This brochure describes the benefits of the Association Benefit Plan under the Government Employees Health Associa-tion's
contract (CS 1065) with the Office of Personnel Management (OPM), as authorized by the Federal Employees
Health Benefits law. The Plan is underwritten by Mutual of Omaha Insurance Company. This brochure is the official
statement of benefits. No oral statement can modify or otherwise affect the benefits, limitations, and exclusions of this
brochure.

If you are enrolled in this Plan, you are 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. You do not have a right to benefits that
were available before January 1, 2001, unless those benefits are also shown in this brochure.

OPM negotiates benefits and rates with each plan annually. Benefit changes are effective January 1, 2001, and are sum-marized
on page 72. Rates are shown at the end of this brochure.

Plain Language
The President and Vice President are making the Government's communication more responsive, accessible, and under-standable
to the public by requiring agencies to use plain language. In response, a team of health plan representatives
and OPM staff worked cooperatively to make this brochure clearer. Except for necessary technical terms, we use com-mon
words. "You" means the enrollee or family member; "we" means the Association Benefit Plan.

The plain language team reorganized the brochure and the way we describe our benefits. When you compare this Plan
with other FEHB plans, you will find that the brochures have the same format and similar information to make compari-sons
easier.

If you have comments or suggestions about how to improve this brochure, let us know. Visit OPM's "Rate Us" feedback
area at www. opm. gov/ insure or e-mail us at fehbwebcomments@ opm. gov or write to OPM at Insurance Planning and
Evaluation Division, PO Box 436, Washington, DC 20044-0436.

Introduction/ Plain Language 5
5 Page 6 7
2001 Association Benefit Plan 4 Section 1
Section 1. Facts about this fee-for-service plan
This Plan is a fee-for-service (FFS) plan. You can choose your own physicians, hospitals, and other health care provid-ers.

We reimburse you or your provider for your covered services, usually based on a percentage of the amount we allow.
The type and extent of covered services, and the amount we allow, may be different from other plans. Read brochures
carefully.

We also have Preferred Provider Organizations (PPO):
Our fee-for-service plan offers services through a PPO. When you reside in the PPO network area and use our PPO pro-viders,
you will receive covered services at reduced cost. If you reside in Washington, DC, or in one of the states listed
below, contact us at 1-800-634-0069 for information concerning your PPO. You can also go to the Mutual of Omaha
website, www. mutualofomaha. com, for PPO information. Do not call OPM for our provider directory. Also, when you
phone for an appointment, please verify that your physician is still a PPO provider.

PPO benefits apply only when you reside in the PPO network area and use a PPO provider. You must present your
PPO identification (ID) card confirming your PPO participation to be eligible for PPO benefits. Provider networks
may be more extensive in some areas than others. We cannot guarantee the availability of every specialty in all areas. If
no PPO provider is available, or you do not use a PPO provider, the standard non-PPO benefits apply. When you use a
PPO hospital, keep in mind that the professionals who provide services to you in the hospital, such as radiologists, emer-gency
room physicians, anesthesiologists, and pathologists, may not all be preferred providers. If they are not, they will
be paid as non-PPO providers.

The PPO Network Area consists of Washington, D. C. and selected counties and cities in the following states:
Alaska California Delaware
Florida Idaho Maryland
Pennsylvania Virginia Washington
If you reside in the PPO network area and no PPO provider is available, or if you do not use a PPO provider, non-PPO
benefits apply.

How we pay providers
Our participating providers are generally reimbursed according to an agreed-upon fee schedule and are not offered addi-tional
financial incentives based on care provided or not provided to you. Our standard provider agreements do not con-tain
any contractual provisions that include incentives to restrict a providers ability to communicate with and advise
patients of any appropriate treatment options. In addition, the Plan has no compensation, ownership, or other influential
interests that are likely to affect provider advice or treatment decisions.

Patients' Bill of Rights
OPM requires that all FEHB Plans comply with the Patients' Bill of Rights, recommended by the President's Advisory
Commission on Consumer Protection and Quality in the Health Care Industry. You may get information about us, our
networks, providers, and facilities. If you want more information about us, call 1-800-634-0069, or write to Association
Benefit Plan, PO Box 668587, Charlotte, NC 28266-8587. 6
6 Page 7 8
2001 Association Benefit Plan 5 Section 2
Section 2. How we change for 2001
Program-wide changes
° The plain language team reorganized the brochure and the way we describe our benefits. We hope this will make it
easier for you to compare plans.

° This year, the Federal Employees Health Benefits Program is implementing network mental health and substance
abuse parity. This means that your coverage for mental health, substance abuse, medical, surgical, and hospital ser-vices
from providers in our PPO network will be the same with regard to deductibles, coinsurance, copays, and day
and visit limitations when you follow a treatment plan that we approve. Previously, we placed shorter day or visit lim-itations
on mental health and substance abuse services than we did on services to treat physical illness, injury, or dis-ease.

