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The Affordable Care Act

The Blue Cross and Blue Shield Service Benefit Plan will keep working to bring you the most affordable coverage that meets your needs. We also want to answer questions you may have on how the healthcare law affects you.  If you have questions, please click on the links below:

What is the Affordable Care Act?

The Affordable Care Act (ACA) is the healthcare law that was signed into effect in 2010. It is also called health reform. The ACA began taking effect in 2010, with the largest changes occurring in 2014.

The ACA doesn’t have much impact on the coverage offered through most large employers, including the federal government. Instead, most of the changes affect health insurance coverage that individuals pay for on their own and the insurance that small businesses buy.

The healthcare law has brought coverage to those who previously had not had or could not afford health insurance. As of October 1, 2013, U.S. citizens and legal residents can use the online marketplaces called “exchanges” to buy health insurance.

By law, starting in 2014, everyone has to carry health insurance or pay a fee. The Medicaid program has been expanded in some states to cover more people, and financial assistance is available for people with incomes at or below 400% of the federal poverty level.

Federal employees covered by the Blue Cross and Blue Shield Service Benefit Plan—or another Federal Employees Health Benefits Program (FEHBP) carrier—only saw a few changes. The Service Benefit Plan offers preventive care benefits and extended coverage for children up to age 26 in order to comply with the law.

Three Critical Parts of the Healthcare Law

  • Guaranteed coverage: Means you are guaranteed the chance to enroll in a health plan once you apply for it and the premium is paid.
  • Cost assistance: Tax credits and financial assistance are available to help pay for health insurance for those below a certain income threshold.
  • Individual mandate: Requires most Americans to have health insurance.

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How the Affordable Care Act affects federal employees

Summary of Changes 

Here’s a quick summary of what changed for the Service Benefit Plan since health reform became law and features that were already in place prior to the law.

Health Reform Key FeaturesIn place before health reformAdded to comply with health reform
Coverage of Young Adults up to age 26NoYes
Coverage of preventive health services with no cost shareNoYes
No Annual and Lifetime Dollar LimitsYesn/a
Limited insurance cancellationsYesn/a
Right to appeal health plan decisionsYesn/a
Full access to Emergency ServicesYesn/a
No Exclusion for Pre-Existing ConditionsYesn/a
Review premium amount spent primarily on healthcare and administrative costsYesn/a
Coverage for Tribal EmployeesNoYes
Summary of Benefits and CoverageNoYes

Coverage for children

If you have children who are covered by your Service Benefit Plan Self and Family enrollment, you are able to add or keep them on your plan up to age 26—whether they are single or married.

The young adult does not have to reside with that parent, be financially dependent on the parent or be a student. Coverage does not extend to a child’s spouse or children, however.

When coverage ends under a parent’s plan, the young adult may continue that coverage on a self-only enrollment for up to 18 months under the Temporary Continuation of Coverage provision of the law. If the young adult does that, he or she must pay the entire premium, plus two percent to cover administrative costs.

There is an exception for unmarried young adults who were disabled before age 26. They can continue to be covered under the parent’s self-and-family plan after they turn 26.

Preventive care services

The Blue Cross and Blue Shield Service Benefit Plan covers preventive care and screenings. In fact, the Office of Personnel Management (OPM) requires that enrollees pay nothing out-of-pocket for such care when they use their plan’s in-network providers.

The Service Benefit Plan's broad coverage of preventive services complies with the ACA.

Read the 2014 Blue Cross and Blue Shield Service Benefit Plan brochure to review preventive benefits. 

Lifetime limits & pre-existing conditions

Two important parts of the ACA had no effect on health plans in the FEHBP:

  • There can be no limit on the dollar amount of health benefits paid during a person’s life. The ACA requires the removal of any lifetime cap on the amount of benefits paid.
  • Health plans cannot consider a person’s health problems when they enroll for insurance coverage. Everyone—even people with pre-existing health conditions—may get health coverage.

These provisions of the law have no effect on the Blue Cross and Blue Shield Service Benefit Plan or other plans in the FEHBP. That is because FEHBP carriers have never excluded benefits for pre-existing conditions and previously eliminated any lifetime dollar limits on healthcare. As of 2013, the law requires these same provisions for all other health insurance plans.

