In 2010, President Barack Obama signed the Patient Protection and Affordable Care Act. Section 10221 of the Affordable Care Act incorporated and enacted the Indian Health Care Improvement Reauthorization and Extension Act of 2009, resulting in additions to the Indian Health Care Improvement Act (IHCIA).
This act allowed Tribes, Tribal Employers, and Urban Indian Organizations carrying out health care programs to purchase the rights and benefits of the Federal Employees Health Benefits (FEHB) Program for their employees.
We’ve listed some common questions people have about insurance for Tribal employees.
ELIGIBILITY
WHO CAN BE COVERED UNDER AN ELIGIBILE EMPLOYEE’S FEHB ENROLLMENT?
Federal Employees Health Benefit Program coverage is available for the employee's current spouse and all unmarried dependent children under age 26.
HOW DOES A TRIBE/TRIBAL ORGANIZATION/URBAN INDIAN ORGANIZATION BECOME ELIGIBLE FOR PARTICIPATION IN FEHB?
To be eligible to enroll, a tribe/tribal organization/urban Indian organization will have to prove they are engaged in an Indian Self-Determination and Education Assistance Act of 1975 (ISDEAA) contractual agreement with either Indian Health Services (HIS) or the Bureau of Indian Affairs (BIA) before they begin enrolling employees.
CAN ELIGIBLE EMPLOYEES ACCESS HEALTH COVERAGE SOLELY FOR THEIR DEPENDENTS?
No, they cannot. The FEHB program only offers two options: Self, and Self and Family.
ARE ALL EMPLOYEES COVERED BY FEHB?
Yes. If a tribe, tribal organization, or urban Indian organization elects to purchase FEHB, all of their common-law employees will be eligible to purchase coverage. Employers cannot offer FEHB to some employees and not to others.
INSURANCE COVERAGE
CAN WE PROVIDE OTHER HEALTH INSURANCE FOR OUR EMPLOYEES?
Unfortunately, no. If you chose to purchase FEHB, you cannot provide other health insurance options to your employees.
IS COVERAGE AVAILABLE FOR TRIBAL RETIREES?
No. This new provision allows the tribe/tribal organization/urban Indian organization to purchase coverage for their employees. It does not provide retirees with rights as annuitants.
IF AN EMPLOYEE HAS A PRE-EXISTING CONDITION, WILL THERE BE A WAITING PERIOD BEFORE THEY ARE ABLE TO RECEIVE COVERAGE?
No. There are no exclusions or waiting periods for pre-existing conditions in the FEHB Program.
MY CHILD DOES NOT LIVE WITH ME. WOULD HE/SHE BE COVERED UNDER FEHB SELF AND FAMILY ENROLLMENT?
Yes. Your child is not required to live with you to be covered under FEHB Self and Family enrollment.
If you are looking for more information about insurance for Indian tribal employees, visit the Office of Personal Management’s Indian tribal section.
Source: FEHB and FEGLI resource guide
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