OPM lays out significant strategies and healthcare objectives for the federal sector in the year 2026
In a bid to enhance the healthcare experience for federal employees and annuitants, the Office of Personnel Management (OPM) has issued a call letter for the 2026 plan year, outlining policy goals and initiatives.
According to a recent survey by the Kaiser Family Foundation (KFF), 58% of respondents encountered issues with their health insurance over the past year. In response to these challenges, OPM is taking several steps to address the concerns.
One of the key areas of focus is improving provider information. OPM is requiring Federal Employee Health Benefits (FEHB) carriers to make improvements in this regard, ensuring that the provider information is accurate and up-to-date. Carriers are also mandated to offer an easy-to-use online provider directory for enrollees. This directory will allow users to search and filter by various parameters, such as provider name, location, network status, specialty, language, and whether the provider is accepting new patients or offers telemedicine services.
To further simplify the application for reimbursement of top services, some FEHB insurers will be required to introduce an online free customer service portal in 2026. However, the specific insurers that will implement this change have not been announced yet.
OPM is also directing carriers to enhance the information available about the disputed claims process on their websites by January 1, 2026. A mobile-friendly fact sheet provided by carriers will include a detailed explanation of the disputed claims process, clear deadlines, guidance on relevant documentation, and direct links to required forms.
Carriers offering multiple plans must ensure that the user is using the right provider lookup tool for the corresponding plan. This will help in reducing confusion and ensuring a smoother process for users.
OPM's initiatives also focus on ongoing healthcare priorities highlighted in previous years. Carriers are currently required to cover preventive services with an "A" or "B" rating by the U.S. Preventive Services Task Force, immunizations recommended by the Advisory Committee on Immunization Practices, and women's health services specified in guidelines issued by the Health Resources and Services Administration, at no cost to plan members.
In addition, OPM requires FEHB carriers to implement an online claims submission portal for out-of-network care by the end of 2026. This online portal will serve as an additional option, supplementing the existing mail-based claims submission process.
The aim of these initiatives is to reduce the friction experienced by federal employees and annuitants in the coming year, making their healthcare journey more seamless and efficient.
