Document Outline

• Introduction
• Plain Language
• Stop Health Care Fraud!
• Section 1. Facts about this HMO plan
  • How we pay providers
  • Who provides my health care?
  • Your Rights
  • Service Area
• Section 2. How we change for 2003
  • Program-wide changes
  • Changes to this Plan
• Section 3. How you get care
  • Identification cards
  • Where you get covered care
    • Plan providers
    • Plan facilities
  • What you must do to get covered care
    • Primary care
    • Specialty care
    • Hospital care
  • Circumstances beyond our control
  • Services requiring our prior approval
• Section 4. Your costs for covered services
  • Copayments
  • Coinsurance
  • Your catastrophic protection out-of-pocket for copayments and coinsurance
• Section 5. Benefits OVERVIEW
  • (a). Medical services and supplies provided by physicians and other health care professionals
  • (b). Surgical and anesthesia services provided by physicians and other health care professionals
  • (c). Services provided by a hospital or other facility, and ambulance services
  • (d). Emergency services/accidents
  • (e). Mental health and substance abuse benefits
  • (f). Prescription drug benefits
  • (g). Special features
    • Flexible benefits option
    • Services for deaf and hearing impaired
    • High risk pregnancies
    • Centers of excellence
    • 24 hour nurse line
  • (h). Dental benefits
  • (i). Non-FEHB benefits available to Plan members
• Section 6. General exclusions things we don't cover
• Section 7. Filing a claim for covered services
• Section 8. The disputed claims process
• Section 9. Coordinating benefits with other coverage
  • When you have other health coverage
    • What is Medicare?
    • Medicare managed care plan
    • TRICARE and CHAMPVA
    • Workers Compensation
    • Medicaid
    • When other Government agencies are responsible for your care
    • When others are responsible for injuries
• Section 10. Definitions of terms we use in this brochure
• Section 11. FEHB facts
  • No pre-existing condition limitation
  • Where you can get information about enrolling in the FEHB Program
  • Types of coverage available for you and your family
  • Children's Equity Act
  • When benefits and premiums start
  • When you retire
  • When you lose benefits
    • When FEHB coverage ends
    • Spouse equity coverage
    • Temporary Continuation of Coverage (TCC)
    • Converting to individual coverage
  • Getting a Certificate of Group Health Plan Coverage
• Long Term Care Insurance Is Still Available!
• Index
• Summary of benefits Care
• Rate Information

Pages 1--60

Dear Federal Employees Health Benefits Program Participant: I am pleased to present this Federal Employees Health Benefits (FEHB) Program plan brochure for 2003. The brochure explains all the benefits this health plan offers to its enrollees. Since benefits can vary from year to year, you should review your plan's brochure every Open Season. Fundamentally, I believe that FEHB participants are wise enough to determine the care options best suited for themselves and their families. In keeping with the President's health care agenda, we remain committed to providing FEHB members with affordable, quality health care choices. Our strategy to maintain quality and cost this year rested on four initiatives. First, I met with FEHB carriers and challenged them to contain costs, maintain quality, and keep the FEHB Program a model of consumer choice and on the cutting edge of employer-provided health benefits. I asked the plans for their best ideas to help hold down premiums and promote quality. And, I encouraged them to explore all reasonable options to constrain premium increases while maintaining a benefits program that is highly valued by our employees and retirees, as well as attractive to prospective Federal employees. Second, I met with our own FEHB negotiating team here at OPM and I challenged them to conduct tough negotiations on your behalf. Third, OPM initiated a comprehensive outside audit to review the potential costs of federal and state mandates over the past decade, so that this agency is better prepared to tell you, the Congress and others the true cost of mandated services. Fourth, we have maintained a respectful and full engagement with the OPM Inspector General (IG) and have supported all of his efforts to investigate fraud and waste within the FEHB and other programs. Positive relations with the IG are essential and I am proud of our strong relationship. The FEHB Program is market-driven. The health care marketplace has experienced significant increases in health care cost trends in recent years. Despite its size, the FEHB Program is not immune to such market forces. We have worked with this plan and all the other plans in the Program to provide health plan choices that maintain competitive benefit packages and yet keep health care affordable. Now, it is your turn. We believe if you review this health plan brochure and the FEHB Guide you will have what you need to make an informed decision on health care for you and your family. We suggest you also visit our web site at www.opm.gov/insure.
		Sincerely,    Kay Coles James    Director

For changes in benefits
see page 8.

Enrollment codes for this Plan:
D21 Self Only D22 Self and Family

2003

RI 73-434
Serving: The Louisville metropolitan area
Enrollment in this Plan is limited. You must live or work in our Geographic service area to enroll. See page 7 for requirements. 1.
1 Page 2 3
UNITED STATES
OFFICE OF PERSONNEL MANAGEMENT
WASHINGTON, DC 20415-0001

OFFICE OF THE DIRECTOR

Dear Federal Employees Health Benefits Program Participant:
I am pleased to present this Federal Employees Health Benefits (FEHB) Program plan brochure for 2003. The brochure explains all the benefits this health plan offers to its enrollees. Since benefits
can vary from year to year, you should review your plan's brochure every Open Season. Fundamentally, I believe that FEHB participants are wise enough to determine the care options best
suited for themselves and their families.
In keeping with the President's health care agenda, we remain committed to providing FEHB members with affordable, quality health care choices. Our strategy to maintain quality and cost this
year rested on four initiatives. First, I met with FEHB carriers and challenged them to contain costs, maintain quality, and keep the FEHB Program a model of consumer choice and on the cutting edge
of employer-provided health benefits. I asked the plans for their best ideas to help hold down premiums and promote quality. And, I encouraged them to explore all reasonable options to
constrain premium increases while maintaining a benefits program that is highly valued by our employees and retirees, as well as attractive to prospective Federal employees. Second, I met with
our own FEHB negotiating team here at OPM and I challenged them to conduct tough negotiations on your behalf. Third, OPM initiated a comprehensive outside audit to review the potential costs of
federal and state mandates over the past decade, so that this agency is better prepared to tell you, the Congress and others the true cost of mandated services. Fourth, we have maintained a respectful and
full engagement with the OPM Inspector General (IG) and have supported all of his efforts to investigate fraud and waste within the FEHB and other programs. Positive relations with the IG are
essential and I am proud of our strong relationship.
The FEHB Program is market-driven. The health care marketplace has experienced significant increases in health care cost trends in recent years. Despite its size; the FEHB Program is not
immune to such market forces. We have worked with this plan and all the other plans in the Program to provide health plan choices that maintain competitive benefit packages and yet keep health care
affordable.
Now, it is your turn. We believe if you review this health plan brochure and the FEHB Guide you will have what you need to make an informed decision on health care for you and your family.
We suggest you also visit our web site at www. opm. gov/ insure.
Sincerely,

Kay Cole James Director
CON 131-64-4 September 1993 2.
2 Page 3 4
Notice of the Office of Personnel Management's
Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
REVIEW IT CAREFULLY.
By law, the Office of Personnel Management (OPM), which administers the Federal Employees Health Benefits (FEHB) Program, is required to protect the privacy of your personal medical information. OPM is also required to
give you this notice to tell you how OPM may use and give out (" disclose") your personal medical information held by OPM.

OPM will use and give out your personal medical information:
. To you or someone who has the legal right to act for you (your personal representative), .
To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected,

. To law enforcement officials when investigating and/ or prosecuting alleged or civil or criminal actions, and .
Where required by law.

OPM has the right to use and give out your personal medical information to administer the FEHB Program. For example:

. To communicate with your FEHB health plan when you or someone you have authorized to act on your
behalf asks for our assistance regarding a benefit or customer service issue. . To review, make a decision, or litigate your disputed claim.

. For OPM and the General Accounting Office when conducting audits.
OPM may use or give out your personal medical information for the following purposes under limited circumstances:
. For Government healthcare oversight activities (such as fraud and abuse investigations), .
For research studies that meet all privacy law requirements (such as for medical research or education), and . To avoid a serious and imminent threat to health or safety.

By law, OPM must have your written permission (an "authorization") to use or give out your personal medical information for any purpose that is not set out in this notice. You may take back (" revoke") your written permission
at any time, except if OPM has already acted based on your permission.
By law, you have the right to:

. See and get a copy of your personal medical information held by OPM. .
Amend any of your personal medical information created by OPM if you believe that it is wrong or if information is missing, and OPM agrees. If OPM disagrees, you may have a statement of your disagreement

added to your personal medical information. . Get a listing of those getting your personal medical information from OPM in the past 6 years. The listing
will not cover your personal medical information that was given to you or your personal representative, any information that you authorized OPM to release, or that was given out for law enforcement purposes or to
pay for your health care or a disputed claim. . Ask OPM to communicate with you in a different manner or at a different place (for example, by sending
materials to a P. O. Box instead of your home address). 3.
3 Page 4 5
. Ask OPM to limit how your personal medical information is used or given out. However, OPM may not be
able to agree to your request if the information is used to conduct operations in the manner described above. . Get a separate paper copy of this notice.

