RI 70 -1
Revised November 2002
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OFFICE OF THE DIRECTOR
UNITED STATES
OFFICE OF PERSONNEL MANAGEMENT
WASHINGTON, DC 20415-0001
Dear Federal Employees Health Benefits Program Participant:
I am pleased to present the Federal Employees Health Benefits (FEHB) Program Guide for the FEHB Open Season. I would like to take this opportunity to encourage you to become informed about your health plan choices this year. In keeping with the President's health care agenda, we are committed to providing FEHB Program members with affordable, quality health care choices. Fundamentally, I believe that FEHB participants are wise enough to determine the care options best suited for themselves and their families.
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 this program a model of consumer choice and on the cutting edge of employer-provided health benefits. I reminded them of President Bush's principles for health care: patient-centered health care, preservation of choice, and excellent quality. I encouraged each plan to explore all reasonable options to hold down premium increases while maintaining a benefits package 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 the plans to provide health plan choices this year that maintain competitive benefit packages and yet keep health care affordable. We will continue on this path.
Now, it is your turn. This is the time to reevaluate your personal needs and to change plans, if necessary, based on those needs. The Guide provides a comparison of the plans, benefits, premiums, results of a customer satisfaction survey and quality information. If you review the Guide and the health plan brochures you will have the information you need to make an informed choice. We suggest you also visit our web site at www.opm.gov/insure.
Sincerely,
Kay Coles James
Director
The information in this Guide gives you an overview of the FEHB Program and its participating plans. Read the plan brochures before you make any final decisions about health plans.
Patient Safety
A 1999 report from the Institute of Medicine estimates that up to 98,000 Americans die every year from medical mistakes in hospitals alone. That's about 3,230 preventable deaths in the FEHB Program a year. While death is the most tragic outcome, medical mistakes cause other problems such as permanent disabilities, extended hospital stays, longer recoveries, and even additional treatments. By asking questions, learning more and understanding your risks, you can improve the safety of your own health care, and that of your family members. Take these simple steps:
1
Speak up if you have questions or concerns. Choose a doctor who you feel comfortable talking to about your health and treatment. Take a relative or friend with you if this will help you ask questions and understand the answers. It's okay to ask questions and to expect answers you can understand.
2
Keep a list of all the medicines you take. Tell your doctor and pharmacist about the medicines that you take, including over-the-counter medicines such as aspirin, ibuprofen, and dietary supplements like vitamins and herbals. Tell them about any drug allergies you have. Ask the pharmacist about side effects and what foods or other things to avoid while taking the medicine. When you get your medicine, read the label, including warnings. Make sure it is what your doctor ordered, and you know how to use it. If the medicine looks different than you expected, ask the pharmacist about it.
3
Make sure you get the results of any test or procedure. Ask your doctor or nurse when and how you will get the results of tests or procedures. If you do not get them when expected -- in person, on the phone, or in the mail - don't assume the results are fine. Call your doctor and ask for them. Ask what the results mean for your care.
4
Talk with your doctor and health care team about your options if you need hospital care. If you have more than one hospital to choose from, ask your doctor which one has the best care and results for your condition. Hospitals do a good job of treating a wide range of problems. However, for some procedures (such as heart bypass surgery), research shows results often are better at hospitals doing a lot of these procedures. Also, before you leave the hospital, be sure to ask about follow-up care, and be sure you understand the instructions.
5
Make sure you understand what will happen if you need surgery. Ask your doctor and surgeon: Who will take charge of my care while I'm in the hospital? Exactly what will you be doing? How long will it take? What will happen after the surgery? How can I expect to feel during recovery? Tell the surgeon, anesthesiologist, and nurses if you have allergies or have ever had a bad reaction to anesthesia. Make sure you, your doctor, and your surgeon all agree on exactly what will be done during the operation.
The Federal Employees Health Benefits (FEHB) Program began operating in July 1960. It is the nation's largest employer-sponsored health insurance program. Almost 8.5 million people are in the Program, including 2.2 million Federal employees, 1.85 million retirees, and eligible family members.
Getting information and selecting a health plan
Use this Guide and plan brochures to make your health plan decision. The Guide summarizes FEHB plans' benefits, costs, and quality performance; the plan brochures give complete benefit and cost information. You can get brochures from the health plans or your human resources office. Our web site www.opm.gov/insure provides the Guide, brochures, and other helpful information.
Before selecting a health plan:
Quality
Quality is how well health plans keep their members healthy or treat them when they are sick. Good quality health care means doing the right thing at the right time, in the right way, for the right person -- and getting the best possible results. Health plan quality can be measured from the enrollees' viewpoint (member surveys) and by the independent evaluations (accreditation) in this Guide.
Member survey results in this Guide were collected, scored, and reported by an independent organization - not by the health plans. Here are the survey categories:
Getting Needed Care. Were you satisfied with the choices your health plan gave you to select a personal doctor? Were you satisfied with the time it takes to get a referral to a specialist?
Getting Care Quickly. Did you get the advice or help you needed when you called your doctor during regular office hours? Could you get an appointment for regular or routine care when you wanted?
How Well Doctors Communicate. Did your doctor listen carefully to you and explain things in a way you could understand? Did your doctor spend enough time with you?
Customer Service. Was your plan helpful when you called its customer service department? Did you have paperwork problems? Were the plan's written materials understandable?
Claims Processing. Did your plan pay your claims correctly and in a reasonable time?
Overall Plan Satisfaction. How would you rate your overall experience with your health plan?
Page 2 To Next Page To Previous PageAccreditation is an approval by a private, independent organization. This approval is given after a nationally recognized organization carefully reviews a health plan and decides if it meets the organization's quality standards.
The National Committee for Quality Assurance (NCQA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and URAC (URAC) are independent, private, not-for-profit organizations dedicated to measuring the quality of health care organizations.
Compare the accreditation status of different health plans with the following key (a lower number means a better accredited plan).Also, you should check your health plan's provider directory to see which provider networks are accredited or credentialed.
