Pages 1--24 from RI73-028

A Health Maintenance Organization
changes
in

This plan has full accreditation For benefits
from the NCQA See the FEHB Guide

seepage
5

for more information on NCQA

Serving Phoenix area

Enrollment code
161 Self Only
162 Self and Family

Service Area You must live in the service area to enroll in this Plan

Visit the OPM website at
http www opm gov insure

and
the Plan's website at
http www CIGNA com healthcare

Authorized for distribution by the
United States Office of
Personnel Management Federal Employees
Health Benefits Program

RI 73 028

1 1
1 Page 2 3
CIGNA HealthCare of Arizona Inc Phoenix 2000
Table of Contents

PAGE

Introduction 3
Plain Language 3
How To Use This Brochure 4
SECTION 1 Health Maintenance Organizations 5
SECTION 2 How We Change For 2000 5
SECTION 3 How To Get Benefits 6
SECTION 4 What To Do If We Deny Your Claim Or Request For Service 8
SECTION 5 Benefits 10

Non FEHB Benefits Available To Plan Members 17
SECTION 6 General Exclusions Things We Don't Cover 18
SECTION 7 Limitations Rules That Affect Your Benefits 18
SECTION 8 FEHB Facts 20

Inspector General Advisory Stop Healthcare Fraud 22
Summary Of Benefits Inside Back Cover
Premiums Back Cover

2 2
2 Page 3 4
CIGNA HealthCare of Arizona Inc Phoenix 2000
Introduction

CIGNA HealthCare of Arizona Inc Phoenix
11001 North Black Canyon Highway Suite 400
Phoenix Arizona 85029

This brochure describes the benefits you can receive from CIGNA HealthCare of Arizona Inc Phoenix under
its contract CS 1655 with the Office of Personnel Management OPM as authorized by the Federal
Employees Health Benefits FEHB law This brochure is the official statement of benefits on which you can
rely A person enrolled in this Plan is entitled to the benefits described in this brochure If you are enrolled for
Self and Family coverage each eligible family member is also entitled to these benefits

OPM negotiates benefits and premiums with each plan annually Benefit changes are effective January 1 2000
and are shown on page 5 Premiums are listed at the end of this brochure

Plain Language
The President and Vice President are making the Government's communication more responsive accessible
and understandable to the public by requiring agencies to use plain language Health plan representatives and
Office of Personnel Management staff have worked cooperatively to make portions of this brochure clearer In
it you will find common everyday words except for necessary technical terms you and other personal
pronouns active voice and short sentences

We refer to CIGNA HealthCare of Arizona Inc Phoenix as this Plan throughout this brochure even though
in other legal documents you will see a plan referred to as a carrier

These changes do not affect the benefits or services we provide We have rewritten this brochure only to make it
more understandable

We have not re written the Benefits section of this brochure You will find new benefits language next year

3 3
3 Page 4 5
CIGNA HealthCare of Arizona Inc Phoenix 2000
How To Use This Brochure

This brochure has eight sections Each section has important information you should read If you want to
compare this Plan's benefits with benefits from other FEHB Plans you will find that the brochures have the
same format and similar information to make comparisons easier

1 Health Maintenance Organizations HMOs This Plan is an HMO Turn to this section for a brief
description of HMOs and how they work

2 How We Change For 2000 If you are a current member and want to see how we have changed read this section
3 How To Get Benefits Make sure you read this section it tells you how to get services and how we operate
4 What To Do If We Deny Your Claim Or Request For Service This section tells you what to do if you
disagree with our decision not to pay for your claim or to deny your request for a service

5 Benefits Look here to see the benefits we will provide as well as specific exclusions and limitations
You will also find information about non FEHB benefits

6 General Exclusions Things We Don't Cover Look here to see benefits that we will not provide
7 Limitations Rules That Affect Your Benefits This section describes limits that can affect your benefits
8 FEHB Facts Read this for information about the Federal Employees Health Benefits FEHB Program

4 4
4 Page 5 6
CIGNA HealthCare of Arizona Inc Phoenix 2000
SECTION 1 Health Maintenance Organizations
Health maintenance organizations HMOs are health plans that require you to see Plan providers specific physicians hospitals and other providers that contract with us These providers coordinate your health care services The care you receive includes
preventative care such as routine office visits physical exams well baby care and immunizations as well as treatment for illness and injury

When you receive services from our providers you will not have to submit claim forms or pay bills However you must pay copayments and coinsurance listed in this brochure When you receive emergency services you may have to submit claim forms
You should join an HMO because you prefer the plan's benefits not because a particular provider is available You cannot change plans because a provider leaves our Plan We cannot guarantee that any one physician hospital or other provider will be available
and or remain under contract with us Our providers follow generally accepted medical practice when prescribing any course of treatment

SECTION 2 How We Change For 2000
Program wide changes To keep your premium as low as possible OPM has set a minimum copay of 10 for all primary care office visits

This year you have a right to more information about this Plan care management our networks facilities and providers
If you have a chronic or disabling condition and your provider leaves the Plan at our request you may continue to see your specialist for up to ninety 90 days If your provider leaves the
Plan and you are in the second or third trimester of pregnancy you may be able to continue seeing your OB GYN until the end of your postpartum care You have similar rights if this
Plan leaves the FEHB program See SECTION 3 How To Get Benefits for more information
You may review and obtain copies of your medical records on request If you want copies of your medical records ask your health care provider for them You may ask that a physician
amend a record that is not accurate not relevant or incomplete If the physician does not amend your record you may add a brief statement to it If they do not provide you with your
records call us and we will assist you
If you are over age fifty 50 all FEHB Plans will cover a screening sigmoidoscopy every five 5 years This screening is for colorectal cancer

Changes to this Plan Diabetic pharmaceutical supplies will now be covered under the Prescription Drug benefit Medically necessary diabetic equipment will be covered under Medical Surgical Benefits See
Durable Medical Equipment
Prosthetic and orthopedic devices which include artificial limbs and braces are subject to an annual deductible of 200 and an annual maximum of 1000

Dental care benefits are no longer offered
Your share of the non postal premium will increase by 13.6 for Self Only and decrease 0.6 for Self and Family

5 5
5 Page 6 7
SECTION 3 How To Get Benefits
What is this Plan's To enroll with us you must live in our service area This is where our providers practice
service area Our service area is the Phoenix area