For more information on exercising your rights set out in this notice, look at www. opm. gov/ insure on the web. You may also call 202-606-0191 and ask for OPM's FEHB Program privacy official for this purpose.
If you believe OPM has violated your privacy rights set out in this notice, you may file a complaint with OPM at the following address:
Privacy Complaints Office of Personnel Management
P. O. Box 707 Washington, DC 20004-0707

Filing a complaint will not affect your benefits under the FEHB Program. You also may file a complaint with the Secretary of the Department of Health and Human Services.
By law, OPM is required to follow the terms in this privacy notice. OPM has the right to change the way your personal medical information is used and given out. If OPM makes any changes, you will get a new notice by mail
within 60 days of the change. The privacy practices listed in this notice will be effective April 14, 2003. 4.
4 Page 5 6
2003 Humana Health Plan, Inc. 2 Table of Contents
Table of Contents
Introduction. ............................................................... 4
Plain Language ............................................................................................................................................................. 4
Stop Health Care Fraud! ............................................................................................................................................ 4-5
Section 1. Facts about this HMO plan ...................................................................................................................... 6-7
How we pay providers ................................................................................................................................. 6
Who provides my health care?.................................................................................................................... .6
Your Rights.................................................................................................................................................. 6
Service Area ................................................................................................................................................ 7
Section 2. How we change for 2003.. ............................................................... 8
Program-wide changes................................................................................................................................. 8
Changes to this Plan..................................................................................................................................... 8
Section 3. How you get care ... ............................................................................................................... 9-11
Identification cards ...................................................................................................................................... 9
Where you get covered care......................................................................................................................... 9
. Plan providers ........................................................................................................................................ 9
. Plan facilities.......................................................................................................................................... 9
What you must do to get covered care......................................................................................................... 9
. Primary care........................................................................................................................................... 9
. Specialty care ................................................................................................................................... 9-10
. Hospital care ........................................................................................................................................ 10
Circumstances beyond our control............................................................................................................. 11
Services requiring our prior approval ........................................................................................................ 11
Section 4. Your costs for covered services ................................................................................................................. 12
. Copayments ......................................................................................................................................... 12
. Coinsurance ......................................................................................................................................... 12
Your catastrophic protection out-of-pocket maximum.............................................................................. 12
Section 5. Benefits......................................................... 13-38
Overview ................................................................................................................................................... 13
(a) Medical services and supplies provided by physicians and other health care professionals......... 14-21
(b) Surgical and anesthesia services provided by physicians and other health care professionals ..... 22-26
(c) Services provided by a hospital or other facility, and ambulance services................................... 27-29
(d) Emergency services/ accidents ...................................................................................................... 30-31
(e) Mental health and substance abuse benefits ................................................................................. 32-33
(f) Prescription drug benefits ............................................................................................................. 34-35
(g) Special features................................................................................................................................... 36
. Flexible benefits option
. Services for deaf and hearing impaired 5.
5 Page 6 7
2003 Humana Health Plan, Inc. 3 Table of Contents
. High risk pregnancies
. Centers of excellence
. 24-hour nurse line
(h) Dental benefits.................................................................................................................................... 37

(i) Non-FEHB benefits available to Plan members ................................................................................. 38
Section 6. General exclusions things we don't cover ............................................................................................... 39
Section 7. Filing a claim for covered services ............................................................................................................ 40
Section 8. The disputed claims process ................................................................................................................ 41-42
Section 9. Coordinating benefits with other coverage .......................................................................................... 43-47
When you have other health coverage ....................................................................................................... 43
. What is Medicare?......................................................................................................................... 43-45
. Medicare managed care plan............................................................................................................... 46
. TRICARE and CHAMPVA................................................................................................................ 46
. Workers' Compensation ...................................................................................................................... 47
. Medicaid.............................................................................................................................................. 47
. Other Government agencies ................................................................................................................ 47
. When others are responsible for injuries ............................................................................................. 47
Section 10. Definitions of terms we use in this brochure ....................................................................................... 48-49
Section 11. FEHB facts .......................................................................................................................................... 50-53
Coverage information .......................................................................................................................... 50-51
. No pre-existing condition limitation .................................................................................................... 50
. Where you get information about enrolling in the FEHB Program ..................................................... 50
. Types of coverage available for you and your family.......................................................................... 50
. Children's Equity Act .................................................................................................................... 50-51
. When benefits and premiums start....................................................................................................... 51
. When you retire ................................................................................................................................... 51
When you lose benefits........................................................................................................................ 51-53
. When FEHB coverage ends ................................................................................................................. 51
. Spouse equity coverage........................................................................................................................ 51
. Temporary Continuation of Coverage (TCC) ...................................................................................... 52
. Converting to individual coverage....................................................................................................... 52
. Getting a Certificate of Group Health Plan Coverage.................................................................... 52-53
Long term care insurance is still available................................................................................................................... 54
Index............................................................................................................................................................................ 55
Summary of benefits.................................................................................................................................................... 56
Rates .............................................................................................................................................................. Back cover 6.
6 Page 7 8
2003 Humana Health Plan, Inc. 4 Introduction/ Plain Language
Introduction
This brochure describes the benefits of Humana Health Plan, under our contract (CS 2336) with the Office of Personnel Management (OPM), as authorized by the Federal Employees Health Benefits law. The address for Humana
Health Plan, Inc. administrative offices is:
Humana Health Plan, Inc. 201 W. Main St.
Riverview Square Louisville, KY 40202

This brochure is the official statement of benefits. No oral statement can modify or otherwise affect the benefits, limitations, and exclusions of this brochure. It is your responsibility to be informed about your health benefits.
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, 2003, unless those benefits are also shown in this brochure.
OPM negotiates benefits and rates with each plan annually. Benefit changes are effective January 1, 2003, and changes are summarized on page 8. Rates are shown at the end of this brochure.

Plain Language
All FEHB brochures are written in plain language to make them responsive, accessible, and understandable to the public. For instance,

. Except for necessary technical terms, we use common words. For instance, "you" means the enrollee or family
member; "we" means Humana Health Plan, Inc.

. We limit acronyms to ones you know. FEHB is the Federal Employees Health Benefit Program. OPM is the
Office of Personnel Management. If we use others, we tell you what they mean first.

. Our brochure and other FEHB plans' brochures have the same format and similar descriptions to help you
compare plans.

If you have comments or suggestions about how to improve the structure of this brochure, let OPM know. Visit OPM's "Rate Us" feedback area at www. opm. gov/ insure or email OPM at fehbpwebcomments@ opm. gov. You may
also write OPM at the Office of Personnel Management, Office of Insurance Planning and Evaluation Division, 1900 E Street, NW Washington, DC 20415-3650.

Stop Health Care Fraud!
Fraud increases the cost of health care for everyone and increases your Federal Employees Health Benefits (FEHB) Program premium.
OPM's Office of the Inspector General investigates all allegations of fraud, waste, and abuse in the FEHB Program regardless of the agency that employs you or from which you retired.
Protect Yourself From Fraud -Here are some things you can do to prevent fraud:
. Be wary of giving your plan identification (ID) number over the telephone or to people you do not know, except
to your doctor, other provider, or authorized plan or OPM representative.

. Let only the appropriate medical professionals review your medical record or recommend services. 7.
7 Page 8 9
2003 Humana Health Plan, Inc. 5 Introduction/ Plain Language
. Avoid using health care providers who say that an item or service is not usually covered, but they know how to
bill us to get it paid.

. Carefully review explanations of benefits (EOBs) that you receive from us.
. Do not ask your doctor to make false entries on certificates, bills or records in order to get us to pay for an item or
service.

. If you suspect that a provider 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/ 4HUMANA and explain the situation.
. If we do not resolve the issue:

CALL THE HEALTH CARE FRAUD HOTLINE
202/ 418-3300
OR WRITE TO:
The United States Office of Personnel Management Office of the Inspector General Fraud Hotline

1900 E Street, NW, Room 6400 Washington, DC 20415

. Do not maintain as a family member on your policy:
. your former spouse after a divorce decree or annulment is final (even if a court order stipulates
otherwise); or

. your child over age 22 unless he/ she is disabled and incapable of self support.
. If you have any questions about the eligibility of a dependent, check with your personnel office if you are
employed or with OPM is you are retired.

. You can be prosecuted for fraud and your agency may take action against you if you falsify a claim to obtain
FEHB benefits or try to obtain services for someone who is not an eligible family member or who is no longer enrolled in the Plan. 8.
8 Page 9 10
2003 Humana Health Plan, Inc. 6 Section 1
Section 1. Facts about this HMO plan
This Plan is a health maintenance organization (HMO). We require you to see specific physicians, hospitals, and other providers that contract with us. These Plan providers coordinate your health care services. The Plan is solely
responsible for the selection of these providers in your area. Contact the Plan for a copy of their most recent provider directory.

HMOs emphasize preventive care such as routine office visits, physical exams, well-baby care, and immunizations, in addition to treatment for illness and injury. Our providers follow generally accepted medical practice when
prescribing any course of treatment.
When you receive services from Plan providers, you will not have to submit claim forms or pay bills. You only pay the copayments and coinsurance described in this brochure. When you receive emergency services from non-Plan

providers, 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.

How we pay providers
We contract with individual physicians, medical groups, and hospitals to provide the benefits in this brochure. These Plan providers accept a negotiated payment from us, and you will only be responsible for your copayments and

coinsurance.
Who provides my health care?
As a mixed-model provider, Humana Health Plan, Inc. consists of both group practice and individual practice health care providers. Under a group model, members receive their primary medical services at a group facility, such as a

medical center. The doctors who provide medical care under the individual practice form are members of an Individual Practice Association (IPA) and see Plan members at their own private offices.

Your Rights
OPM requires that all FEHB Plans provide certain information to their FEHB members. You may get information about us, our networks, providers and facilities. OPM's FEHB website (www. opm. gov/ insure) lists the specific types

of information that we must make available to you. Some of the required information is listed below.
. Medical case management is a special Humana program that coordinates the provision of care and the management of benefits in cases of catastrophic illness or injury, transplant management and disease management. The program

strives to ensure that patients receive the most appropriate, cost-effective care and also derive maximum advantage from plan benefits.

. Humana has adopted preventative care guidelines based on the United States Preventative Health Task Force and subscribes to their Healthy People 2000 goals. Our Patterns of Preventative Care (POPC) program monitors the
delivery of well care and uses an automated reminder system to help assure that our members schedule routine preventative services.

. Humana provides comprehensive disease management programs to plan members. Key to each program is ongoing education, communication and coordination. Each contracted vendor offers plan members access to a staff of highly
specialized nurses and doctors, experienced in the respective disease field. The programs focus on linking the plan member with a specialized nurse or interdisciplinary team to ensure an individualized care development approach.
These nurses work closely with the plan member, member's family, member's primary care physician (PCP) and other involved providers to provide information, education and assistance when needed.