Benefits
What type of services do you think you and your family will need? Are there limits on the number of visits for the services you want or the types of services you want? All FEHB plans cover major medical benefits -hospital costs, doctors' inpatient and outpatient visits -but your share of the costs vary by plan. Don't assume benefits will be the same as they were last year.
Cost
The premium you pay is an important consideration. What can you afford biweekly or monthly? Plans that offer two options distinguish the difference between the two by the benefits or services provided, and this in turn affects the premium and out-of-pocket costs you pay. What benefits and services do you need, and how much do you have to pay?
You also need to consider other costs: Check to see how you are protected by the plan's annual out-of-pocket maximum. If you need to go to the hospital, how much will you pay? What will you pay for an emergency room visit? If you have children, what will you pay for a well-child visit? What will you pay for your prescription?
Do you pay a deductible for the services you need? You share medical expenses by paying a coinsurance (a percentage of the bill) or a copayment (a fixed dollar amount). Which option do you prefer? Does the plan limit the dollar amount it pays for certain services, making you pay the rest?
How the Plan Works
Different types of plans help you get and pay for care differently. Fee-For-Service (FFS) plans generally use two approaches. In the first approach, you use a Fee-For-Service plan's Preferred Provider Organization (PPO), which offers you a choice of doctors and hospitals within a network. Most networks are quite wide, but they may not have the specific doctor or hospital you want. Using PPO providers usually will save you money and reduce your paperwork.
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In the second approach, you choose any doctor and hospital. This may be more expensive for you and require extra paperwork.
Enrolling in a FFS plan does not guarantee that a PPO will be available in your area. PPOs have a stronger presence in some regions than others, and in areas where there is no PPO, the non-PPO benefit is the only benefit. In a PPO-only option, you must use the PPO's providers to receive benefits.
Health Maintenance Organizations (HMOs) generally limit their networks of physicians and facilities. You must use their network to get covered services and follow their guidance for referrals, prior authorizations, and other services. HMOs limit your out-of-pocket costs to the relatively low amounts shown in the benefit brochures.
Some plans are Point Of Service (POS) plans and have features similar to both FFS plans and HMOs. POS plans are identified in the charts by lines for "In-Network" and "Out-of-Network."
Be sure to look at the primary care physicians, specialists, and hospitals with whom your health plan contracts (the provider network). Does it have the specialists to treat your chronic condition? Does it contract with primary doctors and hospitals that are convenient to you?
You are in a FFS plan and…
You use the PPO:
You do not use the PPO (or one is not available):
NOTE: APWU's Consumer Driven Option differs from its FFS option in many important ways. Read the brochure for details.
You are in a FFS plan's “PPO-only” option:
You belong to an HMO:
You belong to a POS plan and...
You use only the providers in that network:
You will have very little paperwork
You do not use the network providers or referral
procedures:
Things to do to make a plan work best for you
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Use the FEHB web site for additional help in choosing the health plan that is right for you.
The FEHB web site at www.opm.gov/insure/health can help you to choose your health plan and enroll. In addition to the information found in this Guide you will find:
Program Features
Definitions
Accreditation - A rigorous and comprehensive evaluation performed by independent organizations that includes a review of records as well as on-site reviews of managed care organizations. Accreditation also includes an assessment of the care and service plans are delivering in important areas of public concern such as immunization rates, mammography rates, and member satisfaction. The following three organizations perform accreditation reviews we recognize:
NCQA - The National Committee for Quality Assurance. These are NCQA's accreditation levels.
JCAHO - The Joint Commission on Accreditation of Healthcare Organizations. These are JCAHO's accreditation levels:
Demonstrates satisfactory compliance with JCAHO standards in all performance areas.
URAC - Formerly known as the American Accreditation Healthcare Commission. These are URAC's accreditation levels.
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Coinsurance - The amount you pay as your share of the medical services you receive, like for a doctor's visit. Coinsurance is a percentage of the cost of the service (e.g., 20%).
Consumer Driven Option - A fee-for-service option under the FEHB that offers you greater control over choices of your health care expenditures. You decide which health care services will be reimbursed under the health plan funded Personal Care Account. Unused funds from the account will roll over at the end of the year. If you spend the entire account fund before the end of the year, then you must satisfy a member responsibility/deductible before benefits are payable under the traditional type of insurance covered by your plan. You decide whether to use PPO or Non-PPO providers to reach the maximum fund allowed under your account.
Copayment - The amount you pay as your share of the medical services you receive, like for a doctor's visit. Copayment is a fixed dollar amount (e.g., $15).
Fee-For-Service (FFS) - Health coverage in which doctors and other providers receive a fee for each service such as an office visit, test, procedure, or other health care service. The health plan will either pay the medical provider directly or reimburse you for covered services after you have paid the bill and filed an insurance claim. When you need medical attention, you visit the doctor or hospital of your choice.
Health Maintenance Organization (HMO)- A health plan that provides care through contracted or employed physicians and hospitals located in particular geographic or service areas. HMOs emphasize prevention and early detection of illness. Your eligibility to enroll in an HMO is determined by where you live or, in some plans, where you work.
In-Network - You receive treatment from the doctors, clinics, health centers, hospitals, medical practices, and other providers with whom your plan has an agreement to care for its members. Examples include
a Fee-For-Service plan's PPO or a Health Maintenance Organization. Members have fewer out-of-pocket costs when they use in-network providers.
Managed care - A very broad term that generally refers to a system that manages the quality of health care, access to care, and the cost of that care. For example, a formulary controls the quality of medications dispensed to enrollees; a referral ensures that you see the right specialist for your condition; and going to a hospital that has an agreement with your plan can save both you and the plan money.
Out-of-Network - You receive treatment from doctors, hospitals, and medical practitioners other than those with whom the plan has an agreement, and pay more to do so. Members in a PPO-only option who receive services outside the PPO network generally pay all charges.
Point of Service (POS) - A product offered by an HMO or FFS plan that has both in-network and out-of-network features. In a POS you don't have to use the plan's network of providers, but there are advantages if you do.
