Which FEHB Plan Shares the Most Data With OPM?

Last Updated: June 24, 2026

OPM wants monthly, patient-level medical and pharmacy claims on roughly 8 million federal enrollees. Most of the coverage has focused on whether that proposal is legal. The question almost nobody has answered is more practical: does your choice of FEHB carrier change how much of your data already flows to OPM? The short version: yes, today it does, and the difference comes down to how your plan is paid, not which logo is on your card.

This is a carrier-by-carrier look at FEHB privacy in 2026, including the brochure language your own plan already uses.

Key Takeaways

  • OPM's data proposal (ICR 3206-NEW) is still pending OMB approval as of June 2026. It is not withdrawn, and it is not yet in effect.
  • Your data flow depends on carrier type, not carrier choice. Experience-rated PPO plans already send claims data; community-rated HMOs currently send less.
  • BCBS FEP and Aetna already say so in writing. Their 2026 privacy notices state they must disclose your PHI to OPM's claims data warehouse.
  • HMOs like Kaiser have a structural buffer, for now. They submit encounter data for rate-setting, not adjudicated claims. The proposed rule would erase that buffer.
  • No carrier protects you contractually. Switching plans cannot stop OPM data collection if the rule is approved.

What OPM Is Actually Asking For

In December 2025, OPM published a proposal that would require all 65 FEHB and Postal Service Health Benefits carriers to submit monthly patient-level data: medical claims, pharmacy claims, encounter data, and provider data. The scope covers about 8 million people, because it includes retirees and enrolled family members, not just the 2.2 million active employees.

The comment period closed in February 2026. The proposal drew heavy opposition and was not withdrawn. As of late June 2026 it sits in OMB review with no announced start date.

OPM has tried to address the backlash. In June 2026, the OPM director said the agency's Inspector General would strip names, Social Security numbers, phone numbers, and full addresses before OPM receives any data, keeping only ZIP code, birth year, and a hashed member ID. NARFE called itself "cautiously optimistic." Privacy advocates were not satisfied, because a diagnosis code attached to a consistent hashed ID can still be re-linked in many cases.

For the policy fight itself, see our companion explainers: OPM Wants Your Medical Records: The 8M-Person Privacy Fight and OPM Wants Your Medical Records: What Feds Need to Know. This page is about something they don't cover: the differences between carriers.

The Part Nobody Explains: How Your Plan Gets Paid Decides What OPM Sees

FEHB carriers fall into two payment structures, and that structure determines what data OPM already receives.

Experience-rated plans (BCBS FEP, GEHA, Mail Handlers) work like a reimbursement arrangement. OPM is financially exposed to actual claims costs, so it has long required detailed, adjudicated claims data for audits and improper-payment reviews. That individual-level data already flows to OPM.

Community-rated HMOs (Kaiser, regional HMOs) work like a flat monthly premium. OPM pays a fixed per-member rate and has no per-claim exposure. These plans submit encounter data for rate-setting, a narrower feed than full adjudicated claims, and historically not in a form OPM uses to track individual care.

That is the whole story behind the privacy difference. It is architecture, not a promise any carrier made to protect you.

What Your Plan's 2026 Brochure Actually Says

You don't have to take this on faith. The disclosure is in the privacy language of the plans themselves.

  • BCBS FEP Notice of Privacy Practices: the plan is "required to disclose your protected health information to OPM for its Federal Employees Health Benefits (FEHB) Program Claims Data Warehouse."
  • Aetna 2026 FEHB brochure: "We're also required to share your PHI to OPM for its claims data warehouse."
  • GEHA 2026 brochure: confirms it keeps medical and claims records confidential and lists your HIPAA rights, but does not reference the OPM claims data warehouse.
  • Kaiser Permanente 2026 FEHB brochure: covers HIPAA rights and member data protections, with no mention of the OPM claims data warehouse. Kaiser declined to tell reporters how it would comply with the new rule.

One caution: a brochure that doesn't mention the warehouse is not proof a carrier sits outside it. It means the carrier hasn't disclosed that participation to members. Read these as what each plan is willing to put in front of you, not as a guarantee.

Carrier-by-Carrier Data Exposure: 2026 Comparison

This table compares how each carrier type transmits data to OPM today and how the pending rule would change it.