Ordinarily you must get your care from providers who contract with us If you receive care outside our service area we will pay only for emergency care We will not pay for any other
health care services
If you or a covered family member move outside of our service area you can enroll in another plan If your dependents live out of the area for example if your child goes to college in
another state you should consider enrolling in a fee for service plan or an HMO that has agreements with affiliates in other areas If you or a family member move you do not have to
wait until Open Season to change plans Contact your employing or retirement office

How much do I pay You must share the cost of some services This is called either a copayment a set dollar
for services amount or coinsurance a set percentage of charges Please remember you must pay this amount when you receive services except for certain benefits

After you pay 1,500 in copayments or coinsurance for one family member or 3,000 for two or more family members you do not have to make any further payments for certain services
for the rest of the year This is called a catastrophic limit However copayments or coinsurance for your prescription drugs dental services durable medical equipment external
prosthetic supplies or mental health substance abuse services do not count toward these limits and you must continue to make these payments

Be sure to keep accurate records of your copayments and coinsurance since you are responsible for informing us when you reach the limits

Do I have to submit claims You normally won't have to submit claims to us unless you receive emergency services from a provider who doesn't contract with us If you file a claim please send us all of the documents
for your claim as soon as possible You must submit claims by December 31st of the year after the year you received the service Either OPM or we can extend this deadline if you
show that circumstances beyond your control prevented you from filing on time

Who provides my The Plan contracts with a group of doctors to provide your health care You will select a
health care primary care physician who supervises your total health care needs A woman may see her Plan gynecologist for her annual routine examination without a referral

What do I do if my Call us We will help you select a new one
primary care physician
leaves the Plan

What do I do if I need Talk to your Plan physician If you need to be hospitalized your primary care physician or
to go into the hospital specialist will make the necessary hospital arrangements and supervise your care

6 6
6 Page 7 8
What do I do if I'm in the First call our Customer Service Department at 1 800 832 3211 If you are new to the FEHB
hospital when I join Program we will arrange for you to receive care If you are currently in the FEHB Program this Plan and are switching to us your former plan will pay for the hospital stay until

You are discharged not merely moved to an alternative care center or
The day your benefits from your former plan run out or
The 92nd day after you became a member of this Plan whichever happens first
These provisions only apply to the person who is hospitalized

How do I get specialty care Your primary care physician will arrange your referral to a specialist
If you need to see a specialist frequently because of a chronic complex or serious medical condition your primary care physician will develop a treatment plan that allows you to see
your specialist for a certain number of visits without additional referrals Your primary care physician in consultation with the Plan will use our criteria when creating your treatment plan

What do I do if I am Your primary care physician will decide what treatment you need If they decide to refer you
seeing a specialist when to a specialist ask if you can see your current specialist If your current specialist does not
I enroll participate with us you must receive treatment from a specialist who does Generally we will not pay for you to see a specialist who does not participate with our Plan

What do I do if my Call your primary care physician who will arrange for you to see another specialist You may
specialist leaves the Plan call Customer Service in order to receive services from your current specialist until we can make arrangements for you to see someone else

But what if I have a Please contact us if you believe your condition is chronic or disabling You may be able to serious illness and my continue seeing your provider for up to ninety 90 days after we notify you that we are
provider leaves the Plan terminating our contract with the provider unless the termination is for cause If you are in or this Plan leaves the second or third trimester of pregnancy you may continue to see your OB GYN until the
the Program end of your postpartum care You may also be able to continue seeing your provider if your plan drops out of the FEHB
Program and you enroll in a new FEHB plan Contact the new plan and explain that you have a serious or chronic condition or are in your second or third trimester Your new plan will pay
for or provide for your care for up to ninrty 90 days after you receive notice that your prior plan is leaving the FEHB program If you are in your second or third trimester your new plan
will pay for the OB GYN care you receive from your current provider until the end of your postpartum care

How do you authorize Your physician must get our approval before sending you to a hospital referring you to a
medical services specialist or recommending follow up care Before giving approval we consider if the service is medically necessary and if it follows generally accepted medical practice

How do you decide if a The Plan evaluates new and emerging treatments experimental or investigational treatments
service is experimental on a case by case basis The Plan uses a Medical Technology Assessment Council
or investigational peer reviewed medical literature and independent medical experts to assist the Plan Medical Director in reaching determinations

7 7
7 Page 8 9
CIGNA HealthCare of Arizona Inc Phoenix 2000
SECTION 4 What To Do If We Deny Your Claim Or Request For Service
If we deny services or won't pay your claim you may ask us to reconsider our decision Your request must
1 Be in writing
2 Refer to specific brochure wording explaining why you believe our decision is wrong and
3 Be made within six 6 months from the date of our initial denial or refusal We may extend this time limit if you show that you were unable to make a timely request due to reasons beyond your control

We have thirty 30 days from the date we receive your reconsideration request to
1 Maintain our denial in writing
2 Pay the claim
3 Arrange for a health care provider to give you the service or
4 Ask for more information

If we ask your medical provider for more information we will send you a copy of our request We must make a decision within thirty 30 days after we receive the additional information If we do not receive the requested information within sixty 60 days
we will make our decision based on the information we already have

When may I ask OPM to You may ask OPM to review the denial after you ask us to reconsider our initial denial or
review a denial refusal OPM will determine if we correctly applied the terms of our contract when we denied your claim or request for service

What if I have a serious or Call us at 1 800 832 3211 and we will expedite our review
life threatening condition
and you have not responded
to my request for service

What if you have denied my If we expedite your review due to a serious medical condition and deny your claim we will
request for care and my inform OPM so that they can give your claim expedited treatment too Alternatively you can
condition is serious or call OPM's health benefits Contracts Division IV at 202 606 0737 between 8 a m and 5 p m
life threatening Serious or life threatening conditions are ones that may cause permanent loss of bodily function or death if they are not treated as soon as possible

Are there other time limits You must write to OPM and ask them to review our decision within ninety 90 days after we uphold our initial denial or refusal of service You may also ask OPM to review your claim if
1 We do not answer your request within thirty 30 days In this case OPM must receive your request within one hundred twenty 120 days of the date you asked us to reconsider
your claim
2 You provided us with the additional information we asked for and we did not answer
within thirty 30 days In this case OPM must receive your request within one hundred twenty 120 days of the date we asked you for additional information

8 8
8 Page 9 10
CIGNA HealthCare of Arizona Inc Phoenix 2000
What do I send to OPM Your request must be complete or OPM will return it to you You must send the following information