Preferred Provider Organization (PPO) - The PPO is similar to FFS insurance except it uses a network of providers. PPOs give you the choice of using doctors and other providers within the plan's network (the PPO benefit), or using ones outside the plan's network. You don't have to use the PPO, but there are advantages if you do. (Be aware, however, that some of the services provided in a PPO hospital may not be covered by PPO arrangements. Room and board will be covered, but anesthesia and radiology, for instance, will probably be covered under non-PPO benefits.) Note that some FFS plans may offer an enrollment option that is “PPO-only.” Under this option you must use network providers to receive benefits.
Provider - A doctor, hospital, health care practitioner, pharmacy, or health care facility.
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Open Season for Long Term Care Insurance
FEHB Doesn't Cover It
You Can Also Apply Later, But…
You Must Act to Receive an Application
Find Out More -- Contact LTC Partners by calling 1-800-LTC-FEDS (1-800-582-3337) (TDD for the hearing impaired: 1-800-843-3557) or visiting www.ltcfeds.com to get more information and to request an application.
Fraud increases the cost of health care for everyone and increases your Federal Employees Health Benefits Program (FEHBP) premium. OPM's Office of the Inspector General investigates all allegations of fraud, waste, and abuse in the FEHBP 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:
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
Want more information on health care quality and safety? The following web sites have information consumers can use when considering health plans, doctors and hospitals, medications, and more.
www.ihealthcoalition.org/content/tips.html
www.ahrq.gov/consumer/pathqpack.htm
www.talkaboutrx.org/consumer.html
www.nchc.org/releases/medical_error.pdf
Nationwide Fee-For-Service Plans
Open to All
(Pages 12 through 14)
Fee-For-Service (FFS) Plans with a Preferred Provider Organization (PPO) - A FFS option that allows you to see medical providers who reduce their charges to the plan; you pay less money out-of-pocket when you use a PPO provider. When you visit a PPO you usually won't have to file claims or paperwork. However, going to a PPO hospital does not guarantee PPO benefits for all services received within that hospital. For instance, lab work and radiology services from independent practitioners within the hospital may not be covered by the PPO agreement.
Fee-For-Service (FFS) Plans (non-PPO) - A traditional type of insurance in which the health plan will either pay the medical provider directly or reimburse you after you have filed an insurance claim for each covered medical expense. When you need medical attention, you visit the doctor or hospital of your choice.
In PPO-only options, you must use PPO providers to receive benefits.
Consumer Driven Option offers three major benefit elements.
A) In-Network Preventive Care - you pay nothing for preventive services provided in PPO. Your in-network preventive care does not count against your Personal Care Account.
B) Personal Care Account - you pay nothing for the first $1,000 ($2,000 for self and family enrollment) in covered services by your FFS plan. A PPO or Non-PPO provider may provide your service. These services may include limited dental and vision care that you select.
C) Traditional Health Care - you pay stated coinsurance after spending the amount allowed in the Personal Care Account and satisfy the member responsibility/deductible. A PPO or Non-PPO provider may provide your service.
Nationwide Fee-for-Service Plans Open to All
How to read this chart:
The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. The chart does not show all of your possible out-of-pocket costs.
The Premium shown is not for part-time employees. See your human resources office for details.
The Deductibles shown are the amount of covered expenses that you pay before your health plan begins to pay. Calendar Year deductibles for families are two or more times the per person amount shown.
In some plans your combined Prescription Drug purchases from Home delivery and local pharmacies count toward the deductible. In other plans only purchases from local pharmacies count. Some plans require each family member to meet a per person deductible.
The Per Stay Hospital Inpatient deductible is what you pay each time you are admitted to a hospital.
What you pay for Doctors (inpatient visits and surgical services) and Outpatient Tests (provided, or ordered, and billed by a physician or physicians' group).
| Plan name | Telephone number | Enrollment code | Your share of premium | ||||
|---|---|---|---|---|---|---|---|
| Monthly | Biweekly | ||||||
| Self only | Self & family | Self only | Self & family | Self only | Self & family | ||
| Alliance Health Plan (AHP) | 202/939-6325 | 1R1 | 1R2 | 157.06 | 294.19 | 72.49 | 135.78 |
| APWU Health Plan-High (APWU) | 800/222-2798 | 471 | 472 | 112.84 | 226.49 | 52.08 | 104.53 |
| APWU Health Plan-Consumer Driven (APWU) | 800/222-2798 | 474 | 475 | 78.87 | 186.99 | 36.40 | 86.30 |
| Blue Cross and Blue Shield Service Benefit Plan-Std (BCBS) | Local phone # | 104 | 105 | 98.93 | 227.98 | 45.66 | 105.22 |
| Blue Cross and Blue Shield Service Benefit Plan-Basic (BCBS) | Local phone # | 111 | 112 | 75.82 | 178.26 | 34.99 | 82.27 |
| GEHA Benefit Plan-High (GEHA) | 800/821-6136 | 311 | 312 | 145.53 | 291.29 | 67.17 | 134.44 |
| GEHA Benefit Plan-Std (GEHA) | 800/821-6136 | 314 | 315 | 59.58 | 135.42 | 27.50 | 62.50 |
| Mail Handlers-High (MH) | 800/410-7778 | 451 | 452 | 139.29 | 252.51 | 64.29 | 116.54 |
| Mail Handlers-Std (MH) | 800/410-7778 | 454 | 455 | 60.86 | 132.11 | 28.09 | 60.97 |
| NALC | 888/636-6252 | 321 | 322 | 104.95 | 189.48 | 48.44 | 87.45 |
| PBP Health Plan-High (PBP) | 800-544-7111 | 361 | 362 | 346.27 | 717.21 | 159.82 | 331.02 |
| PBP Health Plan-Std (PBP) | 800-544-7111 | 364 | 365 | 104.97 | 233.35 | 48.45 | 107.70 |
Your share of Hospital Inpatient Room and Board and Other (e.g., nursing, supplies, and medications) covered charges are shown, usually after any per stay deductible. Services provided and billed by the hospital for outpatient care (other than surgery) are shown as Hospital Outpatient Other expenses.
