Federal Health Plan-May not have to wait until open season !!

My hubby just reminded me that under some cir****tances you can change insurance in the middle of the year even though its not open season. For those of you following - BCBS federal does cover bypass but not Lap band. I was thinking I would have to wait until open season in january and switch then as there are some plans offered by my employer that do cover the lap band. Anyway - according to the OPM website if your spouse's private insurance is terminated mid-year that is a "qualifying life event" which would allow me to switch plans mid-year !!!! I am still waiting to hear back from OPM to see if I am reading the regs correctly... (FYI - Other Qualifying Life Events that might enable a federal employee to switch insurance mid-year include the birth or death of a family member covered under your policy, a minor reaching age 22, divorce, adoption, getting a foster child, change from full-time to part-time or the reverse, spouses dependent coverage is terminated, or employee becomes entitled to medicare) Just thought I would share this with everyone since there have been a few threads on the federal Blue Cross Lap-Band issue. If one of these qualifying life events applies to you you may be able to switch plans mid-year and not wait until open season.

I currently have BCBS/FEP and it is true they do not cover AGB or Lap Band but I tried to research the other options for insurance and I could not find where any of the other insurance offering covered WLS at all. I went to each of their web pages and looked at their benefits and did not find one other one who did cover any kind of WLS. If you find they do, please let me know. Thanks. Bill

GEHA definetly does. It does say in their brochure that they cover WLS, but it doesn't specify whether its bybass or AGB. I had to call to find out that they covered AGB. MHBP in their brochure also says they cover WLS - but doesn't say what kind. You would have to call and ask. In GEHA the info is on page 36 of their brocure: http://www.opm.gov/insure/05/brochures/pdf/71-006.pdf In mailhandlers the info is on page 39 of their brochure: http://www.opm.gov/insure/05/brochures/pdf/71-007.pdf

Hmmm??? Although I live in Delaware my Lapband Surgery on 7/15/05 was covered by Federal BC/BS. I am absolutely certain my surgeon would not have performed the surgery had he not received approval. Are you sure you are up-to-date on your info? Chis Jones Surgeon: Isais Irgau Newark, Delaware

I will call them again I guess just to make sure -- do you have federal blue cross blue shield PPO ?? (I think the HMO has different benefits than the PPO) The PPO preapproval people said its absolutely not covered -- do you mind if I call your doctors office and ask them what they did ??

Sure you can call. Dr. Irgau of CHRIAS ( Christiana Institute of Advanced Surgery) (302) 892-9900. I have FepBC/BS, PPO. I certainly hope they got approval before the Surgery because there is NO WAY I am paying the hospital bill alone was over 23,000 although I did have some complications ans was there a few extra days. I amy event, best of luck. I also had a few comorbidities, Diabetes, sleep apnea, hyperlipidemia.