1 A statement about why you believe our decision is wrong based on specific benefit provisions in this brochure
2 Copies of documents that support your claim such as physicians letters operative reports bills medical records and explanation of benefits EOB forms
3 Copies of all letters you sent us about the claim
4 Copies of all letters we sent you about the claim and
5 Your daytime phone number and the best time to call

If you want OPM to review different claims you must clearly identify which documents apply to which claim

Who can make the request Those who have a legal right to file a disputed claim with OPM are
1 Anyone enrolled in the Plan
2 The estate of a person once enrolled in the Plan and
3 Medical providers legal counsel and other interested parties who are acting as the enrolled person's representative They must send a copy of the person's specific written

consent with the review request

What address should I Send your request for review to Office of Personnel Management Office of Insurance
send my disputed claim to Programs Contracts Division IV P O Box 436 Washington D C 20044

What if OPM upholds OPM's decision is final There are no other administrative appeals If OPM agrees with our
the Plan's denial decision your only recourse is to sue

If you decide to sue you must file the suit against OPM in Federal court by December 31st of the third year after the year in which you received the disputed services or supplies

What laws apply if I Federal law governs your lawsuit benefits and payment of benefits The Federal court will
file a lawsuit base its review on the record that was before OPM when OPM made its decision on your claim You may recover only the amount of benefits in dispute

You or a person acting on your behalf may not sue to recover benefits on a claim for treatment services supplies or drugs covered by us until you have completed the OPM
review procedure described above

Your records and Chapter 89 of Title 5 United States Code allows OPM to use the information it collects from
the Privacy Act you and us to determine if our denial of your claim is correct The information OPM collects during the review process becomes a permanent part of your disputed claims file and is

subject to the provisions of the Freedom of Information Act and the Privacy Act OPM may disclose this information to support the disputed claim decision If you file a lawsuit this

information will become part of the court record

9 9
9 Page 10 11
CIGNA HealthCare of Arizona Inc Phoenix 2000
SECTION 5 Benefits

Medical and Surgical Benefits
What is covered A comprehensive range of preventive diagnostic and treatment services is provided by Plan doctors and other Plan providers This
includes all necessary office visits you pay a 10 office visit copay 20 for after hour visits but no additional copay for laboratory tests and X rays Within the service area house calls will be provided if in the judgement of the Plan doctor such care is necessary
and appropriate you pay a 10 copay for a doctor's house call and nothing for home visits by nurses and health aides
The following services are included and are subject to the office visit copay unless stated otherwise
Preventive care including well baby care and periodic check ups
Mammograms are covered as follows for women age 35 through 39 one 1 mammogram during these five 5 years for women age 40 through 49 one 1 mammogram every two 2 years for women age 50 through 64 one 1 mammogram

every year and for women age 65 and above one 1 mammogram every two 2 years In addition to routine screening mammograms are covered when prescribed by the doctor as medically necessary to diagnose or treat your illness

Routine immunizations and boosters
Consultations by specialists
Diagnostic procedures such as laboratory tests and X rays
Complete obstetrical maternity care for all covered females including prenatal delivery and postnatal care by a Plan doctor Copays are waived for maternity care The mother at her option may remain in the hospital up to forty eight 48 hours after a

regular delivery ninety six 96 hours after a cesarean delivery If enrollment in the Plan is terminated during pregnancy benefits will not be provided after coverage under the Plan has ended Ordinary nursery care of the newborn child during the
covered portion of the mother's hospital confinement for maternity will be covered under either a Self Only or Self and Family enrollment other care of an infant who requires definitive treatment will be covered only if the infant is covered under a Self
and Family enrollment
Voluntary sterilization and family planning services
Diagnosis and treatment of diseases of the eye
Allergy testing and treatment including testing and treatment materials such as allergy serum
The insertion of internal prosthetic devices such as pacemakers and artificial joints
Cornea heart kidney and liver transplants allogenic donor bone marrow transplants autologous bone marrow transplants autologous stem cell and peripheral stem cell support for the following conditions acute lymphocytic or non lymphocytic

leukemia advanced Hodgkin's lymphoma advanced non Hodgkin's lymphoma advanced neuroblastoma breast cancer multiple myeloma epithelial ovarian cancer and testicular mediastinal retroperitoneal and ovarian germ cell tumors
Transplants are covered when approved by the Medical Director Related medical and hospital expenses of the donor are covered when the recipient is covered by this Plan

Dialysis
Women who undergo a mastectomy may at their option have this procedure performed on an inpatient basis and remain in the hospital up to forty eight 48 hours after the procedure

Chemotherapy radiation therapy and inhalation therapy
Surgical treatment of morbid obesity
Orthopedic devices such as braces
Durable medical equipment such as wheelchairs and hospital beds
Home health services of nurses and health aides including intravenous fluids and medications when prescribed by your Plan doctor who will periodically review the program for continuing appropriateness and need

All necessary medical or surgical care in a hospital or extended care facility from Plan doctors and other Plan providers

10 CARE MUST BE RECEIVED FROM OR ARRANGED BY PLAN DOCTORS 10
10 Page 11 12
CIGNA HealthCare of Arizona Inc Phoenix 2000
Limited benefits

Oral and maxillofmacial surgery is provided for nondental surgical and hospitalization procedures for congenital defects such as cleft lip and cleft palate and for medical or surgical procedures occurring within or adjacent to the oral cavity or sinuses including

but not limited to treatment of fractures and excision of tumors and cysts All other procedures involving the teeth or intra oral areas surrounding the teeth are not covered including any dental care involved in the treatment of temporomandibular joint TMJ pain
dysfunction syndrome
Reconstructive surgery will be provided to correct a condition resulting from a functional defect or from an injury or surgery that has produced a major effect on the member's appearance and if the condition can reasonably be expected to be corrected by such

surgery A patient and her attending physician may decide whether to have breast reconstructive surgery following a mastectomy and whether surgery on the other breast is needed to produce a symmetrical appearance

Short term rehabilitative therapy physical speech and occupational is provided on an inpatient or outpatient basis for 60 consecutive days per condition if significant improvement can be expected within two 2 months you pay 10 per outpatient
session Speech therapy is limited to treatment of certain speech impairments of organic origin Occupational therapy is limited to services that assist the member to achieve and maintain self care and improved functioning in other activities of daily living

