The rule is a notice of proposed rulemaking and is open for public comment for 30 days until June 23, 2024. After considering comments received through the notice and comment process, OPM will work toward the goal of issuing a final rule with an effective date before the PSHB transitional Open Season begins on November 11, 2024.

Under the Postal Service Reform Act (PSRA), all PSHB carriers are required to provide prescription drug benefits for Medicare Part D-eligible Postal Service annuitants and their Part D-eligible family members through a Medicare Part D employer group waiver plan (EGWP). This is a new requirement for PSHB plans that does not apply to FEHB plans. PSHB Carriers must offer a Part D EGWP to all Medicare Part D-eligible PSHB annuitants and their Part D-eligible covered family members. This Part D EGWP will provide prescription drug benefits to these Part D-eligible individuals.

While the proposed rule reflects that Medicare Part D-eligible annuitants and their Part D-eligible family members would be automatically group enrolled into the Part D EGWP, it reflects that they may choose to opt out of receiving prescription drug coverage through the PSHB Part D EGWP. This proposed rule provides, consistent with the statute, that the Part D EGWP offered by their PSHB plan is the only PSHB prescription drug benefit available for Part D-eligible PSHB annuitants and their Part D-eligible covered family members. As proposed, Medicare Part D-eligible annuitants and their family members who choose to opt out of or disenroll from the PSHB plan’s Part D EGWP would not have access to prescription drug benefits through their PSHB plan and would not pay a lower premium than those enrolled in the Part D EGWP. An individual who opts out of or disenrolls from the Part D EGWP would be allowed to enroll again during the next open season or an applicable Qualifying Life Event (QLE) if they wish.

Group enrollment is a permitted method of Medicare Part D enrollment that allows a Carrier to enroll a group of individuals into Medicare Part D at one time. OPM is proposing to require PSHB Carriers to group enroll Medicare Part D eligible enrollees into their PSHB plan’s Part D EGWP.  As proposed, Medicare Part D-eligible annuitants and Part D-Eligible covered family members could choose to opt out of this group enrollment and decline Medicare Part D coverage through PSHB. Carriers must comply with Medicare requirements regarding Part D EGWP group enrollment.

The NPRM proposes that OPM will be responsible for reconsidering certain initial enrollment decisions and issuing final decisions regarding enrollments and coverage of family members for the PSHB Program. This is similar to how these processes are handled currently in FEHB.

PSHB enrollment decisions are different from FEHB because, for purposes of the Part B enrollment requirements for certain Postal Service annuitants, OPM is relying on information received from other federal agencies. For example, Medicare eligible Postal Service annuitants may be eligible for an exception from the Part B enrollment requirement if they are receiving health care benefits from the Department of Veterans Affairs. The proposed reconsiderations process for PSHB would provide a process for enrollees to contest accuracy of information that came from an agency other than OPM.

The proposed rule also includes deadlines for requesting reconsiderations, and the circumstances under which the time limit may be extended. These time limits align with those for FEHB.

The NPRM proposes an expanded role for OPM in the correction of enrollment errors for PSHB as compared to FEHB. This is to account for OPM’s central role in administering the PSHB enrollment process. The NPRM proposes that OPM could also make prospective or retroactive corrections of administrative errors at any time, rather than only the employing office which makes such corrections for FEHB. The NPRM proposes that retroactive corrections would be subject to certain withholding and contributions.

The NPRM proposes a process and timeline for PSHB enrollment-related lawsuits for OPM enrollment actions that are based on data received from other agencies. In general, lawsuits involving information from agencies other than OPM must be brought no later than December 31 of the 3^rd year after the year of the enrollment action, which aligns with the timeline for court review of FEHB claims. OPM proposed the new process because PSHB enrollment actions may account for the Medicare Part B enrollment requirement for most Medicare eligible Postal annuitants, which would require information from agencies other than OPM.

USPS employees, annuitants and their covered family members will be automatically enrolled into a PSHB plan for the 2025 plan year to avoid coverage disruptions. OPM is proposing to more clearly delineate the process for automatic enrollment into a PSHB plan for those enrollees who do not select a PSHB plan option during the 2024 transitional Open Season. OPM has proposed that enrollees who take no action during the transitional Open Season would be automatically enrolled into the same plan that has equivalent benefits and cost-sharing to the 2025 FEHB plan option in which the Postal employee or annuitant was enrolled for the 2024 plan year. If there is no equivalent option, the enrollee would be enrolled in the lowest cost option for that carrier in the same geographic region that is not a high deductible health plan and does not charge an association or membership fee. OPM has also proposed automatic enrollment options for when a carrier does not offer a plan in FEHB in 2025 but does offer a 2025 PSHB plan and the automatic enrollment option, established in the PSRA, if no equivalent or similar plan is offered in PSHB (the lowest cost nationwide plan that is not a high deductible health plan and does charge a membership fee).

As a reminder, enrollees may select a different PSHB plan during Open Season if they choose.

More information about automatic enrollment is available in the preamble to the NPRM.

The Postal Service Reform Act of 2022 (PSRA) requires that OPM maintain separate PSHB reserves, including separate contingency reserves, and requires that PSHB plans are credited with a proportional amount of FEHB reserve funds for the new PSHB plans. OPM proposes to credit the PSHB reserves as soon as practicable on or after January 1, 2025.

OPM is proposing to credit reserves from FEHB plans to PSHB plans based on the 2024 premium attributable to the Postal enrollee population as a percentage of 2024 premium income. As proposed, the requirement to credit reserves would apply to all 2024 FEHB Carriers with Postal enrollees, whether or not they are offering 2025 PSHB plans. More detail about OPM’s proposals to attribute these credits to plans and plan options is available in the preamble to the NPRM and in Carrier Letter 2023-13 published July 19, 2023.