Federal Employees' Health Insurance Costs

Gao ID: 112393 May 15, 1980

Comments were provided by GAO on its report about the differences between the enrollment data on records of Federal agencies and those of insurance carriers. In reviewing the Federal agencies enrollment data for insurance coverage, GAO found that the overall error rate ranged from 0.2 to 35.5 percent for the agency payroll office and insurance carrier records tested. Additionally, GAO found that the errors in the enrollment data: (1) resulted in underpayments of premiums and overpayments of benefits; (2) increased program costs between $2 and $5 million annually; (3) varied by agency and carrier; and (4) delayed payments of claims. As a result of its findings, GAO recommended that the Director of the Office of Personnel Management (OPM) should adopt the use of automated procedures to report health benefits enrollment data to carriers and to reconcile agency and carrier enrollment records. Moreover, the Director of OPM should direct subordinates to: (1) develop and arrange with carriers the use of a common identifying number for each enrollee; (2) have agencies and carriers develop a standard format for exchanging enrollment information; (3) require carriers to provide payroll offices with verification enrollment data in computer-readable form on claimants of the reporting period; and (4) prepare instructions for agencies on automated reporting and reconciliation of enrollment data. Finally, GAO stated that the results of its report and recommendations were that OPM is working with Blue Cross/Blue Shield and the Veterans Administration to develop a standard for the transmission of enrollment data in machine-readable form.

The Justia Government Accountability Office site republishes public reports retrieved from the U.S. GAO These reports should not be considered official, and do not necessarily reflect the views of Justia.