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Tribal Employees Eligible for the Federal Employees Health Benefits Program

Certain tribal organizations are able to enroll in the Federal Employees Health Benefits Program (FEHBP).  The Service Benefit Plan has been part of the FEHBP since it began in 1960. About 5.3 million federal employees, retirees and their families are covered by the Blue Cross and Blue Shield Service Benefit Plan.

For more information

Your local Blue Cross and Blue Shield company can help you with any questions about your benefits and provider network. You can find the phone number of your local company on the Contact Us  page of this website.

Request a benefits brochure

You can either review a PDF copy of the Blue Cross and Blue Shield Service Benefit Plan brochure on your computer or submit a request to receive a printed brochure.

Compare benefit options

The Service Benefit Plan provides two coverage options, Standard Option and Basic Option. Plus, we offer a wide variety of wellness tools to help you and your family stay healthy. Review the coverage options available to you by using the AskBlue guide.

Find a healthcare provider

As a Service Benefit Plan member, you have access to a nationwide network of doctors, hospitals and other healthcare providers. Search our online National Doctor and Hospital Finder to find Preferred healthcare providers who will save you money.

For quick help on the go, you can use your Apple or Android device to find a doctor, hospital or urgent care center anywhere in the country. The National Doctor and Hospital Finder mobile application is available for free download at the App Store, Google Play, or at

Interested in enrolling?

Talk to your employer’s Human Resources representative to be sure you are eligible for FEHBP coverage. Then go to the U.S. Office of Personnel Management (OPM) website to find out how to enroll.

Learn more about the FEHBP

To learn more about the FEHBP, visit the OPM website. Details for tribal organizations and employees are available at

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Q & A about health reform

General questions

Q: How did the Affordable Care Act (ACA) affect me as a member of the Service Benefit Plan?
A: While the ACA expanded access to insurance for millions of Americans and broadened health insurance benefits, it didn’t have a big impact on most federal employees covered by the Service Benefit Plan. The two main changes for FEHBP plans include expanding preventive care benefits and extended eligibility up to age 26 for covered young adult children. Members of Congress and certain congressional staff are not eligible to participate in the FEHBP as of 2014.

Q: With an increase of insured people, are there enough providers in the Blue Cross and Blue Shield network?
A: The Blue Cross and Blue Shield Service Benefit Plan relies on the provider networks of all the local Blue Cross and Blue Shield companies throughout the United States. This network has the largest number of hospitals, physicians and specialists of any health insurer in the country. We are always working on improving our network to make sure members have access to the care they need.

Q: How did the ACA impact overseas members?
A: In general, any ACA changes made to the Service Benefit Plan also applied to members who live overseas. Examples include the extension of dependent coverage from age 21 up to age 26 and the expansion of preventive services coverage.

Q: Did the ACA affect prescription drug coverage?
A: No. The ACA did not affect prescription drug benefits for anyone with Blue Cross and Blue Shield Service Benefit Plan coverage.

Q: Did the ACA limit or restrict benefits offered by the Service Benefit Plan?
A: No. Your benefits have not been limited or restricted as a result of the ACA. In fact, the ACA expanded the benefits offered by the Service Benefit Plan—for example, by extending the coverage of dependent children up to age 26 and by adding some preventive benefits.

Medicare questions

Q: I have Medicare and Service Benefit Plan coverage. How did the ACA affect the way these health plans work?
A: It didn’t. Currently, for members who have Medicare as their primary payer, the Blue Cross and Blue Shield Service Benefit Plan offers a strong, comprehensive benefits package. The ACA did not change this.

Q: Is it necessary to have both Medicare and the Blue Cross and Blue Shield Service Benefit Plan?
A: This has never been required, but having both gives you additional coverage. While Medicare pays a significant part of your healthcare costs, it leaves some gaps. Your Service Benefit Plan coverage plus Medicare coverage work together to increase your benefits and lower your out-of-pocket costs.