Orthopedic and External Prosthetic devices such as artificial limbs are covered up to a 1,000 maximum Plan payment per calendar year limited to the initial purchase and fitting unless replacement is due to normal anatomical growth You pay the first
200 per calendar year and all charges after the Plan maximum annual benefit
External lenses intraocular and lenticular following cataract surgery You pay nothing
Diagnosis and treatment of infertility is covered you pay 20 per diagnostic visit Intravaginal insemination IVI is covered you pay 20 cost of donor sperm is not covered Injectable fertility drugs are not covered under the Prescription Drug benefit Injectable
infertility drugs are covered as part of a Plan approved infertility treatment program under the Medical benefit Other assisted reproductive technology ART procedures such as in vitro fertilization intrauterine insemination IUI and embryo transfer and
infertility drugs are not covered
Durable medical equipment such as wheelchairs and hospital beds is covered you pay nothing per device

What is not covered
Physical examinations that are not necessary for medical reasons such as those required for obtaining or continuing employment or insurance attending school or camp or travel

Reversal of voluntary surgically induced sterility
Surgery primarily for cosmetic purposes
Homemaker services
Hearing aids
Transplants not listed as covered
Long term rehabilitative therapy
Cardiac rehabilitation
Foot orthotics
Chiropractic services
Pulmonary rehabilitation
Shower chairs and commodes

CARE MUST BE RECEIVED FROM OR ARRANGED BY PLAN DOCTORS 11 11
11 Page 12 13
Hospital Extended Care Benefits
What is covered

Hospital care The Plan provides a comprehensive range of benefits with no dollar or day limit when you are hospitalized under the care of a Plan doctor You pay nothing All necessary services are
covered including
Semiprivate room accommodations when a Plan doctor determines it is medically necessary the doctor may prescribe private accommodations or private duty nursing care

Specialized care units such as intensive care or cardiac care units

Extended care The Plan provides a comprehensive range of benefits up to sixty 60 days per calendar year when full time skilled nursing care is necessary and confinement in a skilled nursing facility is
medically appropriate as determined by a Plan doctor and approved by the Plan You pay nothing All necessary services are covered including

Bed board and general nursing care
Drugs biologicals supplies and equipment ordinarily provided or arranged by the skilled nursing facility when prescribed by a Plan doctor

Hospice care Supportive and palliative care for a terminally ill member is covered in the home or a hospice facility Services include inpatient and outpatient care and family counseling these services
are provided under the direction of a Plan doctor who certifies that the patient is in the terminal stages of illness with a life expectancy of approximately six 6 months or less

Ambulance service Benefits are provided for ambulance transportation ordered or authorized by a Plan doctor You pay nothing

Limited benefits
Inpatient dental Hospitalization for certain dental procedures is covered when a Plan doctor determines there is procedures a need for hospitalization for reasons totally unrelated to the dental procedure the Plan will
cover the hospitalization but not the cost of professional dental services Conditions for which hospitalization would be covered include hemophilia and heart disease the need for
anesthesia by itself is not such a condition

Acute inpatient Hospitalization for medical treatment of substance abuse is limited to emergency care detoxification diagnosis treatment of medical conditions and medical management of withdrawal symptoms
acute detoxification if the Plan doctor determines that outpatient management is not medically appropriate See page 15 for non medical substance abuse benefits

What is not covered Personal comfort items such as telephone and television
Custodial care rest cures domiciliary or convalescent care

12 CARE MUST BE RECEIVED FROM OR ARRANGED BY PLAN DOCTORS 12
12 Page 13 14
Emergency Benefits
What is a A medical emergency is the sudden and unexpected onset of a condition or an injury that you
medical emergency believe endangers your life or could result in serious injury or disability and requires immediate medical or surgical care Some problems are emergencies because if not treated

promptly they might become more serious examples include deep cuts and broken bones Others are emergencies because they are potentially life threatening such as heart attacks

strokes poisonings gunshot wounds or sudden inability to breathe There are many other acute conditions that the Plan may determine are medical emergencies what they all have in
common is the need for quick action

Emergencies within If you are in an emergency situation please call your primary care doctor In extreme
the service area emergencies if you are unable to contact your doctor contact the local emergency system e g the 911 telephone system or go to the nearest hospital emergency room Be sure to tell

the emergency room personnel that you are a Plan member so they can notify the Plan You or a family member must notify the Plan within forty eight 48 hours unless it was not

reasonably possible to do so It is your responsibility to ensure that the Plan has been timely notified

If you need to be hospitalized the Plan must be notified within forty eight 48 hours or on the first working day following your admission unless it was not reasonably possible to notify the
Plan within that time If you are hospitalized in non Plan facilities and a Plan doctor believes care can be better provided in a Plan hospital you will be transferred when medically feasible
with any ambulance charges covered in full
Benefits are available for care from non Plan providers in a medical emergency only if delay in reaching a Plan provider would result in death disability or significant jeopardy to your
condition
To be covered by this Plan any follow up care recommended by non Plan providers must be approved by the Plan or provided by Plan providers

Plan pays Reasonable charges for emergency services to the extent the services would have been covered if received from Plan providers
You pay 50 per hospital emergency room visit or 20 per urgent care center visit in Plan facilities for emergency services that are covered benefits of this Plan If emergency results in admission to
a hospital the copay is waived

Emergencies outside Benefits are available for any medically necessary health service that is immediately required
the service area because of injury or unforeseen illness

If you need to be hospitalized the Plan must be notified within forty eight 48 hours or on the first working day following your admission unless it was not reasonably possible to notify the
Plan within that time If a Plan doctor believes care can be better provided in a Plan hospital you will be transferred when medically feasible with any ambulance charges covered in full

Any follow up care recommended by non Plan providers must be approved by the Plan or provided by Plan providers

Plan pays Reasonable charges for emergency services to the extent the services would have been covered if received from Plan providers
You pay 50 per hospital emergency room visit or 20 per urgent care center visit in Plan facilities for emergency services that are covered benefits of this Plan If the emergency results in
admission to a hospital the copay is waived
CARE MUST BE RECEIVED FROM OR ARRANGED BY PLAN DOCTORS 13 13
13 Page 14 15
What is covered Emergency care at a doctor's office or an urgent care center
Emergency care as an outpatient or inpatient at a hospital including doctors services
Ambulance service approved by the Plan

What is not covered Elective care or non emergency care
Emergency care provided outside the service area if the need for care could have been foreseen before leaving the service area

Medical and hospital costs resulting from a normal full term delivery of a baby outside the service area

