SAMBA

You are here: FEHB Home > 2002 Plan Comparison > FFS Plan Profile: SAMBA

General Information

Plan Name:	SAMBA
Service Area:	Specific Groups
Brochure:	PDF Version
Brochure:	Text Version
NCQA Accreditation:	n/a
JCAHO Accreditation:	n/a
URAC Accreditation:	n/a
Plan Type:	FFS
Enrollment Code-Self:	441
Enrollment Code-Self & Family:	442
Link to Plan Home Page:	http://www.samba-insurance.com
Telephone:	800/638-6589
Summary results of the 2001 consumers assessment of health plans survey

Benefits

	PPO	Non PPO
Deductible Per Person Calendar Year	$300	$300
Deductible Per Person-Prescription Drug	None	None
Deductible Per Hospital Stay-Inpatient	$200	$300
Copay Coinsurance Doctors & Outpatient Tests	10%	30%
Copay Coinsurance Hospital Inpatient R & B	Nothing	30%
Copay Coinsurance Hospital Inpatient Other	10%	30%
Copay Coinsurance Hospital Outpatient	10%	30%
Copay Coinsurance Prescription Drugs Home Delivery Generic	$15	$15
Copay Coinsurance Prescription Drugs Home Delivery Brand Name	$25/$30	$25/$30
Copay Coinsurance Prescription Drugs Generic	$15	$15
Copay Coinsurance Prescription Drugs Brand Name	$25/$30	$25/$30
Copay Coinsurance Prescription Drugs Nonformulary	$25/$30	$25/$30

Rates

Non-Postal
Biweekly	Self: $66.97	Self: & Family: $164.76
Twice Biweekly	Self: $133.94	Self: & Family: $329.52
Monthly	Self: $145.10	Self: & Family: $356.98
_
Annuitants
Monthly	Self: $145.10	Self: & Family: $356.98
_
U.S. Postal Service Employees (Type A)
Biweekly	Self: $49.31	Self: & Family: $124.42
Monthly	Self: $106.84	Self: & Family: $269.58
_
U.S. Postal Service Employees (Type B)
Monthly	Self: $120.46	Self: & Family: $331.57
Biweekly	Self: $55.60	Self: & Family: $153.03
_
Worker's Compensation Recipients
Twice Biweekly	Self: $133.94	Self: & Family: $329.52
_
Certain Temporary Employees
Biweekly	Self: $164.83	Self: & Family: $388.17
Monthly	Self: $357.13	Self: & Family: $841.04
_
Former Spouse Enrollees
Monthly	Self: $357.13	Self: & Family: $841.04
Biweekly	Self: $164.83	Self: & Family: $388.17
_
Temporary Continuation of Coverage
Biweekly	Self: $168.13	Self: & Family: $395.93
Monthly	Self: $364.27	Self: & Family: $857.86
_
FDIC
Biweekly	Self: $49.31	Self: & Family: $124.42
_