. Nationally, Humana has been in the health care business since 1961. Locally, Humana has been in existence since 1983.
. Humana is a for profit corporation which is publicly traded on the New York Stock Exchange (NYSE). 9.
9 Page 10 11
2003 Humana Health Plan, Inc. 7 Section 1
If you want more information about us, call 1-800/ 494-7156, or write to the Plan at 201 W. Main St., Riverview Square, Louisville, KY 40202. You may also contact us by fax at 502/ 580-7896 or 1-800/ 817-8294, or visit our
website at www. humana. com.

Service Area
To enroll in this Plan, you must live in or work in our Service Area. This is where our providers practice. Our Service Area is:

The Kentucky counties of Bullitt, Carroll, Hardin, Henry, Jefferson, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble and Washington.
The Indiana counties of Clark, Crawford, Floyd, Harrison, Jefferson, Scott and Washington.
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 benefits. We will not pay for any other health care services out of our service

area unless the services have prior plan approval.
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. 10.
10 Page 11 12
2003 Humana Health Plan, Inc. 8 Section 2
Section 2. How we change for 2003
Do not rely on these change descriptions; this page is not an official statement of benefits. For that, go to Section 5 Benefits. Also, we edited and clarified language throughout the brochure; any language change not shown here is a
clarification that does not change benefits.

Program-wide changes
. A Notice of the Office of Personnel Management's Privacy Practices is included.
. A section on the Children's Equity Act describes when an employee is required to maintain Self and Family
coverage.

. Program information on TRICARE and CHAMPVA explains how annuitants or former spouses may suspend
their FEHB Program enrollment.

. Program information on Medicare is revised.
. By law, the DoD/ FEHB Demonstration project ends on December 31, 2002.

Changes to this Plan
. Your share of the non-Postal premium will increase by 19.8% for Self Only and 32.1% for Self and Family.
. You pay a $15 copay for a primary care visit and a $25 copay for a specialist visit.
. You pay nothing for allergy injections.
. You pay a $25 copay for outpatient physical, occupational, cardiac and speech therapy.
. You pay a $250 copay per day for the first three days per inpatient hospital admission.
. You pay a $200 copay for outpatient surgery; and a $100 copay for other hospital outpatient services.
. You pay $75 for emergency care, including doctor fees, at a hospital outpatient facility.
. You pay a $10 copay for Level One drugs; a $25 copay for Level Two drugs; $45 for Level Three drugs; and
25% of the amount the Plan pays for Level Four drugs.

. Your catastrophic protection out of pocket for copayments and coinsurance is $2,500 per Self or $5,000 per Self
and Family enrollment in a calendar year.

. On hospice care we removed the dollar limit. 11.
11 Page 12 13
2003 Humana Health Plan, Inc. 9 Section 3
Section 3. How you get care
Identification cards We will send you an identification (ID) card when you enroll. You should carry your ID card with you at all times. You must show it whenever you
receive services from a Plan provider, or fill a prescription at a Plan pharmacy. Until you receive your ID card, use your copy of the Health
Benefits Election Form, SF-2809, your health benefits enrollment confirmation (for annuitants), or your Employee Express confirmation
letter.
If you do not receive your ID card within 30 days after the effective date of your enrollment, or if you need replacement cards, call us at

1-800/ 494-7156 or write to us at 201 West Main St., Riverview Square, Louisville, KY 40202. You may also request replacement cards through
our website at www. humana. com.

Where you get covered care You get care from "Plan providers" and "Plan facilities." You will only pay copayments or coinsurance, and you will not have to file claims.

. Plan providers Plan providers are physicians and other health care professionals in our
service area that we contract with to provide covered services to our members. We credential Plan providers according to national standards.

We list Plan providers in the provider directory, which we update periodically. The list is also on our website at www. humana. com.

. Plan facilities Plan facilities are hospitals and other facilities in our service area that we
contract with to provide covered services to our members. We list these in the provider directory, which we update periodically. The list is also

on our website at humana. com.

What you must do to get covered care It depends on the type of care you need. First, you and each family
member must choose a primary care physician. This decision is important since your primary care physician provides or arranges for
most of your health care. You may choose your primary care physician from our Provider Directory or our website, or you may call us for
assistance.
. Primary care Your primary care physician can be a family practitioner, internist or
pediatrician. Your primary care physician will provide most of your health care, or give you a referral to see a specialist.

If you want to change primary care physicians or if your primary care physician leaves the Plan, call us. We will help you select a new one.

. Specialty care Your primary care physician will refer you to a specialist for needed care.
When you receive a referral from your primary care physician, you must return to the primary care physician after the consultation, unless your

primary care physician authorized a certain number of visits without additional referrals. The primary care physician must provide or
authorize all follow-up care. Do not go to the specialist for return visits unless your primary care physician gives you a referral. On referrals, the
primary care doctor will give specific instructions to the consultant as to what services are authorized. However, you may see the following
participating providers without a referral: 12.
12 Page 13 14
2003 Humana Health Plan, Inc. 10 Section 3
. OB/ GYN providers for your annual well-woman exam
. Another doctor your primary care physician has designated to provide
patient care when he or she is not available.

Here are other things you should know about specialty care:
. 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 will use our criteria when creating your treatment plan
(the physician may have to get an authorization or approval beforehand).

. If you are seeing a specialist when you enroll in our Plan, talk to
your primary care physician. Your primary care physician will decide what treatment you need. If he or she decides to refer you

to a specialist, ask if you can see your current specialist. If your current specialist does not 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.

. If you are seeing a specialist and your specialist leaves the Plan, call
your primary care physician, who will arrange for you to see another specialist. You may receive services from your current specialist

until we can make arrangements for you to see someone else.
. 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; or

. reduce our service area 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 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 Your Plan primary care physician or specialist will make necessary
hospital arrangements and supervise your care. This includes admission to a skilled nursing or other type of facility.

If you are in the hospital when your enrollment in our Plan begins, call our customer service department immediately at 1-800/ 494-7156. If you
are new to the FEHB Program, we will arrange for you to receive care.
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.

These provisions apply only to the benefits of the hospitalized person. 13.
13 Page 14 15
2003 Humana Health Plan, Inc. 11 Section 3
Circumstances beyond our control Under certain extraordinary circumstances, such as natural disasters, we may have to delay your services or we may be unable to provide them.
In that case, we will make all reasonable efforts to provide you with the necessary care.

Services requiring our Your primary care physician has authority to refer you for most services. prior approval For certain services, however, your physician must obtain approval from
us. Before giving approval, we consider if the service is covered, medically necessary, and follows generally accepted medical practice.

We call this review and approval process precertification. Your physician must obtain precertification for the following services:
. Growth hormone therapy .
Organ/ Tissue transplants . All elective medical and surgical hospitalizations

. MRI's .
Uvulopalatopharyngoplasty (UPPP) . Obesity surgery

. All durable medical equipment (DME) over $750 .
Acute rehabilitation services . Home health care services

. Genetic testing .
Infertility services . Pain Management services

. PET and SPECT scans .
Sclerotherapy . Occupational and Physical therapies

. Speech therapy

Your physician must obtain our approval before sending you to a hospital, referring you to a specialist, or recommending follow-up care
from a specialist. 14.
14 Page 15 16
2003 Humana Health Plan, Inc. 12 Section 4
Section 4. Your costs for covered services
You must share the cost of some services. You are responsible for:
. Copayments A copayment is a fixed amount of money you pay to the provider,
facility, pharmacy etc., when you receive services.

Example: When you see your primary care physician you pay a copayment of $15 per office visit, and a $25 copayment for specialist

office visits.
. Deductible We do not have a deductible.
. Coinsurance Coinsurance is the percentage of our negotiated fee that you must pay for
your care.

Example: In our Plan, you pay 50% of our allowance for infertility services.

Your catastrophic protection out-of-pocket for copayments
and coinsurance After your copayments and coinsurance total $2,500 per person or $5,000 per family enrollment in any calendar year, you do not have to pay any
more for covered services. However, copayments for the following services do not count toward your catastrophic protection out-of-pocket
maximum, and you must continue to pay copayments for these services:
. Prescription drugs

Be sure to keep accurate records of your copayments since you are responsible for informing us when you reach the maximum. 15.
15 Page 16 17
2003 Humana Health Plan, Inc. 13 Section 5
Section 5. Benefits OVERVIEW (See page 8 for how our benefits changed this year and page 56 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 1-800/ 494-7156 or at our website at www. humana. com.

(a) Medical services and supplies provided by physicians and other health care professionals .......................... 14-21
. 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
. Physical, occupational and cardiac therapies

. Speech therapy
. 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
. Chiropractic
. Alternative treatments
. Educational classes and programs

(b) Surgical and anesthesia services provided by physicians and other health care professionals....................... 22-26
. Surgical procedures
. Reconstructive surgery
. Oral and maxillofacial surgery
. Organ/ tissue transplants
. Anesthesia

(c) Services provided by a hospital or other facility, and ambulance services..................................................... 27-29
. Inpatient hospital
. Outpatient hospital or ambulatory surgical
center

. Extended care benefits/ skilled nursing care
facility benefits .
Hospice care .
Ambulance

(d) Emergency services/ accidents ........................................................................................................................ 30-31
. Medical emergency . Ambulance

(e) Mental health and substance abuse benefits ................................................................................................... 32-33
(f) Prescription drug benefits............................................................................................................................... 34-35
(g) Special features..................................................................................................................................................... 36
. Flexible benefits option .
Services for deaf and hearing impaired . High risk pregnancies

. Centers of excellence
. 24-hour nurse line

(h) Dental benefits...................................................................................................................................................... 37

(i) Non-FEHB benefits available to Plan members ................................................................................................... 38
Summary of benefits.................................................................................................................................................... 56 16.
16 Page 17 18
2003 Humana Health Plan, Inc. 14 Section 5( a)
Section 5 (a). Medical services and supplies provided by physicians and other health care professionals
I M
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T

Here are some important things to 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.