Filing claims for With your authorization the Plan will pay benefits directly to the providers of your emergency
non Plan providers care upon receipt of their claims Physician claims should be submitted on the HCFA 1500 claim form If you are required to pay for the services submit itemized bills and your receipts

to the Plan along with an explanation of the services and the identification information from your ID card

Payment will be sent to you or the provider if you did not pay the bill unless the claim is denied If it is denied you will receive notice of the decision including the reasons for the
denial and the provisions of the contract on which denial was based If you disagree with the Plan's decision you may request reconsideration in accordance with the disputed claims
procedure described on pages 8 and 9

Mental Conditions Substance Abuse Benefits
MENTAL CONDITIONS
What is covered To the extent shown below the Plan provides the following services necessary for the diagnosis and treatment of acute and chronic psychiatric conditions including the treatment of

mental illness or disorders
Diagnostic evaluation
Psychological testing
Psychiatric treatment including individual and group therapy
Hospitalization including inpatient professional services

Outpatient care Up to thirty 30 outpatient visits to Plan doctors consultants or other psychiatric personnel each calendar year you pay a 5 copay per visit for sessions 1 through 20 and a 10 copay
per visit for sessions 21 through 30 all charges thereafter

Inpatient care Up to thirty 30 days of hospitalization each calendar year you pay nothing for the first thirty 30 days all charges thereafter The benefits may be exchanged for partial
hospitalization sessions of not less than three 3 hours and not more than twelve 12 hours in any twenty four 24 hour period based on the following exchange formula If the charge for
one partial hospitalization session does not exceed fifty percent 50 of the published charges for one inpatient day of the average semi private rate at the participating hospital
where the session is conducted the benefits exchange shall be two 2 partial hospitalization sessions equal to one day of inpatient care If the charge for one partial hospitalization session
does exceed fifty percent 50 of the published charges for one inpatient day of the average semi private rate at the participating hospital where the session is conducted the benefits
exchange shall be one partial hospitalization session equal to one day of inpatient care

14 CARE MUST BE RECEIVED FROM OR ARRANGED BY PLAN DOCTORS 14
14 Page 15 16
What is not covered Care for psychiatric conditions that in the professional judgment of Plan doctors are not subject to significant improvement through relatively short term treatment
Psychiatric evaluation or therapy on court order or as a condition of parole or probation unless determined by a Plan doctor to be necessary and appropriate
Psychological testing that is not medically necessary to determine the appropriate treatment of a short term psychiatric condition

SUBSTANCE ABUSE
What is covered This Plan provides medical and hospital services such as acute detoxification services for the medical non psychiatric aspects of substance abuse including alcoholism and drug addiction
the same as for any other illness or condition and to the extent shown below the services necessary for diagnosis and treatment

Outpatient care All necessary visits to Plan providers for treatment you pay a 5 copay for each covered visit
Inpatient care All necessary care in an alcohol detoxification or rehabilitation center approved by the Plan you pay nothing

What is not covered Treatment that is not authorized by a Plan doctor

Prescription Drug Benefits
What is covered Prescription drugs prescribed by a Plan or referral doctor and obtained at a Plan pharmacy will be dispensed for up to a 30 day or 100 unit supply whichever is less you pay a 5 copay for
generic drugs or 10 for name brand drugs per prescription unit or refill When generic substitution is possible i e a generic drug is available and the prescribing doctor does not
require the use of a name brand drug but you request the name brand drug you pay the price difference between the generic and name brand drug as well as the 10 copay per prescription
unit or refill
You may also obtain Prescription drugs through the Home Delivery Pharmacy Service you pay a 10 copay for up to a 90 day supply of generic drugs or 20 copay for name brand
drugs when a generic drug is not permissible with no annual deductible When generic substitution is permissible i e a generic drug is available and the prescribing doctor does not
require the use of a name brand drug but you request the name brand drug you pay the price difference between the generic and the name brand drug as well as the 20 copay per 90 day
supply
Drugs are prescribed by Plan doctors and dispensed in accordance with the Plan's drug formulary Non formulary drugs will be covered when prescribed by a Plan doctor and
approved by the Plan's medical director The Plan must arrange for the non formulary drug to be dispensed when required to do so by the prescribing doctor

The Plan's drug formulary is updated regularly by the Pharmacy and Therapeutics Committee The Committee consists of providers pharmacists medical directors and pharmacy directors
They review medications for safety therapeutic value and cost effectiveness Based on this review medications are added or deleted from the formulary

CARE MUST BE RECEIVED FROM OR ARRANGED BY PLAN DOCTORS 15 15
15 Page 16 17
CIGNA HealthCare of Arizona Inc Phoenix 2000 Covered medications and accessories include
Drugs for which a prescription is required by Federal law
Oral and injectable contraceptive drugs and contraceptive devices contraceptive diaphragms

Implanted time release medications such as Norplant you pay a one time copay of 10 for the office visit There is no charge when the device is implanted during a covered
hospitalization
Disposable needles and syringes needed for injecting covered prescribed medication including insulin

Glucose test strips and lancets
Insulin

Intravenous fluids and medication for home use implantable drugs and some injectable drugs are covered under Medical and Surgical Benefits

Limited benefit Drugs to treat sexual dysfunction are limited Contact the Plan for dose limits You pay a 10 copayment up to the dosage limits and all charges above that
What is not covered Drugs available without a prescription or for which there is a non prescription equivalent available
Drugs obtained at a non Plan pharmacy except for out of area emergencies
Drugs for cosmetic purposes
Smoking cessation drugs and medication including nicotine patches
Drugs to enhance athletic performance
Vitamins and nutritional substances that can be purchased without a prescription
Medical supplies such as dressings and antiseptics
Infertility drugs

Other Benefits
VISION CARE
What is covered In addition to the medical and surgical benefits provided for diagnosis and treatment of diseases of the eye annual eye refractions which may include a lens prescription may be

obtained from Plan providers You pay a 10 copay Additionally one pair single vision glass or plastic prescription lenses are provided each year you pay a 10 copay

What is not covered Replacements for any lenses provided during the same calendar year
Eye exercises
Frames
Contact lenses and their fitting

16 CARE MUST BE RECEIVED FROM OR ARRANGED BY PLAN DOCTORS 16
16 Page 17 18
CIGNA HealthCare of Arizona Inc Phoenix 2000
Non FEHB Benefits Available to Plan Members The benefits described on this page are neither offered nor guaranteed under the contract with the FEHB Program but are made
available to all enrollees and family members of this Plan The cost of the benefits described on this page is not included in the FEHB premium and any charges for these services do not count toward any FEHB deductibles or out of pocket maximums
These benefits are not subject to the FEHB disputed claims procedure