° Many healthcare organizations have turned their attention this year to improving healthcare quality and patient safety.
OPM asked all FEHB plans to join them in this effort. You can find specific information on our patient safety activi-ties
by calling 1-800-634-0069. You can find out more about patient safety on the OPM website, www. opm. gov/
insure. To improve your health care, take these five steps:

° Speak up if you have questions or concerns.
° Keep a list of all the medicines you take.
° make sure you get the results of any tests or procedures.
° Talk with your doctor and health care team about your options if you need hospital care.
° Make sure you understand what will happen if you need surgery.
° We clarified the language to show that anyone who needs a mastectomy may choose to have the procedure performed
on an inpatient basis and remain in the hospital up to 48 hours after the procedure. Previously, the language refer-enced
only women.

° North Dakota is deleted from the list of states designated as medically underserved in 2001. See page 7 for informa-tion
on medically underserved areas.

Changes to this Plan
° You no longer have to meet your $250 calendar year PPO deductible for adult preventative care (routine physicals,
cancer screenings, etc.). When you reside in the PPO network area and use a PPO provider, you will simply pay your
copayment or coinsurance when receiving these services.

° We have added a three-tier formulary prescription drug plan. This means that you will have three levels of copay-ments
depending on which prescription drug you are prescribed or choose to receive. Tier one includes all generic
drugs. Tier two includes all brand name drugs that are on the Plan's formulary. Tier three includes all other brand
name drugs.

° Selected counties and cities in the states of Pennsylvania and Delaware have been added to our optional hospital and
physician Preferred Provider Organization (PPO) network area.

° Your share of the premium will increase by 9. 4% for Self Only or 6. 7% for Self and Family. 7
7 Page 8 9
2001 Association Benefit Plan 6 Section 3
Section 3. How you get care
Identification cards We will send you an identification (ID) card and a Prescription Drug Card when you enroll. You should carry both cards with you at all times. You
must show your ID card whenever you receive services from a medical or
dental provider, or your Prescription Drug Card to fill a prescription at a
participating Plan pharmacy. Until you receive your ID card, use your copy
of the Health Benefits Election Form, SF-2809, or your health benefits
enrollment confirmation (for annuitants).

If you do not receive your cards within 30 days after the effective date of
your enrollment, or if you need replacement cards, call us at 1-800-634-
0069.

Where you get covered care You can get care from any "covered provider" or "covered facility." How much we pay – and you pay – depends on the type of covered provider or
facility you use. If you reside in the PPO network area and use our pre-ferred
providers, you will pay less.

° Covered providers We consider the following to be covered providers when they perform ser-vices within the scope of their license or certification:

°° Physician: Doctors of medicine or psychiatry (M. D.), osteopathy
(D. O.), dental surgery (D. D. S.), medical dentistry (D. M. D.), podiatric
medicine (D. P. M.), and optometry (O. D.) when acting within the scope
of their licenses or certification.

°° Qualified Clinical Psychologist: An individual who has earned either a
Doctoral or Masters Clinical Degree in psychology or an allied disci-pline
and who is licensed or certified in the state where services are per-formed.
This presumes a licensed individual has demonstrated to the
satisfaction of state licensing officials that he/ she, by virtue of academic
and clinical experience, is qualified to provide psychological services in
that state.

°° Nurse Midwife: A person who is certified by the American College of
Nurse Midwives or is licensed or certified as a nurse midwife in states
requiring licensure or certification.

°° Nurse Practitioner/ Clinical Specialist: A person who 1) has an active
R. N. license in the United States, 2) has a baccalaureate or higher degree
in nursing, and 3) is licensed or certified as a nurse practitioner or clini-cal
nurse specialist in states requiring licensure or certification.

°° Clinical Social Worker: A social worker who 1) has a Master's or Doc-toral
degree in social work, 2) has at least two years of clinical social
work practice, and 3) in states requiring licensure, certification or regis-tration,
is licensed, certified, or registered as a social worker where the
services are rendered.

°° Physician Assistant: A person who is licensed, registered, or certified
in the state where services are performed.

°° Licensed Professional Counselor or Master's Level Counselor: A
person who is licensed, registered, or certified in the state where ser-vices
are performed 8
8 Page 9 10
2001 Association Benefit Plan 7 Section 3
°° Nursing School Administered Clinic: A clinic that is
1) licensed or certified in the state where the services are performed,
and

2) provides ambulatory care in an outpatient setting— primarily in
rural or inner city areas where there is a shortage of physicians.
Services billed for by these clinics are considered outpatient
'office' services rather than facility charges

°° Christian Science Practitioner: If you choose to visit a Christian Sci-ence
practitioner instead of a physician, the charges are still considered
allowable expenses. To qualify for benefits, you must make this choice
annually. The benefits will then apply to all subsequent expenses
incurred during the year. You can change your mind only at the time of
your first claim each year. The practitioner you choose must be listed as
such in the Christian Science Journal that is current at the time the ser-vice
is provided. Your choice will not apply to, or prevent payment of, a
physician's maternity charges.

