There are 19 nationwide fee-for-service plans in the FEHB program. Does that mean you need to consider 19 different provider networks? Does that mean each plan has to negotiate individually with providers?
The answer to both questions is “no”! Despite the seemingly large array of options, there are actually only four main provider networks in play: Aetna, Cigna, Blue Cross/Blue Shield, and UnitedHealthCare.
Aetna
- Foreign Service Benefit Plan (Aetna Choice POS II)
- In addition, Multiplan, Three Rivers Provider Network, and Preferred Medical Claim Solutions providers are considered “other participating providers”, paid at the out-of-network benefit level, but not subject to balance billing
- MHBP (Standard, Value, and High Deductible options) (Aetna Choice POS II)
- Except in Utah, where the legacy Coventry network is still in use
- Mental health through OptumHealth, formerly United Behavioral Health
- Rural Carrier Benefit Plan (Aetna Choice POS II)
- GEHA (in 16 states)
- Providers in Arizona, California, Connecticut, Florida, Kentucky, Maine, Massachusetts, Michigan, New Hampshire, New York, New Jersey, Nevada, Oregon, Rhode Island, Vermont, and Washington
Blue Cross/Blue Shield Preferred Providers
- Service Benefit Plan (FEPBlue)
- Standard option provides access to the broader Blue Cross/Blue Shield “participating” providers, with out-of-network benefits, but protection from balance billing
- Basic option has coverage for preferred providers only
Cigna Open Access Plus
- SAMBA (High and Standard Options)
- In addition, Multiplan, Viant, and Private Healthcare Systems providers are considered “other participating providers”, paid at the out-of-network benefit level, but not subject to balance billing
- NALC (High, Value, and Consumer Driven options)
- High Option mental health through OptumHealth, formerly United Behavioral Health
- APWU (High Option Only)
- Mental health through Beacon Health, formerly Value Options
UnitedHealthCare
- Compass Rose Health Plan (UHC Choice Plus)
- APWU Consumer Driven Option (UHC Choice Plus)
- Mental health through Beacon Health, formerly Value Options
- GEHA (in 27 states and the District of Columbia) (UHC Options PPO)
- Providers in Alabama, Alaska, Arkansas, Colorado, Delaware, Hawaii, Idaho, Indiana, Iowa, Louisiana, Maryland, Minnesota, Mississippi, Montana, Nebraska, New Mexico, North Dakota, Ohio, Oklahoma, South Dakota, Tennessee, Texas, Utah, Virginia, Washington DC, West Virginia, Wisconsin, and Wyoming
GEHA’s networks in the 7 non-Aetna/UHC states
- Coventry Health Care/Health America: North Carolina, South Carolina, Georgia, Pennsylvania
- Freedom Network: E/S Kansas and W Missouri
- Health Partners: the rest of Kansas
- HealthLink: Illinois and E/S Missouri
Questions? Please write to [email protected]!