We are looking for new Community Rated HMOs
- Letter to Prospective Applicant
[203 KB]
- Federal Employees Health Benefits (FEHB) Carrier Medical Loss Ratio (MLR) [28 KB]
- Frequently Asked Questions About the SSSG and MLR Processes [24 KB]
The U.S. Office of Personnel Management (OPM), administrator of the Federal Employees Health Benefits (FEHB) Program, would like to expand nationwide the number of health maintenance organizations (HMO) available in the Program. With the introduction of the medical loss ratio (MLR) regulations, OPM is hoping that health insurance carriers will be interested in either applying or re-applying for participation under this new pricing method, which replaces the similarly-sized subscriber groups (SSSG) method.
Thank you for visiting the Federal Employees Health Benefits (FEHB) Program's carrier application and information web pages. We created the following pages for health insurance companies interested in participating as a health carrier in our Program. There are three screens:
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This first screen provides information on the types of health insurers that the Office of Personnel Management (OPM) can approve for participation in the FEHB program.
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The second screen will ask you to enter specific identifying data such as your name and professional title, your health insurance company and its address. Completing this screen does not constitute submission of your application. We use this information to follow-up with you concerning your interest and your progress in completing the application.
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The third screen will automatically appear once you complete the data we requested on the second screen. On this screen you will find links to the downloadable application files. To apply for participation in the FEHB Program, you must complete all files. OPM must receive your application by January 31.
What types of health insurers qualify for participation in the FEHB Program?
We will consider applications only from comprehensive, prepaid medical plans. The FEHB Program contracts only with health benefits carriers that 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 can not 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, Alaska, Arizona, Idaho, Illinois, Kentucky, Louisiana, Mississippi, Missouri, Montana, New Mexico, North Dakota, Oklahoma, 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)
We invite you to apply if you believe you qualify to participate in the FEHB Program. Please go to the next screen. 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.