Medically underserved areas. In medically underserved areas, we cover
any licensed medical practitioner for any covered service performed within
the scope of that license in states OPM determines are "medically under-served."
For 2001, the states are: Alabama, Idaho, Kentucky, Louisiana,
Mississippi, Missouri, New Mexico, South Carolina, South Dakota, Utah,
and Wyoming.

° Covered facilities Covered facilities include:
°° Hospital

1) An institution that is accredited as a hospital under the hospital
accreditation program of the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO); or

2) Any other institution that is operated pursuant to law, under the
supervision of a staff of doctors and with 24-hours-a-day nursing
service, and that is primarily engaged in providing:

a) General patient care and treatment of sick and injured persons
through medical, diagnostic and major surgical facilities, all of
which facilities must be provided on its premises or under its
control; or

b) specialized inpatient medical care and treatment of sick or
injured persons through medical and diagnostic facilities
(including X-ray and laboratory) on its premises, under its
control, or through a written agreement with a hospital (as
defined above) or with a specialized provider of those
facilities.

In no event shall the term hospital include a convalescent nursing home or
institution or part thereof that:

1) is used principally as a convalescent facility, rest facility, nursing
facility or facility for the aged;

2) furnishes primarily domiciliary or custodial care including
training in the routines of daily living; or

3) is operated as a school. 9
9 Page 10 11
2001 Association Benefit Plan 8 Section 3
For inpatient and outpatient treatment of alcohol and drug abuse, the term
hospital also includes a free-standing alcohol and drug abuse treatment
facility approved by the JCAHO.

°° Skilled nursing facility: An institution, or that part of an institution that
provides convalescent skilled nursing care 24 hours a day and is
classified as a skilled nursing facility under Medicare.

°° Birthing Center: A licensed facility that is equipped and operated
solely to provide prenatal care, to perform uncomplicated spontaneous
deliveries and to provide immediate post-partum care.

°° Hospice: A facility that meets all of the following:
1) primarily provides inpatient hospice care to terminally ill persons;
2) is certified by Medicare as such, or is licensed or accredited as
such by the jurisdiction it is in;

3) is supervised by a staff of M. D. s or D. O. s, at least one of whom
must be on call at all times; and

4) provides 24-hour-a-day nursing services under the direction of an
R. N. and has a full-time administrator; and

5) provides an ongoing quality assurance program.

What you must do to
get covered care
It depends on the kind of care you want to receive. You can go to any
physician you want, but we must approve some care in advance.

Transitional care: Specialty care: If you have a chronic or disabling condition and lose access to your specialist because we:

° terminate our contract with your specialist for other than cause; or
° drop out of the Federal Employees Health Benefits (FEHB) Program
and you enroll in another FEHB Plan,

you may be able to continue seeing your specialist for up to 90 days after
you receive notice of the change. Contact us or, if we drop out of the
Program, contact your new plan.

If you are in the second or third trimester of pregnancy and you lose access
to your specialist based on the above circumstances, you can continue to
see your specialist until the end of your postpartum care, even if it is
beyond the 90 days.

Hospital care. We pay for covered services from the effective date of your
enrollment. However, if you are in the hospital when your enrollment in
our Plan begins, call our customer service department immediately at
1-800-634-0069.

If you changed from another FEHB plan 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 92 nd day after you become a member of this Plan, whichever
happens first. 10
10 Page 11 12
2001 Association Benefit Plan 9 Section 3
These provisions apply only to the benefits of the hospitalized person.
How to Get Approval for…
° Your hospital stay ° Precertification is the process by which— prior to your inpatient hospi-tal admission— we evaluate the medical necessity of your proposed stay

and the number of days required to treat your condition. Unless we are
misled by the information given to us, we won't change our decision on
medical necessity.

° In most cases, you physician or hospital will take care of precertifica-tion.
Because you are still responsible for ensuring that we are asked to
precertify your care, you should always ask your physician or hospital
whether they have contacted us.

Warning: We will reduce our benefits for the inpatient hospital stay by $500 if no one contacts us for precertification. If the stay is not medically necessary, we
may not pay any benefits.
How to precertify an
admission: ° You, your representative, your physician, or your hospital must call us at

1-800-634-0069 before admission.

° If you have an emergency admission due to a condition that you
reasonably believe puts your life in danger or could cause serious
damage to bodily function, you, your representative, the physician, or
the hospital must telephone us within two business days following the
day of the emergency admission, even if you have been discharged from
the hospital.