Member Programs
CIGNA HealthCare of Arizona Greater Metro Phoenix

Alternative Care We offer a variety of health education classes including Tai Chi Additionally through vendor arrangements our members are entitled to discounts on vitamins and supplements as well as
massage therapy
Birthday Card We understand that people are very busy and might forget important things like childhod Reminders immunizations and mammography screenings So we send reminders to all women and

children on our Plan to make sure we see them for this and other preventive care
Direct Access to Women may choose to see a contracted OB GYN for covered services without a referral OB GYN from their PCP

Guest Privileges Eligible members can participate as a guest through CIGNA's extensive national physician network when in another location for at least ninety days For instance a covered dependent
student away at school There are over fifty 50 networks nationwide
Temporary job assignments to another location
Family separations due to divorce
Children attending school away from home

Healthy Babies A program to encourage mothers to receive all routine prenatal care Program includes highrisk Program assessment access to health information line no copayments for pre and postnatal visits
and lots of extras to help care for your new baby Call our Baby Line at 602 553 2229 for more information

24 Hour Health We know that health issues don't care what time of day it is That's why we offer our 24 hour Information Line health information line Members in need of assistance can talk with one of our specially
trained nurses or select over 1200 topics on tape in our health information library Call Member Services to receive a directory of topics

Internet Access The information you need instantly easily and online Our web site helps you find answers to your questions You can search for participating providers refill your Tel Drug
prescriptions change your PCP read online health and wellness publications or send us an email Visit our national web site at www cigna com healthcare and explore to learn more

Member Service We have extensive Member Service hours to serve you A friendly representative is available to Hours assist you from 7am to 9pm Monday through Friday 8am to 5pm on Saturday

Wellness Classes We offer classes for children adults and seniors Instruction is provided by professionally trained educators on topics ranging from nutrition to stress management
Well Being Stay current with your healthplan benefits and programs We mail our members a health and wellness newsletter three times per year Well Being includes reminders about preventive care
quality programs tips for using your health coverage and information on topics important to help you lead a healthy life

This program is provided for the benefit of CIGNA members and is not an endorsement of the services or vendors listed
Medicare prepaid This Plan offers Medicare recipients the opportunity to enroll in the Plan through Medicare
plan enrollment As indicated on page 5 annuitants and former spouses with FEHB coverage and Medicare Part B may elect to drop their FEHB coverage and enroll in a Medicare prepaid plan when
one is available in their area They may then later reenroll in the FEHB Program Most Federal annuitants have Medicare Part A Those without Medicare Part A may join this

Medicare prepaid plan but will probably have to pay for hospital coverage in addition to the Part B premium Before you join the plan ask whether the plan covers hospital benefits and
if so what you will have to pay Contact your retirement system for information on dropping your FEHB enrollment and changing to a Medicare prepaid plan Contact us at 1 800 430 0768
for information on the Medicare prepaid plan and the cost of that enrollment

Benefits on this page are not part of the FEHB contract 17 17
17 Page 18 19
SECTION 6 General Exclusions Things We Don't Cover
The exclusions in this section apply to all benefits Although we may list a specific service as a benefit we will not cover it unless your Plan doctor determines it is medically necessary to prevent diagnose or treat your illness or condition

We do not cover the following
Services drugs or supplies that are not medically necessary
Services not required according to accepted standards of medical dental or psychiatric practice
Care by non Plan providers except for authorized referrals or emergencies see Emergency Benefits
Experimental or investigational procedures treatments drugs or devices
Procedures services drugs and supplies related to abortions except when the life of the mother would be endangered if the fetus were carried to term or when the pregnancy is the result of an act of rape or incest

Procedures services drugs and supplies related to sex transformations
Services or supplies you receive from a provider or facility barred from the FEHB Program and
Expenses you incurred while you were not enrolled in this Plan

SECTION 7 Limitations Rules That Affect Your Benefits
Medicare Tell us if you or a family member is enrolled in Medicare Part A or B Medicare will determine who is responsible for paying for medical services and we will coordinate the
payments On occasion you may need to file a Medicare claim form
If you are eligible for Medicare you may enroll in a Medicare Choice plan and also remain enrolled with us

If you are an annuitant or former spouse you can suspend your FEHB coverage and enroll in a Medicare Choice plan when one is available in your area For information on suspending your
FEHB enrollment and changing to a Medicare Choice plan contact your retirement office If you later want to re enroll in the FEHB Program generally you may do so only at the next
Open Season
If you involuntarily lose coverage or move out of the Medicare Choice service area you may re enroll in the FEHB Program at any time

If you do not have Medicare Part A or B you can still be covered under the FEHB Program and your benefits will not be reduced We cannot require you to enroll in Medicare
For information on Medicare Choice plans contact your local Social Security Administration SSA office or request it from SSA at 1 800 638 6833 For information on the
Medicare Choice plan offered by this Plan see page 17

Other group When anyone has coverage with us and with another group health plan it is called double
insurance coverage coverage You must tell us if you or a family member has double coverage You must also send us documents about other insurance if we ask for them

When you have double coverage one plan is the primary payer it pays benefits first The other plan is secondary it pays benefits next We decide which insurance is primary
according to the National Association of Insurance Commissioners Guidelines
If we pay second we will determine what the reasonable charge for the benefit should be After the first plan pays we will pay either what is left of the reasonable charge or our regular

benefit whichever is less We will not pay more than the reasonable charge If we are the secondary payer we may be entitled to receive payment from your primary plan

We will always provide you with the benefits described in this brochure Remember even if you do not file a claim with your other plan you must still tell us that you have double
coverage

18 18
18 Page 19 20
Circumstances beyond Under certain extraordinary circumstances we may have to delay your services or be unable
our control to provide them In that case we will make all reasonable efforts to provide you with necessary care

When others are responsible When you receive money to compensate you for medical or hospital care for injuries or illness
for injuries that another person caused you must reimburse us for whatever services we paid for We will cover the cost of treatment that exceeds the amount you received in the settlement If you do

not seek damages you must agree to let us try This is called subrogation If you need more information contact us for our subrogation procedures

TRICARE TRICARE is the health care program for members eligible dependents and retirees of the military TRICARE includes the CHAMPUS program If both TRICARE and this Plan cover
you we are the primary payer See your TRICARE Health Benefits Advisor if you have questions about TRICARE coverage