. Plan physicians must provide or arrange your care.
. Be sure to read Section 4, Your costs for covered services, for valuable
information about how cost sharing works. Also read Section 9 about coordinating benefits with other coverage, including with Medicare.

I M
P O
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T

Benefit Description You pay
Diagnostic and treatment services
Professional services of physicians
. In a physician's office
. In an urgent care center
. Office medical consultations
. Second surgical opinion

$15 per office visit to your primary care physician
$25 per office visit to a specialist

. During a hospital stay
. In a skilled nursing facility
Nothing

. At home $15 per house call from your primary care physician
$25 per house call from a specialist
Lab, x-ray and other diagnostic tests
Such as:
. Blood tests
. Urinalysis
. Non-routine pap tests
. Pathology
. X-rays
. Non-routine Mammograms
. CAT Scans/ MRI
. Ultrasound
. Electrocardiogram and EEG

Nothing if you receive these services during your office visit;
otherwise:
$15 per office visit to your primary care physician

$25 per office visit to a specialist 17.
17 Page 18 19
2003 Humana Health Plan, Inc. 15 Section 5( a)
Preventive care, adult You pay
Routine screenings, such as:
. A fasting lipoprotein profile (total cholesterol, LDL, HDL and
triglycerides) once every five years for adults 20 or over; and

. Colorectal Cancer Screening, including Fecal occult blood
test: . Sigmoidoscopy screening every five years starting at age

50; or
. Double contrast barium enema (DCBE) once every five to
ten years at age 50.

. Bone density testing for women age 35 and older
. Chlamydial infection screening
Routine Prostate Specific Antigen (PSA) test one annually for men age 40 and older

Routine pap test one annually
Note: The office visit is covered if pap test is received on the same day; see Diagnostic and treatment services, above.

$15 per office visit to your primary care physician
$25 per office visit to a specialist

Routine mammogram covered for women age 35 and older, as follows:
. From age 35 through 39, one during this five year period
. From age 40 through 64, one every calendar year
. At age 65 and older, one every two consecutive calendar years
. When prescribed by the doctor as medically necessary to
diagnose or treat illness

$15 per office visit to your primary care physician
$25 per office visit to a specialist

Not covered: Physical exams and immunizations required for obtaining or continuing employment or insurance, attending
schools or camp, or travel.
All charges

Routine immunizations, limited to:
. Tetanus-diphtheria (Td) booster once every 10 years, ages19
and over (except as provided for under Preventive care, children)

. Influenzal vaccines, annually
. Pneumococcal vaccine, age 65 and over, or in the presence of
high risk, chronic conditions

$15 per office visit to your primary care physician
$25 per office visit to a specialist 18.
18 Page 19 20
2003 Humana Health Plan, Inc. 16 Section 5( a)
Preventive care, children You pay
. Childhood immunizations recommended by the American
Academy of Pediatrics

. Well-child care charges for routine examinations, immunizations
and care ( under age 22)

. Examinations, such as: .
Eye exams through age 17 to determine the need for vision correction.

. Ear exams through age 17 to determine the need for hearing
correction . Examinations done on the day of immunizations (through

age 22)

$15 per office visit to your primary care physician
$25 per office visit to a specialist

Maternity care
Complete maternity (obstetrical) care, such as:
. Prenatal care
. Delivery
. Postnatal care

Note: Here are some things to keep in mind:
. You may remain in the hospital up to 48 hours after a regular
delivery and 96 hours after a cesarean delivery. We will extend your inpatient stay if medically necessary.

. 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 only

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 Section 5( c) and Section 5( b).

$15 per office visit to your primary care physician
$25 per office visit to a specialist
No copay for other pre-natal and post-natal visits

Not covered: Routine sonograms to determine fetal age, size or sex All charges 19.
19 Page 20 21
2003 Humana Health Plan, Inc. 17 Section 5( a)
Family planning You pay
A range of voluntary family planning services, limited to:
. Voluntary sterilization; see Surgical procedures, Section 5( b)
. Surgically implanted contraceptives (such as Norplant)
. Injectable contraceptive drugs (such as Depo provera)
. Contraceptive devices
. Intrauterine devices (IUDs)
. Diaphragms

Note: We cover oral contraceptives under the prescription drug benefit. See Section 5 (f).

$15 per office visit to your primary care physician
$25 per office visit to a specialist

Not covered: Reversal of voluntary surgical sterilization, All charges
Infertility services
Diagnosis and treatment of infertility, such as:
. Artificial insemination: .
intravaginal insemination (IVI) . intracervical insemination (ICI)

. intrauterine insemination (IUI)
Note: We cover injectable fertility drugs under medical benefits and oral fertility drugs under the prescription drug benefit.

50% of all charges

Not covered:
. Assisted reproductive technology (ART) procedures, such as:
. In vitro fertilization
. Embryo transfer, gamete GIFT and zygote ZIFT
. Zygote transfer

. Services and supplies related to excluded ART procedures
. Cost of donor sperm
. Cost of donor egg

All charges

Allergy care
. Allergy serum
. Allergy injections
Nothing

. Allergy testing Nothing after office visit copayment
Not covered: Provocative food testing and sublingual allergy desensitization All charges 20.
20 Page 21 22
2003 Humana Health Plan, Inc. 18 Section 5( a)
Treatment therapies You pay
. Chemotherapy and radiation therapy
Note: High dose chemotherapy in association with autologous bone marrow transplants is limited to those transplants listed

under Organ/ Tissue Transplants on page 25.
. Respiratory and inhalation therapy
. Dialysis hemodialysis and peritoneal dialysis
. Growth hormone therapy (GHT)

Note: Growth hormone is covered under the prescription drug benefit.

Note: We will only cover Growth Hormone Therapy if the treatment is precertified and there is a laboratory confirmed
diagnosis of Growth Hormone Deficiency. You will need to call the precertification telephone number on the back of your
medical ID (identification) card. We will also ask that your physician submit information that establishes that the GHT is
medically necessary. GHT must be authorized before you begin treatment.

See Services requiring our prior approval in Section 3.

$15 per office visit to your primary care physician
$25 per office visit to a specialist

. Intravenous (IV)/ Infusion Therapy Home IV and antibiotic
therapy Nothing

Physical, occupational and cardiac therapies
. Up to 60 treatments or two consecutive months per condition
for the services of each of the following:

. Qualified physical therapists;
. Occupational therapists.

Note: We only cover therapy to restore bodily function when there has been a total or partial loss of bodily function due to

illness or injury. 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.

$25 per office visit
$25 per outpatient visit
Nothing per visit during covered inpatient admission

. Therapeutic, respite and rehabilitative care for individuals age
2 through 21 for the treatment of autism. Nothing

. Cardiac rehabilitation following a heart transplant, bypass
surgery or a myocardial infarction, is provided for up to 12 weeks. $25 per office visit

Not covered:
. Long-term rehabilitative therapy
. Exercise programs

All charges 21.
21 Page 22 23
2003 Humana Health Plan, Inc. 19 Section 5( a)
Speech therapy You pay
Therapy must be provided within a 60 consecutive day period. $25 per office visit
$25 per outpatient visit
Nothing per visit during covered inpatient admission

Hearing services (testing, treatment, and supplies)
. Cochlear implants
. Screening hearing testing for children through age 17
(see Preventive care, children)

$15 per office visit to your primary care physician
$25 per office visit to a specialist
Not covered:
. All other hearing testing
. Hearing aids, testing and examinations for them

All charges

Vision services (testing, treatment, and supplies)
. One pair of eyeglasses or contact lenses to correct an
impairment directly caused by accidental ocular injury or intraocular surgery (such as for cataracts)

. Diagnosis and treatment of diseases of the eye.
. Screening eye exam to determine the need for vision
correction for children through age 17 (see Preventive care, children)

. One eye exam per year up to age 18, then every other year
thereafter. The plan provides $100 toward the purchase of hardware.

$15 per office visit to your primary care physician
$25 per office visit to a specialist

Not covered:
. Eyeglasses or contact lenses and, examinations for them,
except as shown above

. Eye exercises and orthoptics
. Radial keratotomy and other refractive surgery

All charges

Foot care
Routine foot care when you are under active treatment for a metabolic or peripheral vascular disease, such as diabetes.

See Orthopedic and prosthetic devices for information on podiatric shoe inserts.
$15 per office visit to your primary care physician
$25 per office visit to a specialist

Not covered:
. Cutting, trimming or removal of corns, calluses, or the free
edge of toenails, and similar routine treatment of conditions of the foot, unless primary medical condition requires such

care
. Treatment of weak, strained or flat feet or bunions or spurs;
and of any instability, imbalance or subluxation of the foot (unless the treatment is by open cutting surgery)

All charges 22.
22 Page 23 24
2003 Humana Health Plan, Inc. 20 Section 5( a)
Orthopedic and prosthetic devices You pay
. Artificial limbs
. Orthopedic devices such as braces that are custom-fitted or
custom-made.

. Externally worn breast prostheses and surgical bras, including
necessary replacements, following a mastectomy

. Internal prosthetic devices, such as artificial joints,
pacemakers, cochlear implants, and surgically implanted breast implant following mastectomy. Note: See 5( b) for

coverage of the surgery to insert the device.
. Corrective orthopedic appliances for non-dental treatment of
temporomandibular joint (TMJ) pain dysfunction syndrome.