° Provide the following information:
°° Enrollee's name and Plan identification number;
°° Patient's name, birth date, and phone number;
°° Reason for hospitalization, proposed treatment, or surgery;
°° Name and phone number of admitting physician;
°° Name of hospital or facility; and
°° Number of planned days of confinement.
°° We will then tell the physician and/ or hospital the number of approved
inpatient days and we will send written confirmation of our decision to
you, your physician, and the hospital.

Maternity care You do not need to precertify a maternity admission for a routine delivery.
However, if your medical condition requires you to stay more than 48
hours after a vaginal delivery or 96 hours after a cesarean section, then
your physician or the hospital must contact us for precertification of
additional days. Further, if your baby stays after you are discharged, then
your physician or the hospital must contact us for precertification of
additional days for your baby. 11
11 Page 12 13
2001 Association Benefit Plan 10 Section 3
If your hospital stay needs to
be extended:
If your hospital stay— including for maternity care— needs to be extended,
your physician or the hospital must ask us to approve the additional days.

What happens when you
do not follow the
precertification rules

° When we precertified the admission but you remained in the hospital
beyond the number of days we approved and did not get the additional
days precertified, then:

°° for the part of the admission that was medically necessary, we will
pay inpatient benefits, but

°° for the part of the admission that was not medically necessary, we
will pay only medical services and supplies otherwise payable on an
outpatient basis and will not pay inpatient benefits.

° If no one contacted us, we will decide whether the hospital stay was
medically necessary.

°° If we determine that the stay was medically necessary, we will pay
the inpatient charges, less the $500 penalty.

°° If we determine that it was not medically necessary for you to be an
inpatient, we will not pay inpatient hospital benefits. We will only
pay for any covered medical supplies and services that are otherwise
payable on an outpatient basis.

° If no one contacted us for specified services such as Hospice Care,
Skilled Nursing Facility Care, Home Health Care, we will disqualify
higher paid benefits.

°° If we denied the precertification request, we will not pay inpatient
hospital benefits. We will only pay for any covered medical supplies
and services that are otherwise payable on an outpatient basis.

Exceptions: You do not need precertification in these cases:
° You are admitted to a hospital outside the United States.

° You have another group health insurance policy that is the primary
payer for the hospital stay.

° Your Medicare Part A is the primary payer for the hospital stay. Note: If
you exhaust your Medicare hospital benefits and do not want to use your
Medicare lifetime reserve days, then we will become the primary payer
and you do need precertification.

° Other services Some other services require precertification, or prior authorization, such as:

° Home health care
° Hospice care
° Organ/ tissue transplants
° Skilled nursing facilities
° Psychiatric and substance abuse treatment 12
12 Page 13 14
2001 Association Benefit Plan 11 Section 3
° Growth hormone therapy
° Durable medical equipment rental in excess of 30 days
° Surgery for morbid obesity 13
13 Page 14 15
2001 Association Benefit Plan 12 Section 4
Section 4. Your costs for covered services
This is what you will pay out-of-pocket for your covered care:
° Copayments A copayment is a fixed amount of money you pay to the provider when you receive services.

Example: When you see your PPO physician you pay a copayment of $10
per visit.

° Deductible A deductible is a fixed amount of covered expenses you must incur for cer-tain covered services and supplies before we start paying benefits for them.

Copayments do not count toward any deductible.
°° The calendar year deductible is $250 per person. Under a family enroll-ment,
the deductible is satisfied for all family members when the com-bined
covered expenses applied to the calendar year deductible for
family members reach $500.

Note: If you change plans during open season, you do not have to start a
new deductible under your old plan between January 1 and the effective
date of your new plan. If you change plans at another time during the year,
you must begin a new deductible under your new plan.

And, if you change your enrollment option in this Plan during the year, we
will credit the amount of covered expenses already applied toward the
deductible of your old option to the deductible of your new option.

° Coinsurance Coinsurance is the percentage of our allowance that you must pay for your care. Coinsurance doesn't begin until you meet your deductible.

Example: You pay 10% of our allowance for an X-ray.
Note: If your provider routinely waives (does not require you to pay) your
copayments, deductibles, or coinsurance, the provider is misstating the fee
and may be violating the law. In this case, when we calculate our share, we
will reduce the provider's fee by the amount waived.

For example, if your physician ordinarily charges $100 for a service but
routinely waives your 10% coinsurance, the actual charge is $90. We will
pay $81 (90% of the actual charge of $90).

° Differences between our
allowance and the bill
Our "Plan allowance" is the amount we use to calculate our payment for covered services. Fee-for-service plans arrive at their allowances in

different ways, so their allowances vary. For more information about how
we determine our Plan allowance, see the definition of Plan allowance in
Section 10.

Often, the provider's bill is more than a fee-for-service plan's allowance.
Whether or not you have to pay the difference between our allowance and
the bill will depend on the provider you use.

