans are sponsored by an employee organisation and require membership in it. The membership is usually open to the wider federal community for an annual fee, often in the region of a few tens of dollars, and you must be a member for the plan year.

• Plans sponsored by unions and associations commonly work this way, including options from APWU, NALC, SAMBA, MHBP and Compass Rose.
• Within a single carrier, the rule can differ by option. One option may be open to all while the higher option requires membership.
• The membership fee is on top of the premium, and it is not deducted from pay.

Genuinely restricted

A few plans you cannot join at all unless your employment qualifies you:

• The Foreign Service Benefit Plan, for the Foreign Service community and employees of certain foreign-affairs agencies.
• The Panama Canal Area Benefit Plan, tied to that specific population.
• Rural carrier and postal-specific plans, which follow the job rather than an association you can join.

Postal employees are a separate case altogether: since the Postal Service Health Benefits Program began, postal workers and most postal annuitants enroll in PSHB rather than FEHB, with its own plans and its own premiums.

The other restriction: geography

Most of the FEHB universe is regional HMO plans, and those are only open to you if you live or work in their service area. That is why our estimator asks for your state before showing you anything.

Service areas are defined by county or ZIP code, not by state lines, so a plan available in your state may still exclude your county. Check the plan's service area directly if you are near an edge.

How to check in five minutes

• Open the plan brochure and read the section on who may enroll. It is near the front, and it is the authoritative answer.
• Search the brochure for "membership" to find the fee and the sponsoring organisation.
• Check the service area by county, not by state, for any regional plan.
• Ask your HR office if your agency or appointment type is unusual. Term, temporary and intermittent appointments have their own eligibility rules entirely.
• Join the association before Open Season closes, not after. Enrolling in a plan you are not eligible for gets unwound later, and the unwinding is worse than the premium.

Common questions