Call Now For A Free Consultation 24/7 (941) 954-1234

A Closer Look: Federal Employees Health Benefits Act of 1959

The Federal Employees Health Benefits Act of 1959 is a program that was designed to provide health insurance coverage to all federal employees, retirees, and their dependents. The program is one of the largest employer-sponsored health insurance programs in the country and covers approximately 8.2 million people per year.

The Federal Employees Health Benefits Program provides more than $40 billion a year in healthcare benefits, and 85% of the participants are federal employees, while the retirees make up a staggering 90% of participants.

Before this act was passed in 1959, federal employees were not awarded healthcare benefits through the federal government and each employee had to find and pay for their own health insurance coverage by themselves or through a Union.

Other subsequent government programs, such as Medicaid, considered the information under the Health Benefits Act of 1959 and had used this model for both private and public health insurance programs.

In 1983 Congress passed a law that allowed them to place conditions on these federal funds that were being used for the insurance programs and they prohibited the use of funds for performing abortions, except in severe cases in which the mother was in danger. This provision was amended over the following years, however, and was later excluded.

The provision was later reinstated, but it included other conditions such as cases of rape and incest, as well as the danger of the mother’s life. It continues to be included in appropriations bills every year.

Eligibility Under the Act

To become eligible to participate in this health benefits program an individual must be:

  • An employee, elected officer, or appointed officer in the executive, judicial, or legislative branches of the United States Federal Government
  • An appointed or elected official of the municipal government of DC
  • Any employee that is currently receiving compensation under the Federal Employees Compensation Act due to a work-related injury or illness.
  • Family member for someone receiving monthly compensation under the Federal Employees Compensation Act
  • Spouse of a current employee
  • Spouse of a retired employee
  • An employee or retired employee’s child who is not capable of supporting themselves due to mental incapacity before the child’s nineteenth birthday

In 1988, eligibility was granted to part-time employees as well as temporary workers. Temporary continuation of coverage was also granted to employees that separated from service as long as it was not due to gross misconduct.

What Else is Covered?

  • Nursing
  • Outpatient Mental Benefits
  • Dental and Vision Care
  • Chiropractic Services
  • Infertility Treatments
  • Diabetic Supplies
  • Durable Medical Equipment
  • Nurse Advice

If you ever need advice on any kind of insurance program, claim, or studies, reports, or audits pertaining to health insurance, you may be able to seek counsel from a knowledgeable legal professional. They will be able to walk you through the process and explain the benefits and the district courts of the United States have original jurisdiction that is concurrent with the United States Court of Federal Claims involving a civil action or claim against the United States.

If you have a personal injury case that has arisen, and you are a participant of the FEHBA, then it is important to determine if the plaintiff is a direct beneficiary or dependent under one of these plans.This is to determine that the FEHBA lien is protected and any further litigation is avoided concerning enforcing the lien in a federal court system.

You should keep in mind that there is limited Federal law case concerning the FEHBA and the courts will typically refer any decisions to the ERISA preemption clause. The ERISA is the Employee Retirement Income Security Act of 1974 and is used to provide protection for individuals under the plans. Their preemption clause is very similar to the preemption clause found under the FEHBA.

Attorney David Goldman has a strong belief that everyone should be treated fairly and those with the means should do what they can to bring justice in all areas of our society. That belief has led him to help Florida's injured from being taken advantage of by corporations and insurance companies. Since 1989 David Goldman has been fighting for the rights of Floridians both as an attorney and by personally supporting our community.

A Closer Look: Federal Employees Health Benefits Act of 1959

Goldman Babboni Fernandez
Murphy & Walsh

Attorney Case Review
Get The Justice
You Deserve

Free Attorney Consultation

Law offices
Near you

Serving All Of Southwest Florida