° PPO providers agree to limit what they will bill you. Because of that,
when you use a preferred provider, your share of covered charges
consists only of your deductible and coinsurance. Here is an example:
You see a PPO physician who charges $150, but our allowance is $100.
If you have met your deductible, you are only responsible for your
coinsurance. That is, you pay just— 10% of our $100 allowance ($ 10).
Because of the agreement, your PPO physician will not bill you for the
$50 difference between our allowance and his bill. 14
14 Page 15 16
2001 Association Benefit Plan 13 Section 4
° Non-PPO providers, on the other hand, have no agreement to limit
what they will bill you. For instance,

°° When reside in the PPO network area and use a non-PPO
provider, you will pay your deductible and coinsurance— plus any
difference between our allowance and charges on the bill. Here is an
example: You see a non-PPO physician who charges $150 and our
allowance is again $100. Because you've met your deductible, you
are responsible for your coinsurance, so you pay 25% of our $100
allowance ($ 25). Plus, because there is no agreement between the
non-PPO physician and us, he can bill you for the $50 difference
between our allowance and his bill.

°° When you reside outside the PPO network area, you will pay your
deductible and coinsurance – plus any difference between our
allowance and charges on the bill. As in the exampleabove, once you
have met your deductible, you are responsible for your coinsurance.
You will pay 15% of our allowance ($ 15) and the physician can bill
you for the $50 difference between our allowance and his bill.

The following table illustrates the examples of how much you have to pay
out-of-pocket for services from a PPO physician vs. a non-PPO physician
when you reside in the PPO network area. The table uses our example of a
service for which the physician charges $150 and our allowance is $100.
The table shows the amount you pay if you have met your calendar year
deductible.

Your out-of-pocket maximum
for deductibles, coinsurance,
and copayments

If your out-of-pocket coinsurance expenses exceed your catastrophic limit
in a calendar year, we will pay 100% of the Plan allowance for the
remainder of the year. The calendar year limits are:

° PPO providers: $2, 000

° Non-PPO providers: $3, 000
° Out-of-network providers: $2, 000
Out-of-pocket expenses are:
° Your $250/$ 500 calendar year deductible;

EXAMPLE PPO physician Non-PPO physician
Physician's charge $150 $150
Our allowance We set it at: 100 We set it at: 100
We pay 90% of our allowance: 90 75% of our allowance: 75
You owe:
Coinsurance
10% of our allowance: 10 25% of our allowance: 25

+Difference up to charge?
No: 0 Yes: 50

TOTAL YOU PAY $10 $75 15
15 Page 16 17
2001 Association Benefit Plan 14 Section 4
° The percentage you pay for covered services after you have met your
deductible;

° The percentage you pay for surgery, anesthesia and extended medical
care after an accidental injury; and

° Your $100 copayment for hospital admissions..
The following cannot be included in your out-of-pocket expenses:
° Expenses in excess of the Plan allowance or maximum benefit
limitations;

° Non-covered services and supplies;
° Prescription drug copayments;
° PPO copayments;
° Expenses for dental care including the 20% you pay for extended dental
care after an accidental injury; or

° Any amounts you pay if benefits have been reduced because of
noncompliance with our cost containment requirements.

When government facilities
bill us
Facilities of the Department of Veterans Affairs, the Department of
Defense, and the Indian Health Service are entitled to seek reimbursement
from us for certain services and supplies they provide to you or a family
member. They may not seek more than their governing laws allow.

If we overpay you We will make diligent efforts to recover benefit payments we made in error but in good faith. If your claim has been paid in error for any reason, we
shall make a diligent effort to recover an overpayment to you from you or,
if to the provider, from the provider. We may reduce subsequent benefit
payments to the member or to a provider on behalf of the member to offset
overpayments.

When you are age 65 or over and you do not have Medicare

Under the FEHB law, we must limit our payments for those benefits you would be entitled to if you had Medicare. And,
your physician and hospital must follow Medicare rules and cannot bill you for more than they could bill you if you had
Medicare. The following chart has more information about the limits.

If you…
° are age 65 or over, and
° do not have Medicare Part A, Part B, or both; and
° have this Plan as an annuitant or as a former spouse, or as a family member of an annuitant or former
spouse; and

° are not employed in a position that gives FEHB coverage. (Your employing office can tell you if this
applies.) 16
16 Page 17 18
2001 Association Benefit Plan 15 Section 4
When you the have the Original
Medicare Plan
We limit our payment to an amount that supplements the benefits that
Medicare would pay under Part A (Hospital insurance) and Part B (Medi-cal
insurance), regardless of whether Medicare pays. Note: We pay our
regular benefits for emergency services to an institutional provider, such as
a hospital, that does not participate with Medicare and is not reimbursed by
Medicare.

If you are covered by Medicare Part B and it is primary, your out-of-pocket
costs for services both Medicare Part B and we cover depend on whether
your physician accepts Medicare assignment for the claim.