Nothing

Not covered:
. Foot orthotics
. Orthopedic and corrective shoes
. Arch supports
. Heel pads and heel cups
. Lumbosacral supports
. Corsets, trusses, elastic stockings, support hose, and other
supportive devices

. Prosthetic replacements provided less than 3 years after the
last one we covered

All charges

Durable medical equipment (DME)
Rental or purchase, at our option, including repair and adjustment, of durable medical equipment prescribed by your

Plan physician, such as oxygen and dialysis equipment. Under this benefit, we also cover:

. Hospital beds
. Wheelchairs
. Crutches
. Walkers

Nothing

Home health services
. Home health care ordered by a Plan physician and provided
by a registered nurse (R. N.), licensed practical nurse (L. P. N.), licensed vocational nurse (L. V. N.), or home health aide.

. Services includes intravenous therapy and medications.

Nothing

Not covered:
. Nursing care requested by, or for the convenience of, the
patient or the patient's family

. Home care primarily for personal assistance that does not
include a medical component and is not diagnostic, therapeutic, or rehabilitative

All charges 23.
23 Page 24 25
2003 Humana Health Plan, Inc. 21 Section 5( a)
Chiropractic You pay . Manipulations of the spine ad extremities
. Manipulations of the spine and extremities
. Adjunctive procedures such as ultrasound, electrical muscle
stimulation, vibratory therapy, and cold pack application

$25 per office visit

Alternative treatments
No benefit All charges

Educational classes and programs
. Smoking cessation -Up to $100 for one (1) smoking
cessation program per member per lifetime. Nothing

. Diabetes self management training $15 per office visit to your primary care physician
$25 per office visit to a specialist 24.
24 Page 25 26
2003 Humana Health Plan, Inc. 22 Section 5( b)
Section 5 (b). Surgical and anesthesia services provided by physicians and other health care professionals
I M
P O
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A N
T

Here are some important things to 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.

. Plan physicians must provide or arrange your care.
. Be sure to read Section 4, Your costs for covered services for valuable
information about how cost sharing works. Also read Section 9 about coordinating benefits with other coverage, including with Medicare.

. The amounts listed below are for the charges billed by a physician or
other health care professional for your surgical care. Look in Section 5( c) for charges associated with the facility (i. e. hospital, surgical

center, etc.).
. YOU MUST GET PRECERTIFICATION OF SOME SURGICAL
PROCEDURES. Please refer to the precertification information shown in Section 3 to be sure which services require precertification

and identify which surgeries require precertification.

I M
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Benefit Description You pay
Surgical procedures
A comprehensive range of services, such as:
. Operative procedures
. Treatment of fractures, including casting
. Normal pre-and post-operative care by the surgeon
. Endoscopy procedures
. Biopsy procedures
. Removal of tumors and cysts
. Correction of congential anomalies (See Reconstructive surgery)
. Surgical treatment of morbid obesity a condition in which an
individual weighs 100 pounds or 100% over his or her normal weight according to current underwriting standards; eligible

members must be age 18 or over.
. Insertion of internal prosthetic devices. See 5( a) Orthopedic
and prosthetic devices for device coverage information.

. Voluntary sterilization (e. g., Tubal ligation, Vasectomy) .
Treatment of burns

Note: Generally, we pay for internal prostheses (devices) according to where the procedure is done. For example, we pay

Hospital benefits for a pacemaker and Surgery benefits for insertion of the pacemaker.

Nothing

Not covered:
. Reversal of voluntary sterilization .
Routine treatment of conditions of the foot; see Foot Care

All charges

Surgical procedures continued on next page 25.
25 Page 26 27
2003 Humana Health Plan, Inc. 23 Section 5( b)
Reconstructive surgery You pay
. Surgery to correct a functional defect
. Surgery to correct a condition caused by injury or illness if:
. the condition produced a major effect on the member's
appearance and . the condition can reasonably be expected to be corrected by

such surgery
. Surgery to correct a condition that existed at or from birth and
that is a significant deviation from the common form or norm. Examples of congenital anomalies are: protruding ear

deformities; cleft lip; cleft palate; birth marks; webbed fingers and webbed toes.

. All stages of breast reconstruction surgery following a
mastectomy, such as: . surgery to produce a symmetrical appearance on the other

breast; . treatment of any physical complications, such as
lymphedemas;
. breast prostheses and surgical bras and replacements (see Prosthetic devices)

Note: If you need a mastectomy, you may choose to have the procedure performed on an inpatient basis and remain in the
hospital up to 48 hours after the procedure.

Nothing

Not covered:
. Cosmetic surgery any surgical procedure (or any portion of a
procedure) performed primarily to improve physical appearance through change in bodily form, except repair of accidental injury

. Surgeries related to sex transformation

All charges 26.
26 Page 27 28
2003 Humana Health Plan, Inc. 24 Section 5( b)
Oral and maxillofacial surgery You pay
Oral surgical procedures, limited to:
. Reduction of fractures of the jaws or facial bones;
. Surgical correction of congenital defects such as cleft lip, cleft
palate or severe functional malocclusion;

. Removal of stones from salivary ducts;
. Excision of leukoplakia or malignancies;
. Excision of cysts and incision of abscesses when done as
independent procedures;

. Other surgical procedures that do not involve the teeth or their
supporting structures; and

. Diagnosis and treatment specifically directed toward medical and
functional disorders of the temporomandibular joint (TMJ) and craniomandibular jaw (CMJ).

Nothing

Not covered:
. Oral implants and transplants
. Procedures that involve the teeth or their supporting structures
(such as the periodontal membrane, gingiva, and alveolar bone)

All charges 27.
27 Page 28 29
2003 Humana Health Plan, Inc. 25 Section 5( b)
Organ/ tissue transplants You pay
Limited to:
. Cornea
. Heart
. Lung: Single-double
. Heart/ Lung
. Kidney
. Kidney/ Pancreas
. Liver
. Pancreas
. Allogeneic (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; Wiskott-Aldrich syndrome; severe combined immunodeficiency syndrome; aplastic anemia; ewings sarcoma;
and testicular, mediastinal, retroperitoneal and ovarian germ cell tumors

. Intestinal transplants (small intestine) and the small intestine
with the liver or small intestine with multiple organs such as the liver, stomach, and pancreas

Humana has a National Transplant Network with over 35 facilities in 20 states.
Limited Benefits Treatment for breast cancer, multiple myeloma, and epithelial ovarian cancer may be provided in an NCI-or NIH-approved
clinical trial at a Plan-designated center of excellence if approved by the Plan's medical director in accordance with the
Plan's protocols.
Note: We cover related medical and hospital expenses of the donor when we cover the recipient. All transplants must be precertified.

Nothing

Not covered:
. Donor screening tests and donor search expenses, except those
performed for the actual donor

. Implants of artificial organs
. Transplants not listed as covered

All charges 28.
28 Page 29 30
2003 Humana Health Plan, Inc. 26 Section 5( b)
Anesthesia You pay
Professional services provided in
. Hospital (inpatient)
. Hospital outpatient department
. Skilled nursing facility
. Ambulatory surgical center
. Office

Nothing 29.
29 Page 30 31
2003 Humana Health Plan, Inc. 27 Section 5( c)
Section 5 (c). Services provided by a hospital or other facility, and ambulance services
I M
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A N
T

Here are some important things to remember 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.

. Plan physicians must provide or arrange your care and you must be
hospitalized in a Plan facility.

. Be sure to read Section 4, Your costs for covered services for valuable
information about how cost sharing works. Also read Section 9 about coordinating benefits with other coverage, including with Medicare.

. The amounts listed below are for the charges billed by the facility (i. e.,
hospital or surgical center) or ambulance service for your surgery or care. Any costs associated with the professional charge (i. e.,

physicians, etc.) are covered in Section 5( a) or (b).
. YOU MUST GET PRECERTIFICATION OF HOSPITAL STAYS. Please refer to Section 3 to be sure which services require

precertification.

I M
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T

Benefit Description You pay
Inpatient hospital
Room and board, such as
. Ward, semiprivate, intensive care or cardiac care
accommodations;

. General nursing care;
. Private accommodations when a Plan doctor determines it is
medically necessary;

. Private duty nursing when Plan doctor determines it is medically
necessary; and

. Meals and special diets.

Note: If you want a private room when it is not medically necessary, you pay the additional charge above the semiprivate

room rate.

$250 per day for the first three days per admission

Inpatient hospital services continued on next page 30.
30 Page 31 32
2003 Humana Health Plan, Inc. 28 Section 5( c)
Inpatient hospital (continued) You pay
Other hospital services and supplies, such as:
. Operating, recovery, maternity, and other treatment rooms
. Prescribed drugs and medicines
. Diagnostic laboratory tests and x-rays
. Administration of blood, blood plasma, and other biologicals
. Blood and blood components if not replaced
. Dressings, splints, casts, and sterile tray services
. Medical supplies and equipment, including oxygen
. Anesthetics, including nurse anesthetist services
. Take-home items
. Medical supplies, appliances, medical equipment, and any
covered items billed by a hospital for use at home

Nothing

Not covered:
. Custodial care, rest cures, domiciliary or convalescent care
. Non-covered facilities, such as nursing homes, schools
. Personal comfort items, such as telephone, television, barber
services, guest meals and beds

. Cost of blood and blood components if replaced

All charges

Outpatient hospital or ambulatory surgical center
Outpatient surgery
. Operating, recovery, and other treatment rooms
. Prescribed drugs and medicines
. Laboratory tests, x-rays, and pathology services
. Administration of blood, blood plasma, and other biologicals
. Blood and blood components if not replaced
. Dressings, casts, and sterile tray services
. Medical supplies, including oxygen
. Anesthetics and anesthesia service

$200 copay per visit

Pre-surgical testing Nothing
Other hospital outpatient services
Note: We cover hospital services and supplies related to dental procedures when necessitated by a non-dental physical

impairment. We do not cover the dental procedures.

$100 copay per visit

Not covered: Blood and blood derivatives not replaced by the member All charges 31.
31 Page 32 33
2003 Humana Health Plan, Inc. 29 Section 5( c)
Extended care benefits/ skilled nursing care facility benefits You pay
Extended care benefit:
. Up to 100 days per calendar year, including .
bed and board . general nursing care

. drugs, biologicals, supplies and equipment provided by the
facility

Note: Coverage is provided 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.