Q: I have both Medicare A and B and Blue Cross and Blue Shield Service Benefit Plan coverage. Did the ACA have an effect on what I should have in order to maximize benefits with the least cost?
A: No. When you have Medicare Part A and Part B plus the Service Benefit Plan, most of your covered services are paid in full, and you do not have any out-of-pocket costs. The Service Benefit Plan pays the Medicare Part A deductibles and coinsurance amounts for covered services. When you have Medicare Part B, we pay the Part B deductible and coinsurance amounts. Plus, you won’t have to pay the Service Benefit Plan deductible, coinsurance and copayment amounts for covered services. The Service Benefit Plan also provides prescription drug coverage.

Please read the Blue Cross and Blue Shield Service Benefit Plan’s federal brochure (RI 71-005) for additional information.

Q: Why doesn’t the Service Benefit Plan cover prescription copayments for those who have Medicare Part B?
A: We understand that prescription costs can be a hardship for retired people with fixed incomes. However, it is important to remember that eliminating copayments and deductibles will usually increase premiums. Completely waiving prescription copayments for Service Benefit Plan members with Medicare Part B would not be cost-effective and would significantly increase premiums.

Q: Can you explain how the "donut hole" coverage gap works? How does it affect those of us who have Medicare (Part D) as well as the Service Benefit Plan for prescriptions?
A: The “donut hole” is a feature of the prescription drug benefits available under Medicare Part D, either through separate Medicare Prescription Drug Plans or as part of Medicare Advantage Plans, which also cover hospital and professional services. The “donut hole” is an annual coverage gap that is a feature of Medicare Part D. It occurs because Part D’s coverage temporarily stops after the benefits it has paid reaches a certain dollar amount and does not resume until the person (or certain others on his behalf) has spent a certain amount. Once the “donut hole” is satisfied, the Medicare Part D plan will cover almost all of the cost of covered prescription drugs for the rest of the calendar year. The benefits that the Service Benefit Plan pays as the secondary payer to a Medicare Part D plan do not count toward satisfying the "donut hole."

FEHBP enrollment and eligibility questions

Q: Does the ACA allow all Americans to enroll in the Federal Employees Health Benefits Program (FEHBP)?
A: No. The ACA does not allow everyone to get coverage through the FEHBP as it is an employer-sponsored plan. The ACA allows the general public to enroll in the Health Insurance Marketplace, also known as health insurance exchanges. However, the ACA does allow certain tribal organizations to enroll their employees in the FEHBP. Those organizations that choose to enroll in the FEHBP and their employees must pay 100 percent of their premium with no government contribution.

Q: Do I have to buy another health plan if I already have health insurance through the Service Benefit Plan?
A: No. We believe that any person who has coverage through the Service Benefit Plan meets the ACA requirement and does not need to buy another form of coverage.

Q: Is there a scenario where the FEHBP and the Service Benefit Plan would end?
A: The majority of changes in the ACA related to the private health insurance coverage offered in the individual and small group market. The ACA had very little impact on the coverage offered through most large employers, including the federal government. Ending the FEHBP would require congressional action.

Health Insurance Marketplace (exchange) questions

Q: If I want to opt out of the Service Benefit Plan in the FEHBP and enter the Health Insurance Marketplace, can I do so?
A: You might be able to enroll in a Marketplace health plan, but you should not make a decision to leave the FEHBP until you have talked with your employing agency or OPM about important considerations. These include whether you would receive the government contribution, whether you would be eligible for a subsidy under the law, and whether you would be able to rejoin the FEHBP or continue FEHBP coverage in retirement. You should also consider key differences when choosing the right health plan for you and your family, such as coverage and provider networks.

Q: Do members of Congress and their staff have to get coverage through the exchanges?
A: A provision of the Affordable Care Act requires members of Congress and their official staff to enroll in the Marketplace (exchange) plans. OPM issued their final rule on September 30, 2013.

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Resources for more information

For more Questions and Answers on the Affordable Care Act (ACA) and the Federal Employees Health Benefits Program, visit:

Members of Congress and their official staff can find additional information on OPM’s website:>

For detailed information about the ACA, visit the U.S. Department of Health and Human Services “Health Insurance Marketplace” website:

For a big-picture look at health reform, visit the White House website:

For information about how the ACA affects those who have Medicare, visit “The Affordable Care Act & Medicare:”

For ACA information that affects those over 50, the AARP has helpful fact sheets:

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Page last updated: May 16, 2014

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