A Generic drug is a copy of the manufacturer's Brand Name drug and is approved by the Food and Drug Administration. Non-formulary drugs are Brand Names that are not on your health plan's list of preferred drugs.
Prescription drug benefits have become more complex as you can see from the many variations below. Multiple numbers for a plan mean there are different levels of cost sharing. For instance, you may pay one amount for your first prescription (e.g., 10% or $5) and then a different amount for some refills (e.g., 50%). You may have to pay the greater of a dollar amount or a percentage (e.g., $10 or 20%). In some cases, you'll pay less for a Brand Name drug that has no Generic equivalent than for a Brand Name that has a Generic (e.g., $15 versus $30). A few plans have lower copays for Medicare members. Plans vary in the number of days supply of drugs you get for the copays shown, and you'll almost always pay more if you use a non-PPO pharmacy (e.g., the + sign means you pay the amount shown plus a differential.) Read the brochures for details.
| Plan | Benefit type | Medical Surgical - You pay | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Deductible | Copay ($)/Coinsurance (%) | ||||||||||||
| Per Person | Per stay Hospital inpatient | Doctors & Outpatient Tests | Hospital | Prescription drugs | |||||||||
| Inpatient | Outpatient Other | Generic | Brand Name | Non- Formulary | Home Delivery | ||||||||
| Calendar Year | Prescription Drug | R&B | Other | Generic | Brand Name | ||||||||
| AHP | PPO | $200 | $200 | $150 | 10% | 10% | 10% | 10% | 10%/50% | 15%/50% | 15%/50% | 20% | 25% |
| Non-PPO | $400 | $200 | $250 | 30% | 30% | 30% | 30% | 10%/50% + | 15%/50%+ | 15%/50%+ | 20% | 25% | |
| APWU-High | PPO | $275 | None | None | 10% | 10% | 10% | 10% | $7 | 25% | 25% | $10 | 20% |
| Non-PPO | $350 | None | $200 | 30% | 30% | 30% | 30% | 45% | 45% | 45% | $10 | 20% | |
| APWU | See pages 7 and 11 of this Guide for a benefit description, and carefully read the APWU brochure for details. | ||||||||||||
| BCBS-Std | PPO | $250 | None | $100 | 10% | Nothing | Nothing | 10% | 25% | 25% | 25% | $10/25% | $35/25% |
| Non-PPO | $250 | None | $300 | 25% | 30% | 30% | 25% | 45%+ | 45%+ | 45%+ | 45%+ | 45%+ | |
| BCBS-Basic | PPO | None | None | $100 day/x5 | $20/$30 | Nothing | Nothing | $30 | $10 | $25 | $35 or 50% | $10* | $25* |
| GEHA-High | PPO | $350 | None | $100 | 10% | Nothing | 10% | 10% | $5/50% | $25/50% | $20/$35/50% | $10 | $40/$55 |
| Non-PPO | $350 | None | $300 | 25% | Nothing | 25% | 25% | $5/50% + | $20/50% + | $20/$35/50% + | $10 | $40/$55 | |
| GEHA-Std | PPO | $450 | None | None | 15% | 15% | 15% | 15% | $5 | 50% | 50% | $15 | 50% |
| Non-PPO | $450 | None | None | 35% | 35% | 35% | 35% | $5 + | 50% + | 50% + | $15 | 50% | |
| MH-High | PPO | $250 | $250 | None | 10% | Nothing | Nothing | 10% | $7 | $23 | $35 | $10 | $30/$45 |
| Non-PPO | $250 | $250 | $250 | 30% | Nothing | Nothing | 30% | 50% | 50% | 50% | $10 | $30/$45 | |
| MH-Std | PPO | $300 | $600 | $150 | 10% | Nothing | Nothing | 10% | $8 | $28 | $40 | $10 | $40/$55 |
| Non-PPO | $300 | $600 | $300 | 30% | Nothing | Nothing | 30% | 50% | 50% | 50% | $10 | $40/$55 | |
| NALC | PPO | $250 | None | None | 15% | 10% | 10% | 15% | 25% | 25% | 25% | $10 | $30 |
| Non-PPO | $300 | $25 for Retail | $100 | 30% | 30% | 30% | 30% | 40%+ | 40%+ | 40%+ | $10 | $30 | |
| PBP-High | PPO | $200 | $90 | None | 10% | 10% | 10% | 10% | $3 | $25 or 20% | $40 or 20% | $6 | $25/ |
| Non-PPO | $450 | $90 | $150 | 15%-25% | 25% | 25% | 25% | 20%+ | 20%+ | 20%+ | $6 | $40 or 20% | |
| PBP-Std | PPO | $250 | $90 | None | 9% | 9% | 9% | 9% | $4 | $30 or 20% | $40 or 20% | $8 | $30/ |
| Non-PPO | $500 | $90 | $250 | 30% | 30% | 30% | 30% | 30%+ | 30%+ | 30%+ | $8 | $40 or 20% | |
* Home delivery is available from Internet pharmacies and may be available from certain retail pharmacies. The Mail Service Program is not available under Basic Option.