Carrier type Examples Current data flow to OPM If the rule is approved Brochure privacy language
Experience-rated PPO/FFS BCBS FEP (Standard, Basic, Blue Focus) Adjudicated claims already flowing for audit and the data warehouse Incremental: adds pharmacy data and a standardized monthly format Explicit: "required to disclose PHI to OPM for the FEHB Claims Data Warehouse"
Experience-rated PPO/FFS Aetna Claims for audit; Aetna itself objects to the rule Incremental to material Explicit: "required to share PHI to OPM for its claims data warehouse"
Experience-rated PPO/FFS GEHA (Standard, High, HDHP) Adjudicated claims for audit; warehouse status not stated publicly Incremental if already participating; material if not Confidentiality and HIPAA rights only; no warehouse reference
Experience-rated PPO/FFS Mail Handlers (MHBP) Claims for audit and financial reporting Incremental Likely similar mandatory-disclosure language (not independently verified)
Community-rated HMO Kaiser Permanente (regional plans) Encounter data for rate-setting only; no adjudicated-claims pipeline to OPM Material: a new individualized data pipeline would be required No warehouse reference; Kaiser declined to comment
Community-rated HMO CareFirst BCBS HMO, regional HMOs Encounter data for rate-setting Material change Varies by plan
PSHB NALC (PSHB only for 2026) PSHB is subject to the same proposal Full exposure if approved Not independently reviewed

The pattern: if you are in a national PPO, the proposed rule is mostly an expansion of data OPM already gets. If you are in a community-rated HMO, it is a bigger change, because it would create individualized reporting that does not exist today.

So Should You Switch Plans for Privacy?

Be careful here. The HMO advantage is real but temporary and structural. It exists only because of how those plans are paid today, and only until the rule takes effect. If OMB approves the proposal, every carrier would have to send monthly individualized data, and the gap between an HMO and a PPO would close.

No FEHB or PSHB carrier offers contractual protection against OPM data collection. None of them can promise to keep your claims out of OPM's hands once a federal rule requires the transfer. Choosing a plan for privacy alone, and giving up a network or benefit you need, is usually the wrong trade. Choose your plan on cost and coverage first. If two plans are close, the data structure is a reasonable tiebreaker, not a headline factor.

Compare premiums and plan types side by side with our FEHB Premium Calculator, then weigh the privacy structure as one input among several.

What You Can Actually Do Right Now

  • Read your plan's Notice of Privacy Practices. It tells you, in writing, whether your carrier already routes data to the OPM warehouse.
  • Submit comments and contact your representatives if the rule reopens for comment. Congressional pushback in April 2026 came from members who heard from constituents.
  • Don't panic-switch during a non-Open-Season month. You generally cannot change FEHB plans outside Open Season without a qualifying life event anyway.
  • Use the FEHB Plan Evaluation Guide to compare plans on the factors that affect you every year, then treat data exposure as a secondary lens.

Calculate Your FEHB Costs

Use our free FEHB Premium Calculator to compare 2026 premiums across plan types before Open Season. Compare your FEHB options now →

Frequently Asked Questions

Can OPM see my specific diagnoses under the proposal?

Under the proposed rule (still pending OMB approval as of June 2026), OPM would receive data that includes diagnosis codes from medical claims and encounter records. OPM has said its Inspector General would strip names, Social Security numbers, phone numbers, and full addresses first, keeping only ZIP code, year of birth, and a hashed member ID. Privacy experts dispute whether diagnosis codes tied to a hashed ID are truly de-identified.

Does switching from a PPO to an HMO like Kaiser protect my privacy?

Partly, and only for now. Community-rated HMOs like Kaiser currently submit encounter data for rate-setting, not the adjudicated claims data that national PPO plans like BCBS FEP already route into OPM's claims data warehouse. If the new rule is approved, that gap closes: all 65 carriers would have to send individualized data monthly. Switching plans cannot stop the collection once the rule takes effect.

What is the FEHB claims data warehouse, and does my carrier already use it?

OPM runs an existing Health Claims Data Warehouse that predates the December 2025 proposal. National experience-rated PPO plans including BCBS FEP and Aetna state in their 2026 privacy disclosures that they are required to disclose your protected health information to OPM for this warehouse. Community-rated HMOs like Kaiser do not reference it in their consumer brochures, which matches their different data structure.

Did any carrier legally push back on the OPM data plan?

Yes, but they cannot block it alone. The Association of Federal Health Organizations, representing roughly 90% of FEHB enrollees, filed a 122-page objection arguing the request exceeds OPM's authority under 5 U.S.C. 8902(f), which calls for reasonable reports, not everyone's individual claims. CVS Health (Aetna) also objected on HIPAA minimum-necessary grounds. Compliance is not triggered until OMB approves the rule and OPM sets a start date.

Is my family member's data treated differently from mine?

No. The proposal covers all FEHB and PSHB enrollees: employees, retirees, and enrolled dependents. A spouse's and child's medical and pharmacy data would be reported on the same monthly basis as the primary enrollee. That is why the scope is about 8 million people, far more than the roughly 2.2 million active federal employees.

Are mental health or substance abuse records carved out?

No. The proposal contains no explicit carve-out for mental health claims, which fall under medical claims, or for substance abuse records that can appear in encounter data. The special 42 CFR Part 2 protections for federally funded substance abuse programs do not automatically extend to private FEHB carrier data sent to OPM. Critics raised this gap directly during the comment period.

Sources: Federal Register ICR 3206-NEW, BCBS FEP Notice of Privacy Practices, KFF Health News, HIPAA Journal, GovExec, OPM Community Rating Carrier Letter 2025-09.