SSSGs are defined as a comprehensive medical plan’s two employer groups that as of the date specified by the Office of Personnel Management in the rate instructions have a subscriber enrollment closest to the FEHB subscriber enrollment and use any rating method other than retrospective experience rating and meet the criteria specified in the rate instructions issued by OPM.
This definition given by OPM is the method used prior to the establishment of the Medical Loss Ratio which seems to offer greater accountability and transparency as mandated by the Affordable Care Act. The rate structure of the group could consist of the total self and family contract enrollment, or the total self, couples, and family contract enrollment or some other total largely dependent upon the rate structure of the group.
Groups that enter into contractual agreement with OPM to provide health care services via the FEHB plan may be a similarly-sized subscriber group including government. There are exceptions to who may provide services. The following groups are excluded: Groups consisting of the carriers own employees; Medicaid groups, Medicare groups, and groups that have only a stand alone benefit such as dental only; Groups the carrier rates by the method of retrospective experience rating; A new group in which the carrier first contracted with between July 2, 2005 and July 1, 2006; A second year group that started its second contract year between July 2, 2005, and July 1, 2006 that normally would be rated by adjusted community rating; and A purchasing alliance whose rate-setting is mandated by the State or local government.
It is important to understand terms that are used when discussing any issues with you that impact what kind of decisions you will make for you and your family. It is also valuable to know how the Office of Personnel Management (OPM) is managing and negotiating the most important benefit you will ever need or have – one that will look after your health. Good health is wealth of an untold magnitude. Never leave what is most important to you totally in the hands of anybody if you have any say. A great majority of the time we do have some say, we simply fail to exercise our right to be included.
P. S. Always Remember to Share What You Know.
Dianna Tafazoli