Workers compensation We do not cover services that
You need because of a workplace related disease or injury that the Office of Workers Compensation Programs OWCP or a similar Federal or State agency determine they

must provide
OWCP or a similar agency pays for through a third party injury settlement or other similar proceeding that is based on a claim you filed under OWCP or similar laws

Once the OWCP or similar agency has paid its maximum benefits for your treatment we will provide your benefits

Medicaid We pay first if both Medicaid and this Plan cover you
Other Government Agencies We do not cover services and supplies that a local State or Federal Government agency directly or indirectly pays for
If you have a If you have a malpractice claim because of services you did or did not receive from a plan
malpractice claim provider it must go to binding arbitration Contact us about how to begin our binding arbitration process

19 19
19 Page 20 21
SECTION 8 FEHB Facts
You have a right to OPM requires that all FEHB plans comply with the Patients Bill of Rights which gives you
information about the right to information about your health plan its networks providers and facilities You can
your HMO also find out about care management which includes medical practice guidelines disease management programs and how we determine if procedures are experimental or

investigational OPM's website www opm gov lists the specific types of information that we must make available to you

If you want specific information about us call 1 800 832 3211 or write to 11001 North Black Canyon Highway Suite 400 Phoenix Arizona 85029 You may also visit our website at
www cigna com

Where do I get information Your employing or retirement office can answer your questions and give you a Guide to
about enrolling in the Federal Employees Health Benefits Plans brochures for other plans and other materials you
FEHB Program need to make an informed decision about When you may change your enrollment

How you can cover your family members
What happens when you transfer to another Federal agency go on leave without pay enter military service or retire

When your enrollment ends and
The next Open Season for enrollment

We don't determine who is eligible for coverage and in most cases cannot change your enrollment status without information from your employing or retirement office

When are my benefits The benefits in this brochure are effective on January 1st If you are new to this Plan your
and premiums effective coverage and premiums begin on the first day of your first pay period that starts on or after January 1st Annuitants premiums begin January 1st

What happens when I retire When you retire you can usually stay in the FEHB Program Generally you must have been enrolled in the FEHB Program for the last five 5 years of your Federal service If you do not
meet this requirement you may be eligible for other forms of coverage such as Temporary Continuation of Coverage which is described later in this section

What types of coverage Self Only coverage is for you alone Self and Family coverage is for you your spouse and
are available for me your unmarried dependent children under age twenty two 22 including any foster or step
and my family children your employing or retirement office authorizes coverage for Under certain circumstances you may also get coverage for a disabled child twenty two 22 years of age or

older who is incapable of self support

If you have a Self Only enrollment you may change to a Self and Family enrollment if you marry give birth or add a child to your family You may change your enrollment thirty one
31 days before and up to sixty 60 days after you give birth or add the child to your family The benefits and premiums for your Self and Family enrollment begin on the first day of the
pay period in which the child is born or becomes an eligible family member
Your employing or retirement office will not notify you when a family member is no longer eligible to receive health benefits nor will we Please tell us immediately when you add or
remove family members from your coverage for any reason including divorce
If you or one of your family members is enrolled in one FEHB plan that person may not be enrolled in another FEHB plan

20 20
20 Page 21 22
Are my medical and We will keep your medical and claims information confidential Only the following will have
claims records confidential access to it

OPM this Plan and subcontractors when they administer this contract
Law enforcement officials when investigating and or prosecuting alleged civil or criminal actions

OPM and the General Accounting Office when conducting audits
Individuals involved in bona fide medical research or education that does not disclose your identity or

OPM when reviewing a disputed claim or defending litigation about a claim

Information for
new members

Identification cards We will send you an Identification ID card Use your copy of the Health Benefits Election Form SF 2809 or the OPM annuitant confirmation letter until you receive your ID card You
can also use an Employee Express confirmation letter

What if I paid a Your old plan's deductible continues until our coverage begins deductible under
my old plan

Pre existing conditions We will not refuse to cover the treatment of a condition that you or a family member had before you enrolled in this Plan solely because you had the condition before you enrolled

When you lose benefits
What happens if my You will receive an additional thirty one 31 days of coverage for no additional premium when enrollment in this
Your enrollment ends unless you cancel your enrollment or Plan ends
You are a family member no longer eligible for coverage

You may be eligible for former spouse coverage or Temporary Continuation of Coverage

What is former If you are divorced from a Federal employee or annuitant you may not continue to get spouse coverage benefits under your former spouse's enrollment But you may be eligible for your own
FEHB coverage under the spouse equity law If you are recently divorced or are anticipating a divorce contact your ex spouse's employing or retirement office to get more information
about your coverage choices

What is TCC Temporary Continuation of Coverage TCC If you leave Federal service or if you lose coverage because you no longer qualify as a family member you may be eligible for TCC For
example you can receive TCC if you are not able to continue your FEHB enrollment after you retire You may not elect TCC if you are fired from your Federal job due to gross misconduct

Get the RI 79 27 which describes TCC and the RI 70 5 the Guide to Federal Employees Health Benefits Plans for Temporary Continuation of Coverage and Former Spouse Enrollees from your
employing or retirement office
Key points about TCC
You can pick a new plan
If you leave Federal service you can receive TCC for up to eighteen 18 months after you separate

If you no longer qualify as a family member you can receive TCC for up to thirty six 36 months
Your TCC enrollment starts after regular coverage ends
If you or your employing office delay processing your request you still have to pay premiums from the 32nd day after your regular coverage ends even if several months have passed

You pay the total premium and generally a two percent 2 administrative charge The government does not share your costs
You receive another 31 day extension of coverage when your TCC enrollment ends unless you cancel your TCC or stop paying the premium
You are not eligible for TCC if you can receive regular FEHB Program benefits
21 21
21 Page 22 23
CIGNA HealthCare of Arizona Inc Phoenix 2000 How do I enroll in TCC If you leave Federal service your employing office will notify you of your right to enroll
under TCC You must enroll within sixty 60 days of leaving or receiving this notice whichever is later

Children You must notify your employing or retirement office within sixty 60 days after your child is no longer an eligible family member That office will send you
information about enrolling in TCC You must enroll your child within sixty 60 days after they become eligible for TCC or receive this notice whichever is later

