Employees and Retirees Should Pay Attention to Self and Family Versus Self Plus One Premium Rates When Electing 2025 FEHB Program Enrollment

Those employees and retirees who are married with no eligible children to enroll on their FEHB program plan, and single parents with one child to cover on their FEHB program plan have the option to enroll as Self Plus One rather than Self and Family. By enrolling in Self Plus One coverage rather than Self and Family coverage, the married employee or single parent can usually save two to three hundred dollars a year in FEHB program premium costs. 

But for 2025, there are two national FEHB program health plans (NALC Health Benefit Plan and Foreign Service Benefit Plan) and 54 local FEHB program plans in which monthly Self and Family premiums are less expensive than monthly Self Plus One monthly premiums. For the new Postal Service Health Benefits (PSHB) program, there ae two national FEHB program plans (NALC Health Benefit Plan and Rural Carrier Benefit Plan) and 17 local FEHB plans in which Self and Family premiums are less expensive than Self Plus One monthly premiums.

There are two possible reasons why Self and Family monthly premiums are less expensive than Self Plus One monthly premiums in some FEHB program and PSHB program plans:

• Statutory formula used to calculate the federal government’s contribution. The statutory formula that is used to calculate the federal government’s contribution to the premium cost is based on the average of all plan premiums and requires that OPM calculate a maximum contribution for each enrollment type. In other words, there is a limit as to how much the federal government will contribute towards the cost of a Self Only, Self Plus One or Self and Family enrollment. The federal government contributes the lesser of the maximum contribution or 75 percent of the total premium. The remaining amount is the enrollee’s (employee or retiree) share. In some cases, such as plans with a premium cost that is above the program average, the calculation may result in a higher enrollee share of Self Plus One enrollment than a self and family enrollment.
• Disproportionate high enrollment of older and retired couples with no children. Self plus one was introduced into the FEHB program in 2015. The reason that Self Plus One enrollment was introduced into the program was by forcing to enroll in Self and Family coverage when an employee or a retiree had only one eligible family member to cover, the monthly premium cost actuarially higher. A married couple with no eligible children or a single parent with one eligible child were subsidizing enrollees with more than one eligible family member. Self Plus One premiums should be lower for those individuals.

  That has largely proven to be the case over the past eight years. However, during the past eight years there has also been an anomaly in some FEHB program plans that attract a disproportionately high enrollment of older married couples (particularly retirees) with no eligible children. These couples tend to consume more health care and more expensive health care compared to younger employees. For example, the cost of a hip replacement or bypass heart surgery is likely far greater than the cost of giving birth to a baby. 

OPM has asked agencies to call to the attention of employees, and OPM is calling to the attention of married retirees that some FEHB program health plan premium rates during 2025 for Self Plus One coverage will be more expensive than Self and Family coverage premium rates.