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.

• If you are enrolled in Code 2N, your share of the non-Postal premium will increase by 4.5% for Self Only coverage and decrease 9.1% for Self and Family coverage.

• If you are enrolled in Code GF, your share of the non-Postal premium will increase by 27.8% for Self Only coverage and decrease 10.9% for Self and Family coverage.

• Office visit copayments - You now pay a $20 copayment for visits to your primary care physician and a $40 copayment for visits to specialists, including behavioral health specialist.

• Prescription drugs - You now pay $20 for generic formulary drugs, $40 for brand-name formulary. You pay two copayments per 90-day supply through the mail order program.

• Prescription drugs - You may now purchase non-formulary drugs for a $50 copayment per 30-day supply.

  >Maternity care - You now pay a single $40 copayment for the entire pregnancy.

• Inpatient hospital - You now pay $400 copayment per day up to 5 days per admission.

• Lab, X-ray and other diagnostic tests - You now pay a $200 copayment for all specialized scanning exams, such as, MRI, CT Scans, PET Scans and SPECT Scans.

• Treatment therapy - You now pay a $40 copayment per treatment for chemotherapy and radiation therapy.

• Skilled nursing facility - You now pay a $200 copayment per day up to 5 days per admission to a skilled nursing facility. All necessary services will be covered up to 100 consecutive days per qualifying condition per calendar year.

• Outpatient hospital or ambulatory surgical center - You now pay a $200 copayment per outpatient surgery or procedure.

• Emergency services - You now pay a $20 copayment per visit to an urgent care center and for emergency care provided after hours in your PCP's office. You now pay a $250 copayment per visit to an emergency room. The Plan will no longer waive the copayment if you are admitted to the hospital.

• Physical, occupational and speech therapies - You now pay a $40 copayment for physical, occupational and speech therapy.

• Out-of-pocket maximum - Your catastrophic protection out of pocket maximum has increased to $5,000 per person or $15,000 per family enrollment.

• Service area changes - PacifiCare of Oklahoma will now provide service in Logan County.

• Chiropractic services - We will no longer provide chiropractic care in PacifiCare of Oklahoma or PacifiCare of Texas.