Nationwide Fee-for-Service Plans Open to All
Member Survey Results - See page 1 for a description.
| Plan name | Member Survey Results | ||||||
|---|---|---|---|---|---|---|---|
| Plan code | Overall plan satisfaction | Getting needed care | Getting care quickly | How well doctors communicate | Customer service | Claims processing | |
| Alliance Health Plan | 1R | Average | Average | Above Average | Above Average | Average | Average |
| APWU Health Plan-High | 47 | Above Average | Average | Average | Average | Above Average | Above Average |
| APWU Health Plan-Consumer Driven | 47 | ||||||
| Blue Cross and Blue Shield Service Benefit Plan-Std | 10 | Below Average | Average | Below Average | Average | Average | Below Average |
| Blue Cross and Blue Shield Service Benefit Plan-Basic | 11 | : | : | : | : | : | |
| GEHA Benefit Plan-High | 31 | Above Average | Average | Below Average | Below Average | Above Average | Above Average |
| GEHA Benefit Plan-Std | 31 | Above Average | Average | Below Average | Below Average | Above Average | Above Average |
| Mail Handlers-High | 45 | Below Average | Below Average | Below Average | Average | Average | Below Average |
| Mail Handlers-Std | 45 | Below Average | Below Average | Below Average | Average | Average | Below Average |
| NALC | 32 | Above Average | Above Average | Above Average | Above Average | Above Average | Above Average |
| PBP Health Plan-High | 36 | Below Average | Average | Above Average | Above Average | Below Average | Below Average |
| PBP Health Plan-Std | 36 | Below Average | Average | Above Average | Above Average | Below Average | Below Average |
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Nationwide Fee-For-Service Plans
Open Only to Specific Groups
(Pages 16 through 18)
Fee-For-Service (FFS) Plans with a Preferred Provider Organization (PPO) - A FFS option that allows you to see medical providers who reduce their charges to the plan; you pay less money out-of-pocket when you use a PPO provider. When you visit a PPO you usually won't have to file claims or paperwork. However, going to a PPO hospital does not guarantee PPO benefits for all services received within that hospital. For instance, lab work and radiology services from independent practitioners within the hospital may not be covered by the PPO agreement.
Fee-For-Service (FFS) Plans (non-PPO) - A traditional type of insurance in which the health plan will either pay the medical provider directly or reimburse you after you have filed an insurance claim for each covered medical expense. When you need medical attention, you visit the doctor or hospital of your choice.
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Nationwide Fee-for-Service Plans Open Only to Specific Groups
How to read this chart:
The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. The chart does not show all of your possible out-of-pocket costs.
The Premium shown is not for part-time employees. See your human resources office for details.
The Deductibles shown are the amount of covered expenses that you pay before your health plan begins to pay. Calendar Year deductibles for families are two or more times the per person amount shown. Some plans apply Prescription Drug purchases to the Calendar Year deductible.
The Per Stay Hospital Inpatient deductible is what you pay each time you are admitted to a hospital.
What you pay for Doctors (inpatient visits and surgical services) and Outpatient Tests (provided, or ordered, and billed by a physician or physicians' group).
| Plan name | Telephone number | Enrollment code | Your share of premium | ||||
|---|---|---|---|---|---|---|---|
| Monthly | Biweekly | ||||||
| Self only | Self & family | Self only | Self & family | Self only | Self & family | ||
| Association Benefit Plan (ABP) | 800/634-0069 | 421 | 422 | 118.19 | 276.99 | 54.55 | 127.84 |
| Foreign Service Benefit Plan (FS) | 202/833-4910 | 401 | 402 | 85.06 | 240.92 | 39.26 | 111.19 |
| Panama Canal Area Benefit Plan (PCA) | 800/548-8969 | 431 | 432 | 78.52 | 163.90 | 36.24 | 75.65 |
| Rural Carrier Benefit Plan (Rural) | 800/638-8432 | 381 | 382 | 153.14 | 253.46 | 70.68 | 116.98 |
| SAMBA | 800/638-6589 | 441 | 442 | 159.59 | 392.73 | 73.66 | 181.26 |
| Secret Service (SS) | 800/424-7474 | Y71 | Y72 | 80.49 | 211.17 | 37.15 | 97.46 |
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Your share of Hospital Inpatient Room and Board and Other (e.g., nursing, supplies, and medications) covered charges are shown, usually after any per stay deductible. Services provided and billed by the hospital for outpatient care (other than surgery) are shown as Hospital Outpatient Other expenses.
A Generic drug is a copy of the manufacturer's Brand Name drug and is approved by the Food and Drug Administration. Non-formulary drugs are Brand Names that are not on your health plan's list of preferred drugs.
Prescription drug benefits have become more complex as you can see from the many variations below. Multiple numbers for a plan mean there are different levels of cost sharing. For instance, you may pay one amount for your first prescription (e.g., 10% or $5) and then a different amount for some refills (e.g. 50%). You may have to pay the greater of a dollar amount or a percentage (e.g., $10 or 20%). In some cases, you'll pay less for a Brand Name drug that has no Generic equivalent than for a Brand Name that has a Generic (e.g., $15 versus $30). A few plans have lower copays for Medicare members. Plans vary in the number of days supply of drugs you get for the copays shown, and you'll almost always pay more if you use a non-PPO pharmacy (e.g., the + sign means you pay the amount shown plus a differential). Read the brochures for details.
| Plan | Benefit type | Medical Surgical - You pay | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Deductible | Copay ($)/Coinsurance (%) | ||||||||||||
| Per Person | Per stay Hospital inpatient | Doctors & Outpatient Tests | Hospital | Prescription drugs | |||||||||
| Inpatient | Outpatient Other | Generic | Brand Name | Non- Formulary | Home Delivery | ||||||||
| Calendar Year | Prescription Drug | R&B | Other | Generic | Brand Name | ||||||||
| ABP | PPO | $300 | None | $100 | 10% | Nothing | Nothing | 10% | $10 | $20 | $30/30% | $20 | $40/ |
| Non-PPO | $300 | None | $200 | 30% | 30% | 30% | 30% | $10 | $20 | $30/30% | $20 | $45 or 30% | |
| FS | PPO | $300 | None | Nothing | 10% | Nothing | Nothing | 10% | $10/25% | $20/25% | $20/25% | $20 | $40 |
| Non-PPO | $300 | None | $200 | 30% | 20% | 20% | 30% | $10/25% | $20/25% | $20/25% | $20 | $40 | |
| PCA | POS | None | $400 | $50 | Nothing | Nothing | Nothing | Nothing | 50% | 50% | 50% | N/A | N/A |
| FFS | None | $400 | $125 | 50% | 50% | 50% | 50% | 50% | 50% | 50% | 50% | N/A | |
| Rural | PPO | $350 | CY Applies | Nothing | 10% | Nothing | Nothing | 15% | 25% | 25% | 25% | $15 | $25 |
| Non-PPO | $350 | CY Applies | $200 | 15% | 15% | 15% | 25% | 25% | 25% | 25% | $15 | $25 | |
| SAMBA | PPO | $350 | None | $200 | 10% | Nothing | 10% | $100/10% | $10 | $25 | $40 | $10 | $35/$50 |
| Non-PPO | $350 | None | $300 | 30% | 30% | 30% | $150/30% | $10 | $25 | $40 | $10 | $35/$50 | |
| SS | No PPO | $200 | None | $100 | 20% | Nothing | Nothing | Nothing | $10 | $20 | $20 | $20 | $40 |
*The Panama Canal Area Plan provides a point-of-service product within the Republic of Panama.
