Selling health benefits to the federal government: pricing guidelines and pitfalls.
Approximately 300 health plans contract with the Office of Personnel Management (OPM) to provide health care services to federal employees and their families under the Federal Employees Health Benefits Program. Total enrollment in this program is approximately 10 million persons, making it by far the largest employer health plan in the United States. However, the federal government insists on getting the "best price." This article explores the uncertainties and pitfalls that a health plan faces when it contracts with OPM and does not offer the best price.
Jordan
Mark
M
Kaiser Foundation Health Plan, Oakland, California, USA.
D000206:Actuarial Analysis; D002140:California; D003164:Competitive Bidding / Q000331:legislation & jurisprudence; D003284:Contract Services / Q000191:economics* / Q000331:legislation & jurisprudence; D005249:Fees and Charges; D005607:Fraud; D017408:Guidelines as Topic; D006264:Health Benefit Plans, Employee / Q000191:economics* / Q000331:legislation & jurisprudence; D006279:Health Maintenance Organizations / Q000191:economics* / Q000331:legislation & jurisprudence; D006801:Humans; D006278:Medicare; D017008:Negotiating; D011907:Rate Setting and Review / Q000331:legislation & jurisprudence*; D014481:United States; D037041:United States Government Agencies