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MAJOR CHANGE coming in 2019 for FEP Coverage

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While working on an appeal to the Office of Personnel Management for someone denied a conversion of an LAGB to VSG, I noticed a very significant change that may help anyone who is going to be covered in 2019 under the Federal Employees Benefit Plan (FEP). For many years their criteria for surgery used to require a TWO-YEAR history of morbid obesity. That is changing to ONE YEAR. That is a big deal and might be very important for many folks covered under the FEP plans. Here's what they say about the change:

"We now provide bariatric surgery benefits for members who have a diagnosis of morbid obesity for a period of 1 year prior to surgery. Previously, the requirement was a diagnosis of morbid obesity 2 years prior to surgery. (See page 69.)"

This is a important for anyone who cannot prove they meet the BMI criteria for two years regardless of whether they are (a) trying to get FEP to approve their first surgery OR (b) anyone seeking a revision / conversion for reasons other than a "complication" related to their original surgery. I'm attaching a copy of the 2019 Service Benefit Brochure and here is the link: 2019 FEP Service Benefit Plan

I hope it helps. Happy Holidays to everyone!

2019_SBP_ Brochure.pdf

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