Page 18 To Next Page To Previous Page
Nationwide Fee-for-Service Plans Open Only to Specific Groups
Member Survey Results - See page 1 for a description.
| Plan name | Member Survey Results | ||||||
|---|---|---|---|---|---|---|---|
| Plan code | Overall plan satisfaction | Getting needed care | Getting care quickly | How well doctors communicate | Customer service | Claims processing | |
| Association Benefit Plan | 42 | Above Average | Average | Average | Below Average | Above Average | Average |
| Foreign Service Benefit Plan | 40 | Average | Below Average | Average | Below Average | Below Average | Average |
| Panama Canal Area Benefit Plan | 43 | ||||||
| Rural Carrier Benefit Plan | 38 | Above Average | Above Average | Above Average | Average | Above Average | Above Average |
| SAMBA | 44 | Average | Below Average | Average | Average | Below Average | Below Average |
| Secret Service | Y7 | Below Average | Above Average | Below Average | Average | Below Average | Below Average |
Page 19 To Next Page To Previous Page
Health Maintenance Organization Plans and Plans Offering a Point of Service Product
(Pages 20 through 45)
Health Maintenance Organization (HMO) - A health plan that provides care through a network of physicians and hospitals in particular geographic or service areas. HMOs coordinate the health care service you receive and free you from completing paperwork or being billed for covered services. Your eligibility to enroll in an HMO is determined by where you live or, for some plans, where you work. Some HMOs are affiliated with or have arrangements with HMOs in other service areas for non-emergency care if you travel or are away from home for extended periods. Plans that offer reciprocity discuss it in their brochure.
Plans Offering a Point of Service (POS) Product - A product similar to an HMO and FFS plan.
The POS product lets you use providers who are not part of the HMO network. However, you pay more for using these non-network providers. You usually pay higher deductibles and coinsurances than you pay with a plan provider. You will also need to file a claim for reimbursement, like in a FFS plan. The HMO plan wants you to use its network of providers, but recognizes that sometimes enrollees want to choose their own provider.
The POS plans have two rows for “In Network” and “Out of Network” benefits. In Network shows what you pay if you go to the plan's providers; Out of Network shows what you pay if you decide not to go to the plan's providers.
Health Maintenance Page 20 To Next Page To Previous Page
Organization (HMO) and Point of Service (POS) Plans
How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs.
The Premium shown is not for part-time employees. See your human resources office for details.
Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor.
Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital.
| Plan name - location | Telephone number | Enrollment code | Your share of premium | Accredited | ||||
|---|---|---|---|---|---|---|---|---|
| Monthly | Biweekly | |||||||
| Self only | Self & family | Self only | Self & family | Self only | Self & family | |||
| Alabama | ||||||||
| PrimeHealth of Alabama, Inc. - Southern Alabama and the Montgomery Area | 800/236-9421 | AA1 | AA2 | 57.64 | 147.70 | 26.60 | 68.17 | |
| The Oath - A Health Plan for Alabama, Inc. - Birmingham/Other Areas | 800/947-5093 | DF1 | DF2 | 97.22 | 314.28 | 44.87 | 145.05 | |
| Arizona | ||||||||
| Aetna Health Inc. - Phoenix/Tucson Areas | 800/537-9384 | WQ1 | WQ2 | 56.58 | 155.40 | 26.11 | 71.72 | NCQA 1 |
| Health Net of Arizona, Inc. - Maricopa/Pima/Other AZ counties | 800/289-2818 | A71 | A72 | 69.11 | 175.10 | 31.90 | 80.82 | NCQA 2 |
| PacifiCare Health Plans - Maricopa/Pima/parts of Apache Junction | 800/531-3341 | A31 | A32 | 70.39 | 232.53 | 32.49 | 107.32 | NCQA 1 |
| California | ||||||||
| Aetna Health Inc. - Southern California Area | 800/537-9384 | 2X1 | 2X2 | 58.49 | 138.75 | 26.99 | 64.04 | NCQA 2 |
| Blue Cross- HMO - Most of California | 800/235-8631 | M51 | M52 | 72.25 | 196.46 | 33.34 | 90.67 | NCQA 2 |
| Blue Shield of CA Access+ - Most of California | 800/880-8086 | SJ1 | SJ2 | 70.92 | 175.93 | 32.73 | 81.20 | NCQA 2 |
| CIGNA HealthCare of California - Northern/Southern California | 800/244-6224 | 9T1 | 9T2 | 72.54 | 159.61 | 33.48 | 73.67 | NCQA 2 |
| Health Net - Most of California | 800/522-0088 | LB1 | LB2 | 68.19 | 161.43 | 31.47 | 74.50 | NCQA 2 |
| Kaiser Permanente - Northern California | 800/464-4000 | 591 | 592 | 74.81 | 178.58 | 34.53 | 82.42 | NCQA 1 |
| Kaiser Permanente - Southern California | 800/464-4000 | 621 | 622 | 70.04 | 161.90 | 32.33 | 74.72 | NCQA 1 |
| PacifiCare Health Plans - Most of California | 800/531-3341 | CY1 | CY2 | 57.20 | 148.04 | 26.40 | 68.32 | NCQA 1 |
| UHP Healthcare - LA/Orange/San Bernardino Counties | 800/544-0088 | C41 | C42 | 57.09 | 121.57 | 26.35 | 56.11 | JCAHO 1 |
| Universal Care - Southern California | 800/257-3087 | 6Q1 | 6Q2 | 56.36 | 148.81 | 26.01 | 68.68 | NCQA 2 |
| Colorado | ||||||||
| Kaiser Permanente - Denver/Colorado Springs Areas | 800/632-9700 | 651 | 652 | 72.75 | 221.57 | 33.58 | 102.26 | NCQA 1 |
| PacifiCare of Colorado-High -Denver/Colorado Springs/Ft.Collins | 800/877-9777 | D61 | D62 | 78.69 | 277.53 | 36.32 | 128.09 | NCQA 1 |
| PacifiCare of Colorado-Std - Denver/Colorado Springs/Ft.Collins | 800/877-9777 | D64 | D65 | 56.21 | 146.14 | 25.94 | 67.45 | NCQA 1 |
Page 21 To Next Page To Previous Page
Prescription drugs - Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan's preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two.