Nothing

Not covered: Custodial care, rest cures, domiciliary or convalescent care All charges
Hospice care
Supportive and palliative care for a terminally ill member is covered in the home or hospice facility. Includes:

. Inpatient and outpatient services and supplies
Note: These services are subject to the same conditions and limitations as Medicare benefits; and must be described in a Hospice

Care program that has been approved by us.

Nothing

Not covered: Independent nursing, homemaker services All charges
Ambulance
. Local professional ambulance service when ordered or
authorized by a Plan doctor Nothing 32.
32 Page 33 34
2003 Humana Health Plan, Inc. 30 Section 5( d)
Section 5 (d). Emergency services/ accidents
I M

P O
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A N
T

Here are some important things to 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.

. Be sure to read Section 4, Your costs for covered services, for valuable
information about how cost sharing works. Also read Section 9 about coordinating benefits with other coverage, including with Medicare.

I M
P O
R T
A N
T

What is a medical emergency?
A medical emergency is the sudden and unexpected onset of a condition or an injury that you 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 we may determine are medical emergencies what they all have
in common is the need for quick action.

What to do in case of emergency:
Emergencies within our service area: If you are in an emergency situation, please call your primary care doctor. In extreme 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 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 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.

Emergencies outside our service area: Benefits are available for any medically necessary health service that is immediately required because of injury or unforeseen illness.
If you need to be hospitalized, the Plan must be notified within 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.

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.

Emergency services/ accidents continued on next page 33.
33 Page 34 35
2003 Humana Health Plan, Inc. 31 Section 5( d)
Benefit Description You pay
Emergency within our service area
. Emergency care as an outpatient at a hospital, including
doctor's services

If the emergency results in admission to a hospital, the emergency care copay is waived.

$75 per visit

. Emergency care at a doctor's office
. Emergency care at an urgent care center
$15 per visit to a primary care physician

$25 per visit to a specialist
Not covered: Elective care or non-emergency care All charges
Emergency outside our service area
. Emergency care as an outpatient at a hospital, including
doctor's services

If the emergency results in admission to a hospital, the emergency care copay is waived.

$75 per visit

. Emergency care at a doctor's office
. Emergency care at an urgent care center
$15 per visit to a primary care physician

$25 per visit to a specialist
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

All charges

Ambulance
. Professional ambulance service when medically appropriate.
See 5( c) for non-emergency service.

Note: Air ambulance is covered only when point of pick-up is inaccessible by land vehicle; or great distances or other obstacles

are involved in getting a patient to the nearest hospital with appropriate facilities when prompt admission is essential.

Nothing 34.
34 Page 35 36
2003 Humana Health Plan, Inc. 32 Section 5( e)
Section 5 (e). Mental health and substance abuse benefits
I M
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T

When you get our approval for services and follow a treatment plan we approve, cost-sharing and limitations for Plan mental health and
substance abuse benefits will be no greater than for similar benefits for other illnesses and conditions.

Here are some important things to 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.

. Be sure to read Section 4, Your costs for covered services for valuable
information about how cost sharing works. Also read Section 9 about coordinating benefits with other coverage, including with Medicare.

YOU MUST GET PREAUTHORIZATION OF THESE SERVICES. See the instructions after the benefits description below.

I M
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Description You pay
Mental health and substance abuse benefits
All diagnostic and treatment services recommended by a Plan provider and contained in a treatment plan that we approve.

The treatment plan may include services, drugs, and supplies described elsewhere in this brochure.

Note: Plan benefits are payable only when we determine the care is clinically appropriate to treat your condition and only when
you receive the care as part of a treatment plan that we approve.

Your cost sharing responsibilities are no greater than for other
illnesses or conditions.

. Professional services, including individual or group therapy by
providers such as psychiatrists, psychologists, or clinical social workers

. Medication management

$25 per office visit

. Diagnostic tests Nothing if you receive these services
during your office visit; otherwise:

$25 per office visit

. Services provided by a hospital or other facility
. Services in approved alternative care settings such as partial
hospitalization, half-way house, residential treatment, full-day hospitalization, facility based intensive outpatient treatment

NOTE: Some services are considered to be partial hospitalization. Two partial hospitalization days will be
considered one confinement day.

$250 per day for the first three days per admission
$100 copay for outpatient services

Mental health and substance abuse benefits Continued on next page. 35.
35 Page 36 37
2003 Humana Health Plan, Inc. 33 Section 5( e)
Mental health and substance abuse benefits (continued) You pay
Not covered: Services we have not approved
NOTE: OPM will base its review of disputes about treatment plans on the treatment plan's clinical appropriateness. OPM will

generally not order us to pay or provide one clinically appropriate treatment plan in favor of another.

All charges

Preauthorization To be eligible to receive these benefits you must obtain a treatment plan and follow all of the following authorization processes.
Please contact APS Healthcare Services at 1-800/ 659-0349 to obtain Mental Health/ Substance Abuse treatment services.

Limitation We may limit your benefits if you do not obtain a treatment plan. 36.
36 Page 37 38
2003 Humana Health Plan, Inc. 34 Section 5( f)
Section 5 (f). Prescription drug benefits
I M
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T

Here are some important things to keep in mind about these benefits:
. We cover prescribed drugs and medications, as described in the chart
beginning on the next page.

. All benefits are subject to the definitions, limitations and exclusions in
this brochure and are payable only when we determine they are medically necessary.

. Be sure to read Section 4, Your costs for covered services for valuable
information about how cost sharing works. Also read Section 9 about coordinating benefits with other coverage, including with Medicare.

I M
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There are important features you should be aware of. These include:
. Who can write the prescription? A plan physician or licensed dentist must write the prescription.
. Where can you obtain them? You must fill the prescription at a plan pharmacy, or by mail for a
prescribed maintenance medication. Maintenance medications are drugs that are generally prescribed for the treatment of long term chronic sicknesses or injuries.

. The Rx4 Plan allows members access to any drug that is used to treat a condition the medical plan covers.
Thousands of drugs have been placed in levels based on their a) efficacy, b) safety, c) possible side effects, d) drug interactions, and e) cost compared to similar drugs. The levels are no longer based on a

Drug List or formulary. New drugs are continually reviewed for level placement, dispensing limits and prior authorization requirements that represent the current clinical judgment of our Pharmacy and
Therapeutics Committee.
Level One contains the lowest copayment for low cost generic and brand name drugs.
Level Two copays are higher than Level One this level covers higher cost generic and brand name drugs.

Level Three is made up of higher cost drugs, mostly brand names. These drugs may have generic or brand name options on Levels One or Two.
Level Four includes high technology drugs that are often newly approved by the U. S. Food and Drug Administration.

Rx4's specific copayment amounts for the first three levels eliminate unexpected charges at the pharmacy, which means you won't have to calculate cost differentials when you choose brand name drugs over
generic equivalents. You can visit our web site at www. humana. com to check the copayment for your prescription drug coverage before you get your prescription filled. You can also find out more about
possible drug alternatives and the locations of participating pharmacies.
With Rx4 the member takes on more of the cost share for the drug. In return, members receive access to more drugs to treat their conditions and have more choices, along with their physicians, to decide which

drug to take. Members receive letters offering guidance in changing medications to those with a lower copayment. We use internal data to identify members for whom a less expensive prescription drug option
may be available. We communicate the information to the member to enable them, along with their physician, to make an informed choice regarding prescription drug copayment options.

. What are the dispensing limits? Prescription drugs dispensed at a Plan pharmacy will be dispensed for
up to a 30-day supply. You may receive up to a 90-day supply of prescribed maintenance medications through our mail-order program. 37.
37 Page 38 39
2003 Humana Health Plan, Inc. 35 Section 5( f)
Benefit Description You pay
Covered medications and supplies
We cover the following medications and supplies prescribed by a Plan physician and obtained from a Plan pharmacy or through our mail

order program:
. Drugs and medicines that by Federal law of the United States require a physician's prescription for their purchase, except those

listed as not covered.
. Insulin
. Disposable needles and syringes for the administration of covered medications

. Diabetic supplies including testing agents, lancet devices, alcohol swabs, glucose elevating agents, insulin delivery devices,
and blood glucose monitors approved by us.
. Self administered injectable drugs
. Oral fertility drugs
. Oral contraceptive drugs
. Drugs for sexual dysfunction
. Growth hormones

Note: Drugs to treat sexual dysfunction are limited. Contact the Plan for dosage limits. You pay the applicable drug copay up to

the dosage limits, and all charges after that.

$10 for Level One drugs
$25 for Level Two drugs
$45 for Level Three drugs
25% of the amount that the plan pays to the dispensing pharmacy

for Level Four drugs
Out of pocket maximum for Level Four drugs is $2,500 per

member per calendar year
3 applicable copays for a 90-day supply of prescribed

maintenance drugs, when ordered through our mail-order
program.

Not covered:
. Drugs available without a prescription, or for which there is a
non-prescription equivalent available

. Drugs and supplies for cosmetic purposes (such as Rogaine)
. Vitamins, fluoride, nutrients and food supplements even if a
physician prescribes or administers them

. Drugs to enhance athletic performance
. Smoking cessation drugs and medications, including nicotine
patches

. Any drug used for the purpose of weight control
. Prescriptions that are to be taken by or administered to the
member in whole or part, while a patient in a hospital, skilled nursing facility, convalescent hospital, inpatient facility or other

facility where drugs are ordinarily provided by the facility on an inpatient basis

. Medical supplies such as dressings and antiseptics
. Drugs obtained at a non-Plan pharmacy; except for out-of-area
emergencies

All charges 38.
38 Page 39 40
2003 Humana Health Plan, Inc. 36 Section 5( g)
Section 5 (g). Special features
Feature Description

Flexible benefits option Under the flexible benefits option, we determine the most effective way to provide services.
. We may identify medically appropriate alternatives to
traditional care and coordinate other benefits as a less costly alternative benefit.