° If your physician accepts Medicare assignment, then you pay nothing
for covered charges.

° If your physician does not accept Medicare assignment, then you pay
the difference between our payment combined with Medicare's pay-ment
and the charge.

Then, for your inpatient hospital care,
° The law requires us to base our payment on an amount— the "equivalent Medicare amount"— set by
Medicare's rules for what Medicare would pay, not on the actual charge;

° You are responsible for your applicable deductibles, coinsurance, or copayments you owe under this
Plan;

° You are not responsible for any charges greater than the equivalent Medicare amount; we will show that
amount on the explanation of benefits; and

° The law prohibits a hospital from collecting more than the Medicare equivalent amount.
And, for your physician care, the law requires us to base our payment and your coinsurance on…

° an amount— set by Medicare and called the "Medicare approved amount," or
° the actual charge if it is lower than the Medicare approved amount.
If your physician… Then you are responsible for…
Participates with Medicare or accepts
Medicare assignment for the claim and
is a member of our PPO network,

your deductibles, coinsurance, copayments; and
any balance up to the Medicare approved
amount;

Participates with Medicare and is not in
our PPO network,
your deductibles, coinsurance, copayments, and
any balance up to the Medicare approved
amount;

Does not participate with Medicare, your deductibles, coinsurance, copayments, and
any balance up to 115% of the Medicare
approved amount

It is generally to your financial advantage to use a physician who participates with Medicare. Such physicians are only
permitted to collect up to the Medicare approved amount.

Our explanation of benefits (EOB) form will tell you how much the physician or hospital can collect from you. If your
physician or hospital tries to collect more than allowed by law, ask the physician or hospital to reduce the charges. If
you have paid more than allowed, ask for a refund. If you need further assistance, call us. 17
17 Page 18 19
2001 Association Benefit Plan 16 Section 4
Note: The physician who does not accept Medicare assignment may not
bill you for more than 115% of the amount Medicare bases its payment on,
called the "limiting charge." The Medicare Summary Notice (MSN) form
that Medicare will send you will have more information about the limiting
charge. If your physician tries to collect more than allowed by law, ask
them to reduce their charges. If they do not, report them to your Medicare
carrier who sent you the MSN form. Call us if you need further assistance.

When you have a Medicare
Private Contract
A physician may ask you to sign a private contract agreeing that you can be
billed directly for service ordinarily covered by Medicare. Should you sign
an agreement, Medicare will not pay any portion of the charges, and we
will not increase our payment. We will still limit our payment to the
amount we would have paid after Medicare's payment.

Please see Section 9, Coordinating benefits with other coverage, for more
information about how we coordinate benefits with Medicare. 18
18 Page 19 20
2001 Association Benefit Plan 17 Section 5
Section 5. Benefits – OVERVIEW (See page 5 for how our benefits changed this year and page 72 for a benefits summary.)
NOTE: This benefits section is divided into subsections. Please read the important things you should keep in mind at the
beginning of each subsection. Also read the General Exclusions in Section 6; they apply to the benefits in the following
subsections. To obtain claims forms, claims filing advice, or more information about our benefits, contact us at
1-800-634-0069.

(a) Medical services and supplies provided by physicians and other health care professionals .................................. 18-29

(b) Surgical and anesthesia services provided by physicians and other health care professionals............................... 30-34
(c) Services provided by a hospital or other facility, and ambulance services ............................................................. 35-38

(d) Emergency services/ Accidents................................................................................................................................ 39-40
(e) Mental health and substance abuse benefits............................................................................................................ 41-45
(f) Prescription drug benefits........................................................................................................................................ 46-48
(g) Special features ....................................................................................................................................................... 49

(h) Dental benefits......................................................................................................................................................... 50-51
(i) Non-FEHB benefits available to Plan members ..................................................................................................... 52
SUMMARY OF BENEFITS.......................................................................................................................................... 72

° Diagnostic and treatment services
° Lab, X-ray, and other diagnostic tests
° Preventive care, adult
° Preventive care, children
° Maternity care
° Family planning
° Infertility services
° Allergy care
° Treatment therapies
° Rehabilitative therapies
° Hearing services (testing, treatment, and
supplies)

° Vision services (testing, treatment, and
supplies)

° Foot care
° Orthopedic and prosthetic devices
° Durable medical equipment (DME)
° Home health services
° Alternative treatments
° Educational classes and programs

° Surgical procedures
° Reconstructive surgery
° Oral and maxillofacial surgery

° Organ/ tissue transplants
° Anesthesia

° Inpatient hospital
° Outpatient hospital or ambulatory surgical
center

° Skilled nursing care facility benefit

° Hospice care
° Ambulance

° Medical emergency
° Accidental injury
° Ambulance

° Flexible benefits option
° High risk pregnancies
° Services Overseas

° 24-hour nurse line
° Centers of excellence 19
19 Page 20 21
2001 Association Benefit Plan 18 Section 5 (a)
Section 5 (a). Medical services and supplies provided by physicians and other health care professionals
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Here are some important things you should keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure and are payable only when we determine they are medically
necessary.