Member Survey Results - See page 1 for a description.
Accredited - The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 2 and 6 for details. A lower number means a better accreditation.
| Plan name | Primary care doctor office copay | Specialist office copay | Hospital per stay deductible/copay | Prescription drugs | Member Survey Results | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Generic | Brand Name | Non- formulary | Overall plan satisfactioni | Getting needed care | Getting care quickly | How well doctors communicate | Customer service | Claims processing | ||||
| Alabama | ||||||||||||
| PrimeHealth of Alabama, Inc. | $15 | $25 | $150/day x 4 | $10 | $20 | $40 | Average | Average | Above Average | Above Average | Average | Average |
| The Oath - A Health Plan for Alabama, Inc. | $20 | $20 | $100 | $10 | $20 | $30 | Above Average | Average | Above Average | Above Average | Average | Average |
| Arizona | ||||||||||||
| Aetna Health Inc. | $20 | $25 | $250/day x 3 | $10 | $25 | $40 | Average | Below Average | Below Average | Below Average | Below Average | Average |
| Health Net of Arizona, Inc. | $10 | $10 | $100/day x 5 | $10 | $30 | $45 | Below Average | Below Average | Below Average | Below Average | Below Average | Below Average |
| PacifiCare Health Plans | $10 | $20 | None | $10 | $20 | $20 | Below Average | Below Average | Below Average | Average | Average | Average |
| California | ||||||||||||
| Aetna Health Inc. | $20 | $25 | $250/day x 3 | $10 | $25 | $40 | Below Average | Below Average | Below Average | Below Average | Below Average | Below Average |
| Blue Cross- HMO | $10 | $10 | None | $5 | $10 | 50% | Below Average | Below Average | Below Average | Average | Average | Average |
| Blue Shield of CA Access+ | $10 | $10 | None | $5 | $10 | $25 | Average | Below Average | Below Average | Average | Average | Average |
| CIGNA HealthCare of California | $15 | $25 | $250 | $7 | $15 | $35 | Below Average | Below Average | Below Average | Below Average | Below Average | Below Average |
| Health Net | $10 | $10 | $100 | $10 | $20 | $35 | Below Average | Below Average | Below Average | Below Average | Below Average | Below Average |
| Kaiser Permanente | $15 | $15 | None | $10 | $25 | $25 | Average | Average | Below Average | Below Average | Average | Average |
| Kaiser Permanente | $10 | $10 | None | $10 | $25 | $25 | Average | Average | Above Average | Below Average | Above Average | Average |
| PacifiCare Health Plans | $10 | $20 | None | $10 | $20 | $20 | Average | Below Average | Below Average | Below Average | Below Average | Average |
| UHP Healthcare | $10 | $10 | None | $10 | $20 | $20 | ||||||
| Universal Care | $10 | $10 | $100/day x 3 | $10 | $20 | $30 | Average | Below Average | Below Average | Average | Average | Average |
| Colorado | ||||||||||||
| Kaiser Permanente | $10 | $20 | $100 | $10 | $20 | $20 | Average | Average | Below Average | Below Average | Average | Average |
| PacifiCare of Colorado-High | $10 | $20 | $100 | $10 | $20 | $30 | Below Average | Below Average | Average | Average | Average | Average |
| PacifiCare of Colorado-Std | $15 | $30 | $300 | $10 | $30 | $40 | Below Average | Below Average | Average | Average | Average | Average |
Page 22 To Next Page To Previous Page
Health Maintenance Organization (HMO) and Point of Service (POS) Plans
How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs.
The Premium shown is not for part-time employees. See your human resources office for details.
Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor.
Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital.