. Alternative benefits are subject to our ongoing review.
. By approving an alternative benefit, we cannot guarantee
you will get it in the future.

. The decision to offer an alternative benefit is solely ours,
and we may withdraw it at any time and resume regular contract benefits.

. Our decision to offer or withdraw alternative benefits is not
subject to OPM review under the disputed claims process.

Services for deaf and hearing impaired Humana offers telecommunication devices for the deaf (TDD) and Teletype (TTY) phone lines for the hearing impaired.

High risk pregnancies HumanaBeginnings is an outreach program that provides high-risk plan members support and educational materials so care can
be actively managed during pregnancy.

Centers of excellence Members can use any facility that is within Humana's contracted National Transplant Network. This network has over
35 transplant facilities located in more than 20 states.

24 hour nurse line For any of your health concerns, 24 hours a day, 7 days a week, you may call HumanaFirst at 1-800-622-9529 and talk with a
registered nurse who will discuss treatment options and answer your health questions. 39.
39 Page 40 41
2003 Humana Health Plan, Inc. 37 Section 5( h)
Section 5 (h). Dental benefits
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Here are some important things to 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.

. Plan dentists must provide or arrange your care.
. We cover hospitalization for dental procedures only when a nondental
physical impairment exists which makes hospitalization necessary to safeguard the health of the patient; see Section 5( c) for inpatient

hospital benefits. We do not cover the dental procedure unless it is described below.

. Be sure to read Section 4, Your costs for covered services, for valuable
information about how cost sharing works. Also read Section 9 about coordinating benefits with other coverage, including with Medicare.

I M
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T

Accidental injury benefit You pay
We cover restorative services and supplies necessary to promptly repair (but not replace) sound natural teeth. The need for these

services must result from an accidental injury, not biting or chewing. Services must be received within 12 months of the date
such injury occurs.

Nothing

Dental benefits
We have no other dental benefits. 40.
40 Page 41 42
2003 Humana Health Plan, Inc. 38 Section 5( i)
Section 5 (i). Non-FEHB benefits available to Plan members
The benefits on this page are not part of the FEHB contract or premium, and you cannot file an FEHB disputed claim about them. Fees you pay for these services do not count toward FEHB deductibles or catastrophic
protection out-of-pocket maximums.

. You are eligible to receive savings on dental services when
provided by participating dentists.

. No additional premium required; no application to complete.
. Administered by HumanaDental 1-800-955-0782.

Complementary and Alternative Medicine (CAM) is a program offered to all Humana members, giving discounted access to
supplemental health services. Through the program members will receive a discount of up to 30% on services by participating
providers in the AmericanWholeHealth Network.
Alternative medicine is known for its focus on being healthy and preventing problems, not just treating illness and injury. To learn

more about this program go to www. wholehealthmd. com/ Humana.

. Discounts available at participating providers for eye exams,
frames and lenses. (see separate plan description on how to locate

a provider nearest you). . Mail Order Contact Lens Replacement Program
. Vision Correction (LASIK or PRK) for less than $1,000 per
eye. (see separate Plan description on how to receive the discount)

. No additional premium required.

. Hearing aid evaluations, follow-up visits (limited to 60 days) and
hearing aid adjustments, when medically necessary, covered with no copayment required at participating providers.

. Discounts on standard hearing aids at participating providers.
. No additional premium required.

Contact us for additional information concerning specific benefits, exclusions, limitations, eligible providers and other provisions of each of the above coverages.

Expanded dental benefits . DEN-475
Expanded hearing care . HER-904
Complementary and Alternative Medicine
Vision care . Vision One Discount
Program 41.
41 Page 42 43
2003 Humana Health Plan, Inc. 39 Section 6
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, disease, injury or condition.
We do not cover the following:
. Care by non-Plan providers except for authorized referrals or emergencies (see Emergency benefits);
. Services, drugs, or supplies you receive while you are not enrolled in this Plan;
. Services, drugs, or supplies that are not medically necessary;
. Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric
practice;

. Experimental or investigational procedures, treatments, drugs or devices;
. Services, drugs, or supplies related to abortions, except when the life of the mother would be endangered if
the fetus were carried to term;

. Services, drugs, or supplies related to sex transformations;
. Services, drugs, or supplies you receive from a provider or facility barred from the FEHB Program; or
. Services, drugs, or supplies you receive without charge while in active military service. 42.
42 Page 43 44
2003 Humana Health Plan, Inc. 40 Section 7
Section 7. Filing a claim for covered services
When you see Plan physicians, receive services at Plan hospitals and facilities, or obtain your prescription drugs at Plan pharmacies, you will not have to file claims. Just present your identification card and pay your copayment or
coinsurance.
You will only need to file a claim when you receive emergency services from non-plan providers. Sometimes these providers bill us directly. Check with the provider. If you need to file the claim, here is the process:

Medical and hospital benefits In most cases, providers and facilities file claims for you. Physicians must file on the form HCFA-1500, Health Insurance Claim Form.
Facilities will file on the UB-92 form. For claims questions and assistance, call us at 1-800/ 494-7156.

When you must file a claim such as for services you receive outside of the Plan's service area submit it on the HCFA-1500 or a claim form
that includes the information shown below. Bills and receipts should be itemized and show:

. Covered member's name and ID number;
. Name and address of the physician or facility that provided the service
or supply;

. Dates you received the services or supplies;
. Diagnosis;
. Type of each service or supply;
. The charge for each service or supply;
. A copy of the explanation of benefits, payments, or denial from any
primary payer such as the Medicare Summary Notice (MSN); and

. Receipts, if you paid for your services.

Submit your claims to: Humana Health Plan, Inc. P. O. Box 14601

Lexington, Kentucky 40512-4601

Deadline for filing your claim Send us all of the documents for your claim as soon as possible. You must submit the claim by December 31 of the year after the year you
received the service, unless timely filing was prevented by administrative operations of Government or legal incapacity, provided the claim was
submitted as soon as reasonably possible.

When we need more information Please reply promptly when we ask for additional information. We may delay processing or deny your claim if you do not respond. 43.
43 Page 44 45
2003 Humana Health Plan, Inc. 41 Section 8
Section 8. The disputed claims process
Follow this Federal Employees Health Benefits Program disputed claims process if you disagree with our decision on your claim or request for services, drugs, or supplies including a request for preauthorization:

Step Description
1 Ask us in writing to reconsider our initial decision. You must: (a) Write to us within 6 months from the date of our decision; and
(b) Send your request to us at: Humana Health Plan, Inc., 201 W. Main St., Riverview Square, Louisville, KY 40202; and

(c) Include a statement about why you believe our initial decision was wrong, based on specific benefit provisions in this brochure; and
(d) Include copies of documents that support your claim, such as physicians' letters, operative reports, bills, medical records, and explanation of benefits (EOB) forms.

2 We have 30 days from the date we receive your request to: (a) Pay the claim (or, if applicable, arrange for the health care provider to give you the care); or
(b) Write to you and maintain our denial go to step 4; or
(c) Ask you or your provider for more information. If we ask your provider, we will send you a copy of our request go to step 3.

3 You or your provider must send the information so that we receive it within 60 days of our request. We will then decide within 30 more days.
If we do not receive the information within 60 days, we will decide within 30 days of the date the information was due. We will base our decision on the information we already have.

We will write to you with our decision.
4 If you do not agree with our decision, you may ask OPM to review it.
You must write to OPM within:
. 90 days after the date of our letter upholding our initial decision; or
. 120 days after you first wrote to us if we did not answer that request in some way within 30 days; or
. 120 days after we asked for additional information.

Write to OPM at: Office of Personnel Management, Office of Insurance Programs, Health Benefits Contracts Division 3, 1900 E Street, NW, Washington, DC 20415-3630. 44.
44 Page 45 46
2003 Humana Health Plan, Inc. 42 Section 8
The Disputed Claims process (continued)
Send OPM the following information:
. A statement about why you believe our decision was wrong, based on specific benefit provisions in this
brochure;

. Copies of documents that support your claim, such as physicians' letters, operative reports, bills, medical
records, and explanation of benefits (EOB) forms;

. Copies of all letters you sent to us about the claim;
. Copies of all letters we sent to you about the claim; and
. Your daytime phone number and the best time to call.

Note: If you want OPM to review more than one claim, you must clearly identify which documents apply to which claim.

Note: You are the only person who has a right to file a disputed claim with OPM. Parties acting as your representative, such as medical providers, must include a copy of your specific written consent with the
review request.
Note: The above deadlines may be extended if you show that you were unable to meet the deadline because of reasons beyond your control.

5 OPM will review your disputed claim request and will use the information it collects from you and us to decide whether our decision is correct. OPM will send you a final decision within 60 days. There are no other administrative appeals.
If you do not agree with OPM's decision, your only recourse is to sue. If you decide to sue, you must file the suit against OPM in Federal court by December 31 of the third year after the year in which you received
the disputed services, drugs or supplies or from the year in which you were denied precertification or prior approval. This is the only deadline that may not be extended.

OPM may disclose the information it collects during the review process to support their disputed claim decision. This information will become part of the court record.
You may not sue until you have completed the disputed claims process. Further, Federal law governs your lawsuit, benefits, and payment of benefits. The Federal court will base its review on the record that was
before OPM when OPM decided to uphold or overturn our decision. You may recover only the amount of benefits in dispute.