° The calendar year deductible is: $250 per person ($ 500 per family). The calendar year
deductible applies to almost all benefits in this Section. We added "( No deductible)" to
show when the calendar year deductible does not apply.

° Be sure to read Section 4, Your costs for covered services, for valuable information
about how cost sharing works, with special sections for members who are age 65 or
over. Also read Section 9 about coordinating benefits with other coverage, including
with Medicare.

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Benefit Description You p a y After the calendar year deductible…
NOTE: The calendar year deductible applies to almost all benefits in this Section. We say "No deductible" when it
does not apply.

Diagnostic and treatment services
Professional services of physicians
° In physician's office
PPO: $10 copayment (No deductible)
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount.

Professional services of physicians

° In a hospital or urgent care center
° In a skilled nursing facility
° Second surgical opinion
° At home

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount. 20
20 Page 21 22
2001 Association Benefit Plan 19 Section 5 (a)
Lab, X-ray and other diagnostic tests You p a y
Tests, such as:
° Blood tests
° Urinalysis
° Non-routine pap tests
° Pathology
° X-rays
° Non-routine Mammograms
° CAT Scans/ MRI
° Ultrasound
° Electrocardiogram and EEG
° Sonograms

PPO: Services in physician's office—$ 10
copayment (No deductible)

PPO: Services outside physician's office—
10% of the Plan allowance

Note: If your PPO provider uses a non-PPO
lab or radiologist, we will pay non-PPO bene-fits
for any lab and X-ray charges.

Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount.

Not covered:
Preventative medical care and services (including periodic checkups
and immunizations such as polio, flu, mumps, and smallpox shots),
except as provided under Preventative care, adult and children, page
20

All charges

Preventive care, adult
One annual routine physical examination per person to include a his-tory
and physical, chest X-ray, urinalysis, blood tests, and EKG (elec-trocardiogram).

One annual cervical cancer screening (pap smear) for women age 18
and older.

One annual Prostate Specific Antigen test (PSA— prostate cancer
screening) for men age 40 and older.

One annual fecal occult blood test (colorectal cancer screening) for
members age 40 and older.

A sigmoidoscopy once every five years starting at age 50.
Routine mammogram (breast cancer screening) for women age 35 and
older as follows:

° From age 35-39, one baseline mammogram during this five-year
period

° From 40-45, one mammogram screening every other calendar year
° Starting at age 46, one mammogram every calendar year
NOTE: Your physician's bill must clearly state "Routine Physical
Exam". If a medical diagnosis is provided on the bill, those services
will be paid under the medical benefit.

PPO: Services in physician's office—$ 10
copayment (No deductible)

PPO: Services outside physician's office—
10% of the Plan allowance (No deductible)

Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-Network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount. (No deductible) 21
21 Page 22 23
2001 Association Benefit Plan 20 Section 5 (a)
Preventative care, adult -Continued You P a y
Routine Immunizations, limited to:
° Tetanus-diphtheria (Td) booster – once every 10 years, ages 19 and
over (except as provided for under Childhood immunizations)

° Pneumococcal vaccine, annually, age 65 and over
° Influenza vaccine, annually

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount

Preventive care, children
° Childhood immunizations recommended by the American
Academy of Pediatrics (to age 22)
PPO: Nothing (No deductible)

Non-PPO: Only the difference between the
Plan allowance and the billed amount (No
deductible)

Out-of-network: Only the difference between
the Plan allowance and the billed amount (No
deductible)

° For well-child care charges for routine examinations and care (to
age 2)
PPO: 10% of the Plan allowance.

Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount.

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount

Maternity care
Complete maternity (obstetrical) care such as:
° Prenatal care
° Amniocentesis
° Inpatient delivery
° Initial, routine examination of your newborn infant covered under
your family enrollment

° Circumcision of your newborn infant
° Postnatal care
Note: Here are some things to keep in mind
° You do not have to precertify your normal delivery; see page 9 for
other circumstances, such as extended stays for you or your baby.

° You may remain in the hospital up to 48 hours after a regular
delivery and 96 hours after a cesarean delivery. We will cover an
extended stay, if medically necessary, but you must precertify.

PPO: 10% of the Plan allowance (No
deductible)

Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount (No deductible)

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount (No deductible) 22
22 Page 23 24
2001 Association Benefit Plan 21 Section 5 (a)
Maternity care-Continued You P a y
° We cover routine nursery care of the newborn child during the
covered portion of the mother's maternity stay. We will cover other
care of an infant who requires non-routine treatment if we cover
the infant under a Self and Family enrollment.