| Plan name - location | Telephone number | Enrollment code | Your share of premium | Accredited | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Monthly | Biweekly | |||||||||||
| Self only | Self & family | Self only | Self & family | Self only | Self & family | |||||||
| Connecticut | ||||||||||||
| ConnectiCare - All of Connecticut | 800/251-7722 | TE1 | TE2 | 72.95 | 223.28 | 33.67 | 103.05 | NCQA 1 | ||||
| District of Columbia | ||||||||||||
| Aetna Health Inc.-High -Washington, DC Area | 800/537-9384 | JN1 | JN2 | 76.61 | 172.55 | 35.36 | 79.64 | NCQA 1 | ||||
| Aetna Health Inc.-Std - Washington, DC Area | 800/537-9384 | JN4 | JN5 | 57.27 | 134.04 | 26.43 | 61.86 | NCQA 1 | ||||
| CareFirst BlueChoice - Washington, D.C. Metro Area | 866/520-6099 | 2G1 | 2G2 | 111.39 | 242.58 | 51.41 | 111.96 | NCQA 1 | ||||
| Kaiser Permanente - Washington, DC Area | 301/468-6000 | E31 | E32 | 66.75 | 158.86 | 30.81 | 73.32 | NCQA 2 | ||||
| MD-IPA - Washington, DC Area | 800/251-0956 | JP1 | JP2 | 75.18 | 181.03 | 34.70 | 83.55 | NCQA 1 | ||||
| Florida | ||||||||||||
| Av-Med Health Plan (North Florida) - Tampa | 800/882-8633 | EM1 | EM2 | 76.87 | 304.81 | 35.48 | 140.68 | NCQA 2 | ||||
| Av-Med Health Plan (South Florida) - Broward, Dade and Palm Beach | 800/882-8633 | ML1 | ML2 | 67.98 | 206.92 | 31.38 | 95.50 | NCQA 2 | ||||
| Capital Health Plan - Tallahassee Area | 850/383-3311 | EA1 | EA2 | 76.93 | 277.14 | 35.50 | 127.91 | NCQA 1 | ||||
| Foundation Health - Southern Florida | 800/441-5501 | 5E1 | 5E2 | 49.32 | 135.65 | 22.76 | 62.61 | NCQA 2 | ||||
| Healthplan Southeast - North Florida | 850/668-3000 | RK1 | RK2 | 70.10 | 207.87 | 32.35 | 95.94 | |||||
| Humana Medical Plan - South Florida | 888/393-6765 | EE1 | EE2 | 64.38 | 160.96 | 29.71 | 74.29 | URAC 1 | ||||
| JMH Health Plan - Broward-Dade counties | 800/721-2993 | J81 | J82 | 52.49 | 129.13 | 24.23 | 59.60 | |||||
| Total Health Choice - Broward/Dade/Palm Beach Counties | 305/408-5823 | 4A1 | 4A2 | 63.27 | 157.63 | 29.20 | 72.75 | |||||
| Vista Healthplan - South Florida | 866/847-8235 | 3N1 | 3N2 | 74.62 | 292.01 | 34.44 | 134.77 | NCQA 2 | ||||
| Georgia | ||||||||||||
| Aetna Health Inc. - Atlanta and Athens Areas | 800/537-9384 | 2U1 | 2U2 | 75.57 | 188.31 | 34.88 | 86.91 | NCQA 1 | ||||
| Kaiser Permanente - Atlanta Area | 800/611-1811 | F81 | F82 | 62.38 | 158.38 | 28.79 | 73.10 | NCQA 1 | ||||
Page 23 To Next Page To Previous Page
Prescription drugs - Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan's preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two.
Member Survey Results - See page 1 for a description.
Accredited - The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 2 and 6 for details. A lower number means a better accreditation.
| Plan name | Primary care doctor office copay | Specialist office copay | Hospital per stay deductible/copay | Prescription drugs | Member Survey Results | |||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Generic | Brand Name | Non- formulary | Overall plan satisfactioni | Getting needed care | Getting care quickly | How well doctors communicate | Customer service | Claims processing | ||||
| Connecticut | ||||||||||||
| ConnectiCare | $10 | $10 | None | $10 | $20 | $35 | Above Average | Above Average | Above Average | Average | Above Average | Above Average |
| District of Columbia | ||||||||||||
| Aetna Health Inc.-High | $15 | $20 | $150/day x 3 | $10 | $25 | $40 | Average | Average | Average | Average | Average | Average |
| Aetna Health Inc.-Std | $20 | $25 | $250/day x 3 | $10 | $25 | $40 | Average | Average | Average | Average | Average | Average |
| CareFirst BlueChoice | $20 | $30 | None | $10 | $20 | $35 | Average | Average | Below Average | Below Average | Below Average | Below Average |
| Kaiser Permanente | $10 | $20 | $100 | $10 $20Net | $20 $40Net | $20 $40Net | Average | Average | Average | Below Average | Above Average | Average |
| MD-IPA | $10 | $20 | None | $8 | $17 | $33 | Above Average | Above Average | Average | Average | Above Average | Average |
| Florida | ||||||||||||
| Av-Med Health Plan (North Florida) | $20 | $30 | $100/day x 5 | $15 | $30 | $50 | Average | Below Average | Below Average | Average | Average | Average |
| Av-Med Health Plan (South Florida) | $15 | $15 | $100 | $10 | $20 | $30 | Average | Below Average | Below Average | Average | Average | Average |
| Capital Health Plan | $10 | $10 | $100 | $7 | $20 | $35 | Above Average | Above Average | Average | Average | Above Average | Above Average |
| Foundation Health | $10 | $15 | $200 | $7 | $14 | $34 | Below Average | Below Average | Below Average | Below Average | Below Average | Average |
| Healthplan Southeast | $10 | $10 | Nothing | $7 | $20 | $35 | ||||||
| Humana Medical Plan | $10 | $20 | $100/day x 3 | $5/$20 | $20/$40 | $100 | Average | Below Average | Below Average | Below Average | Average | Average |
| JMH HEALTH PLAN | $10 | $10 | None | $5 | 50% | 50% | ||||||
| Total Health Choice | $10 | $10 | $100 | $5 | $15 | $15 | ||||||
| Vista Healthplan | $10 | $20 | $250 | $10 | $20 | $40 | Below Average | Average | Below Average | Average | Average | Average |
| Georgia | ||||||||||||
| Aetna Health Inc. | $20 | $25 | $250/day x 3 | $10 | $25 | $40 | Average | Below Average | Below Average | Average | Average | Average |
| Kaiser Permanente | $10 | $10 | None | $10 $16Com | $10 $16Com | $10 $16Com | Above Average | Above Average | Average | Average | Above Average | Average |
Page 24 To Next Page To Previous Page
Health Maintenance Organization (HMO) and Point of Service (POS) Plans
How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs.
The Premium shown is not for part-time employees. See your human resources office for details.
Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor.
Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital.
| Plan name - location | Telephone number | Enrollment code | Your share of premium | Accredited | ||||
|---|---|---|---|---|---|---|---|---|
| Monthly | Biweekly | |||||||
| Self only | Self & family | Self only | Self & family | Self only | Self & family | |||
| Guam | ||||||||
| PacifiCare Asia Pacific-High -Guam/N. Mariana Islands/Palau | 671/647-3526 | JK1 | JK2 | 64.19 | 168.66 | 29.62 | ||