U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

This is a general description of the plan changes. This page is not an official statement of benefits. For that, go to the Benefits descriptions in the Plan Brochure. Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.

• For enrollment code 26, your share of the non-Postal premium will increase by 25.0% for Self Only coverage and 32.9% for Self and Family coverage.

• For enrollment code SW, your share of the non-Postal premium will increase by 57.4% for Self Only coverage and 27.7% for Self and Family coverage.

• We now have 4 enrollment codes. Please review the service area information to determine your correct enrollment code for 2004. You must choose an enrollment code based on where you live.

• All current SW1 and SW2 enrollees will be enrolled in the High Option and higher premium codes 4N1 or 4N2. If you actually live in a county that falls under SW1 or SW2 and do not elect the proper code, you will pay the higher premium for 2004. Please review the service area information and call us with questions.

• All current 261 and 262 enrollees should also review the service area carefully. If you live in a county that falls under VJ1 or VJ2, you should make an Open Season change so that you will pay the lower premium rate,

• We now have two benefits options. We are now offering a High Option and Standard Option benefits package. If you were enrolled with us during 2003, we now call that coverage High Option coverage.

• The prescription drug copay for the High Option will increase from $8 generic to $10 generic, $14 brand to $20 brand and $35 non formulary to a $40 non- formulary. Section 5(f)

• The High Option specialty copay will increase from $15 to $20.

• Under the High Option you will pay have a $25 copay for x-rays.

• The High Option emergency room copay will increase from $50 to $75.

• All Self-Administered Injectable Drugs will be covered under your prescription drug benefit subject to the applicable copays.

• Self-Administered Injectable Drugs include the injected drugs for multiple sclerosis, hepatitis C, rheumatoid arthritis, and the blood replenishment drugs such as Procrit and Neupogen.