Note: If you have a serious or life threatening condition (one that may cause permanent loss of bodily functions or death if not treated as soon as possible), and
(a) We haven't responded yet to your initial request for care or preauthorization/ prior approval, then call us at 1-800/ 494-7156 and we will expedite our review; or
(b) We denied your initial request for care or preauthorization/ prior approval, then:
. If we expedite our review and maintain our denial, we will inform OPM so that they can give your claim
expedited treatment too, or

. You may call OPM's Health Benefits Contracts Division 3 at 202/ 606-0737 between 8 a. m. and 5 p. m.
eastern time. 45.
45 Page 46 47
2003 Humana Health Plan, Inc. 43 Section 9
Section 9. Coordinating benefits with other coverage
When you have other health coverage You must tell us if you or a covered family member have coverage under
another group health plan or have automobile insurance that pays health care expenses without regard to fault. This is called "double coverage."

When you have double coverage, one plan normally pays its benefits in full as the primary payer and the other plan pays a reduced benefit as the
secondary payer. We, like other insurers, determine which coverage is primary according to the National Association of Insurance
Commissioners' guidelines.
When we are the primary payer, we will pay the benefits described in this brochure.

When we are the secondary payer, we will determine our allowance. After the primary plan pays, we will pay what is left of our allowance, up
to our regular benefit. We will not pay more than our allowance.
What is Medicare? Medicare is a Health Insurance Program for: . People 65 years of age and older.

. Some people with disabilities, under 65 years of age.
. People with End-Stage Renal Disease (permanent kidney failure
requiring dialysis or a transplant).

Medicare has two parts:
. Part A (Hospital Insurance). Most people do not have to pay for
Part A. If you or your spouse worked for at least 10 years in Medicare-covered employment, you should be able to qualify for premium-free

Part A insurance. (Someone who was a Federal employee on January 1, 1983 or since automatically qualifies.) Otherwise, if you are age 65
or older, you may be able to buy it. Contact 1-800-MEDICARE for more information.

. Part B (Medical Insurance). Most people pay monthly for Part B.
Generally, Part B premiums are withheld from your monthly Social Security check or your retirement check.

If you are eligible for Medicare, you may have choices in how you get your health care. Medicare managed care plan is the term used to
describe the various health plan choices available to Medicare beneficiaries. The information in the next few pages shows how we
coordinate benefits with Medicare, depending on the type of Medicare managed care plan you have.

The Original Medicare Plan (Part A or Part B) The Original Medicare Plan (Original Medicare) is available everywhere
in the United States. It is the way everyone used to get Medicare benefits and is the way most people get their Medicare Part A and Part B benefits.
You may go to any doctor, specialist, or hospital that accepts Medicare. The Original Medicare Plan pays its share and you pay your share. Some
things are not covered under Original Medicare, like prescription drugs.
When you are enrolled in Original Medicare along with this Plan, you still need to follow the rules in this brochure for us to cover your care.
Your care must continue to be authorized by your Plan PCP. 46.
46 Page 47 48
2003 Humana Health Plan, Inc. 44 Section 9
Claims process when you have the Original Medicare Plan You probably will never have to file a claim form when you have both our
Plan and the Original Medicare Plan.
. When we are the primary payer, we process the claim first.
. When Original Medicare is the primary payer, Medicare processes your
claim first. In most cases, your claims will be coordinated automatically and we then provide secondary benefits for covered

charges. You will not need to do anything. To find out if you need to do something to file your claims, contact us at 1-800/ 494-7156 or at
our website: www. humana. com.
We do not waive any costs if the Original Medicare Plan is your primary payer.

(Primary payer chart begins on next page.) 47.
47 Page 48 49
2003 Humana Health Plan, Inc. 45 Section 9
The following chart illustrates whether the Original Medicare Plan or this Plan should be the primary payer for you according to your employment status and other factors determined by Medicare. It is critical that you tell us if you or
a covered family member has Medicare coverage so we can administer these requirements correctly.
Primary Payer Chart
Then the primary payer is A. When either you or your covered spouse are age 65 or
over and Original Medicare This Plan

1) Are an active employee with the Federal government (including when you or a family member are eligible for Medicare solely because of a

disability),
2) Are an annuitant,
3) Are a reemployed annuitant with the Federal government when
a) The position is excluded from FEHB,

b) Or the position is not excluded from FEHB
(Ask your employing office which of these applies to you.)

4) Are a Federal judge who retired under title 28, U. S. C., or a Tax Court judge who retired under Section 7447 of title 26, U. S. C. (or if your

covered spouse is this type of judge),
5) Are enrolled in Part B only, regardless of your employment status, (for Part B
services) (for other services)
6) Are a former Federal employee receiving Workers' Compensation and the Office of Workers' Compensation Programs has determined

that you are unable to return to duty, (except for claims related to Workers' Compensation.)

B. When you or a covered family member have Medicare based on end stage renal disease (ESRD) and
1) Are within the first 30 months of eligibility to receive Part A benefits solely because of ESRD,
2) Have completed the 30-month ESRD coordination period and are still eligible for Medicare due to ESRD,
3) Become eligible for Medicare due to ESRD after Medicare became primary for you under another provision,
C. When you or a covered family member have FEHB and
1) Are eligible for Medicare based on disability, and
a) Are an annuitant, or

b) Are an active employee, or

c) Are a former spouse of an annuitant, or
d) Are a former spouse of an active employee 48.
48 Page 49 50
2003 Humana Health Plan, Inc. 46 Section 9
Medicare managed care plan If you are eligible for Medicare, you may choose to enroll in and get your Medicare benefits from a Medicare managed care plan. These are health
care choices (like HMOs) in some areas of the country. In most Medicare managed care plans, you can only go to doctors, specialists, or
hospitals that are part of the plan. Medicare managed care plans provide all the benefits that Original Medicare covers. Some cover extras, like
prescription drugs. To learn more about enrolling in a Medicare managed care plan, contact Medicare at 1-800-MEDICARE (1-800-633-
4227) or at www. medicare. gov.
If you enroll in a Medicare managed care plan, the following options are available to you:

This Plan and another plan's Medicare managed care plan: You may enroll in another plan's Medicare managed care plan and also
remain enrolled in our FEHB plan. We will still provide benefits when your Medicare managed care plan is primary even out of the managed
care plan's network and/ or service area (if you use our Plan providers), but we will not waive any of our copayments or coinsurance. If you
enroll in a Medicare managed care plan, tell us. We will need to know whether you are in the Original Medicare Plan or in a Medicare managed
care plan so we can correctly coordinate benefits with Medicare.
Suspended FEHB coverage to enroll in a Medicare managed care plan: If you are an annuitant or former spouse, you can suspend your

FEHB coverage and enroll in a Medicare managed care plan, eliminating your FEHB premium. (OPM does not contribute to your Medicare
managed care plan premium.) For information on suspending your FEHB enrollment, 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 unless you involuntarily lose coverage or move out of the
Medicare managed care plan's service area.
. If you do not enroll in
Medicare Part A or Part B If you do not have one or both Parts of Medicare, you can still be covered under the FEHB Program. We will not require you to enroll in Medicare

Part B and, if you can't get premium-free Part A, we will not ask you to enroll in it.

TRICARE and CHAMPVA TRICARE is the health care program for eligible dependents of military persons, and retirees of the military. TRICARE includes the CHAMPUS
program. CHAMPVA provides health coverage to disabled Veterans and their eligible dependents. If TRICARE or CHAMPVA and this Plan
cover you, we pay first. See your TRICARE or CHAMPVA Health Benefits Advisor if you have questions about these programs.

Suspended FEHB coverage to enroll in TRICARE or CHAMPVA: If you are an annuitant or former spouse, you can suspend your FEHB
coverage to enroll in one of these programs, eliminating your FEHB premium. (OPM does not contribute to any applicable plan premiums.)
For information on suspending your FEHB enrollment, 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 unless you involuntarily lose coverage under the program. 49.
49 Page 50 51
2003 Humana Health Plan, Inc. 47 Section 9
Workers' Compensation We do not cover services that: . you need because of a workplace-related illness or injury that the
Office of Workers' Compensation Programs (OWCP) or a similar Federal or State agency determines they must provide; or
. 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 OWCP or similar agency pays its maximum benefits for your treatment, we will cover your care. You must use our providers.

Medicaid When you have this Plan and Medicaid, we pay first.
Suspended FEHB coverage to enroll in Medicaid or a similar State-sponsored program of medical assistance: If you are an annuitant or

former spouse, you can suspend your FEHB coverage to enroll in one of these State programs, eliminating your FEHB premium. For information
on suspending your FEHB enrollment, 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 unless you involuntarily lose coverage under the State program.

When other Government agencies We do not cover services and supplies when a local, State, are responsible for your care or Federal Government agency directly or indirectly pays for them.
When others are responsible When you receive money to compensate you for medical or hospital for injuries care for injuries or illness caused by another person, you must reimburse
us for any expenses we paid. However, 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. 50.
50 Page 51 52
2003 Humana Health Plan, Inc. 48 Section 10
Section 10. Definitions of terms we use in this brochure
Calendar year January 1 through December 31 of the same year. For new enrollees, the calendar year begins on the effective date of their enrollment and
ends on December 31 of the same year.
Coinsurance Coinsurance is the percentage of our allowance that you must pay for your care. See page 12.

Copayment A copayment is a fixed amount of money you pay when you receive covered services. See page 12.
Covered services Care we provide benefits for, as described in this brochure.
Custodial care Services provided to you such as assistance with dressing, bathing, preparation and feeding of special diets, walking, supervision of

medication which is ordinarily self-administered, getting in and out of bed, and maintaining continence which are not likely to improve your
condition. Custodial care that lasts 90 days or more is sometimes known as long term care.

Durable Medical Equipment (DME) Equipment recognized as such by Medicare Part B, that meets all of the
following criteria:
. it can stand repeated use; and
. it is primarily and customarily used to serve a medical purpose rather
than being primarily for comfort or convenience; and

. it is usually not useful to a person in the absence of sickness or
injury; and

. it is appropriate for home use; and
. it is related to the patient's physical disorder; and
. the equipment must be used in the member's home.

Experimental or investigational services A drug, biological product, device, medical treatment, or procedure is
determined to be experimen