Former spouses You or your former spouse must notify your employing or retirement office within sixty 60 days of one of these qualifying events
Divorce
Loss of spouse equity coverage within thirty six 36 months after the divorce
Your employing or retirement office will then send your former spouse information about enrolling in TCC Your former spouse must enroll within sixty 60 days after the event

which qualifies them for coverage or receiving the information whichever is later
Note Your child or former spouse loses TCC eligibility unless you or your former spouse notifies your employing or retirement office within the 60 day deadline

How can I convert to You may convert to an individual policy if
individual coverage Your coverage under TCC or the spouse equity law ends If you canceled your coverage

or did not pay your premium you cannot convert
You decided not to receive coverage under TCC or the spouse equity law or
You are not eligible for coverage under TCC or the spouse equity law
If you leave Federal service your employing office will notify you if individual coverage is available You must apply in writing to us within thirty one 31 days after you receive this

notice However if you are a family member who is losing coverage the employing or retirement office will not notify you You must apply in writing to us within thirty one 31
days after you are no longer eligible for coverage
Your benefits and rates will differ from those under the FEHB Program however you will not have to answer questions about your health and we will not impose a waiting period or limit

your coverage due to pre existing conditions

How can I get a If you leave the FEHB Program we will give you a Certificate of Group Health Plan Coverage Certificate of Group that indicates how long you have been enrolled with us You can use this certificate when
Health Plan Coverage getting health insurance or other health care coverage You must arrange for the other coverage within sixty three 63 days of leaving this Plan Your new plan must reduce or eliminate waiting
periods limitations or exclusions for health related conditions based on the information in the certificate

If you have been enrolled with us for less than twelve 12 months but were previously enrolled in other FEHB plans you may request a certificate from them as well

Inspector General Advisory Stop Health Care Fraud
Fraud increases the cost of health care for everyone If you suspect that a physician pharmacy or hospital has charged you for services you did not receive billed you twice for the same service or misrepresented any information do the following
Call the provider and ask for an explanation There may be an error
If the provider does not resolve the matter call us at 1 800 832 3211 and explain the situation
If we do not resolve the issue call or write

THE HEALTH CARE FRAUD HOTLINE 202 418 3300
U S Office of Personnel Management Office of the Inspector General Fraud Hotline

1900 E Street NW Room 6400 Washington D C 20415

Penalties for Fraud
Anyone who falsifies a claim to obtain FEHB Program benefits can be prosecuted for fraud Also the Inspector General may investigate anyone who uses an ID card if they

Try to obtain services for a person who is not an eligible family member or
Are no longer enrolled in the Plan and try to obtain benefits
Your agency may also take administrative action against you

22 22
22 Page 23 24
CIGNA HealthCare of Arizona Inc Phoenix 2000
Summary of Benefits for CIGNA HealthCare of Arizona Inc Phoenix 2000

Do not rely on this chart alone All benefits are provided in full unless otherwise indicated subject to the limitations and exclusions
set forth in the brochure This chart merely summarizes certain important expenses covered by the Plan If you wish to enroll or
change your enrollment in this Plan be sure to indicate the correct enrollment code on your enrollment form codes appear on the
cover of this brochure ALL SERVICES COVERED UNDER THIS PLAN WITH THE EXCEPTION OF EMERGENCY
CARE ARE COVERED ONLY WHEN PROVIDED OR ARRANGED BY PLAN DOCTORS

Benefits Plan pays provides Page
Inpatient care
Hospital Comprehensive range of medical and surgical services without dollar or day limit Includes in hospital doctor care room and board general nursing care private room and private

nursing care if medically necessary diagnostic tests drugs and medical supplies use of operating room intensive care and complete maternity care You pay nothing
12

Extended Care All necessary services for up to 60 days per year You pay nothing 12
Mental Conditions Diagnosis and treatment of acute and psychiatric conditions for up to 30 days of inpatient
care per year You pay nothing 14

Substance Abuse All necessary care You pay nothing 15

Outpatient care Comprehensive range of services such as diagnosis and treatment of illness or injury including
specialist's care preventive care including well baby care periodic check ups and routine immunizations laboratory tests and X rays complete maternity care You pay a 10 copay

per office visit or house call by a doctor copays are waived for maternity visits after the first visit 14,15

Home Health Care All necessary visits by nurses and health aides You pay nothing 10
Mental Conditions Up to 30 visits per year You pay a 5 copay per visit for visits one through 20 and a 10 copay per visits 21 through 30
14

Substance Abuse All necessary care You pay a 5 copay per visit 14

Emergency care Reasonable charges for services and supplies required because of a medical emergency You pay a 50 copay for each emergency room visit to non Plan facilities and any charges for
services that are not covered benefits of this Plan 13
Prescription drugs Drugs prescribed by a Plan doctor and obtained at a Plan pharmacy You pay a 5 copay for generic drugs or 10 for name brand drugs per prescription unit or refill
15

Dental care Preventive dental care Non FEHBP benefits 16
Vision care Annually one refraction You pay a 5 copay One set of single vision lenses you pay a 5 copay 16

Out of pocket maximum Your out of pocket expenses for benefits covered under this Plan are limited to the stated 20 copayments that are required for a few benefits

23 23
23 Page 24
CIGNA HealthCare of Arizona Inc Phoenix 2000
Authorized for distribution by the

United States Office of
Personnel Management Federal Employees
Health Benefits Program

2000 Rate Information for
CIGNA HealthCare of Arizona Phoenix

Non Postal rates apply to most non Postal enrollees If you are in a special enrollment category
refer to the FEHB Guide for that category or contact the agency that maintains your health
benefits enrollment

Postal rates apply to most career U S Postal Service employees In 2000 two categories of
contribution rates referred to as Category A rates and Category B rates will apply for certain
career employees If you are a career postal employee but not a member of a special postal
employment class refer to the category definitions in The Guide to Federal Employees Health
Benefits Plans for United States Postal Service Employees RI 70 2 to determine which rate
applies to you

Postal rates do not apply to non career postal employees postal retirees certain special postal
employment classes or associate members of any postal employee organization Such persons
not subject to postal rates must refer to the applicable Guide to Federal Employees Health
Benefits Plans

Non Postal Premium Postal Premium A Postal Premium B
Biweekly Monthly Biweekly Biweekly
Type of Gov't Your Gov't Your USPS Your USPS Your
Enrollment Code Share Share Share Share Share Share Share Share

Phoenix Area
Self Only 161 75.98 25.32 164.61 54.87 89.90 11.40 89.90 11.40

Self and Family 162 175.97 62.05 381.27 134.44 207.74 30.28 201.02 37.00

24 24

Page Navigation Panel