° We pay hospitalization and surgeon services (delivery) the same as
for illness and injury. See Hospital benefits (Section 5( c)) and
Surgery benefits (Section 5( b)).

° Bassinet or nursery charges on which you and your baby are
confined are considered your maternity expenses, not your baby's.

° Sonograms and other related tests that are not included in your
routine prenatal or postnatal care are covered in Lab, X-ray, and
other diagnostic tests, page 19.

If your child stays in the hospital after your
discharge and is covered under a Self and
Family enrollment, you must pay a separate
hospital copayment:

PPO: Nothing
Non-PPO: $100 per admission and 25% of the
covered charges

Out-of-network: $100 per admission
Outpatient maternity (obstetrical care) for covered hospital and
physician services at the time of delivery, including the initial, routine
examination of your newborn infant covered under your family
enrollment, when:

° Delivery is on an outpatient basis;
° Delivery is at a licensed birthing center; or
° Inpatient delivery results in a hospital confinement of one day
(overnight) or less and no more than one day's room and board
charge applies

PPO: Nothing
Non-PPO: Only the difference between the
Plan allowance and the billed amount

Out-of-network: Only the difference between
the Plan allowance and the billed amount

Note: If you or your newborn child is transferred from a birthing
center to a hospital due to medical complications, the birth center
expenses will be paid as inpatient care.

If you and your child leave the hospital against medical advice, this
outpatient benefit is not payable.

Not covered:

Routine sonograms to determine fetal age, size or sex; or 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 or rape or incest

All charges 23
23 Page 24 25
2001 Association Benefit Plan 22 Section 5 (a)
Family planning You Pay
° Voluntary sterilization
° Surgically implanted contraceptives
° Intrauterine devices (IUDs)

PPO: 10% of the Plan allowance (No
deductible)

Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount (No deductible)

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount (No deductible)

° Injection of contraceptive drugs

Note: We cover contraceptive drugs in Section 5( f), Prescrip-tion
drug benefits.

PPO: $10 copay (no deductible)
Non-PPO: 25% of the Plan allowance and the
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and the difference between our allowance and
the billed amount

Not covered: reversal of voluntary surgical sterilization,
genetic counseling,
All charges.

Infertility services
Diagnosis and treatment of infertility up to $5, 000 per person per life-
time, except as excluded below.
PPO: Charges in excess of the maximum
$5, 000 benefit

Non-PPO: Charges in excess of the maximum
$5, 000 benefit and the difference between the
Plan allowance and the billed amount

Out-of-network: Charges in excess of the max-imum
$5, 000 benefit and the difference
between the Plan allowance and the billed
amount 24
24 Page 25 26
2001 Association Benefit Plan 23 Section 5 (a)
Infertility services-Continued You P a y
Not covered:
° Fertility drugs
° Assisted reproductive technology (ART) procedures, such as:
°° artificial insemination
°° in vitro fertilization
°° embryo transfer and GIFT
°° intravaginal insemination (IVI)
°° intracervical insemination (ICI)
°° intrauterine insemination (IUI)
° Services and supplies related to ART procedures.

All charges

Allergy care
Allergy testing, injections and treatment

Note: We cover allergy serum in Section 5( f), Prescription drug
benefits

PPO: $10 copayment (No deductible)
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Not covered: Provocative food testing, end point titration techniques,
hair analysis, and sublingual allergy desensitization
All charges 25
25 Page 26 27
2001 Association Benefit Plan 24 Section 5 (a)
Treatment therapies You P a y
° Chemotherapy and radiation therapy

Note: High dose chemotherapy in association with autologous bone
marrow transplants is limited to those transplants listed in Section 5( b),
Organ/ tissue transplants.

Note: We cover chemotherapy drugs in Section 5( f).
° Dialysis – Hemodialysis and peritoneal dialysis

° Intravenous (IV)/ Infusion Therapy – Home IV and antibiotic
therapy

° Respiratory and inhalation therapies
° Growth hormone therapy (GHT)
Note: – We only cover GHT when we preauthorize the treatment. Call
1-800-634-0069 for preauthorization. We will ask you to submit infor-mation
that establishes that the GHT is medically necessary. Ask us to
authorize GHT before you begin treatment; otherwise, we will only
cover GHT services from the date you submit the information. If you
do not ask or if we determine GHT is not medically necessary, we will
not cover the GHT or related services and supplies. See Services
requiring our prior approval in Section 3.

PPO: $10 copayment (No deductible)
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Rehabilitative therapies
Physical therapy, occupational therapy, and speech therapy –
° Visits for the services of each of the following:

°° qualified physical therapists;
°° speech therapists; and
°° occupational therapists
Note: We only cover therapy to restore bodily function or
speech when there has been a total or partial loss of bodily
function or functional speech due to illness or injury and when a
physician:

1) orders the care;
2) identifies