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.

• The PPO catastrophic maximum for deductibles, coinsurance and copays has changed to $3500 for self or any covered family member.

• The $10 copay for one annual routine physical examination has been eliminated and the exam and all associated tests will be paid at 100% up to a maximum of $500.

• The coinsurance for pre-admission test performed within 7 days of hospital admission has changed to 10% PPO, 30% non-PPO and 15% out of network, subject to the deductible.

• PPO treatment therapies have been changed to 10% coinsurance, subject to the deductible.

• The lifetime maximum benefit for wigs has been changed to $300.

• The per confinement copay for non-PPO inpatient hospitalizations has been changed to $300.

• The coinsurance for Non-PPO outpatient surgical services and supplies has been changed to 30%.

• The maximum number of days per confinement in a skilled nursing care facility has changed to 90 days.

• The coinsurance for ambulance service has changed to 10% for PPO, 25% for non-PPO and 15% out of network.

• The accidental injury benefit has changed to 100% payment of all services and supplies for outpatient facility charges, outpatient physician charges, including office visit if used in lieu of emergency room, excluding x-ray, lab or DME.

• The coinsurance for PPO mental health providers has changed to 10% not subject to the deductible.

• The coinsurance for Non-PPO mental health services in an approved alternative care setting has changed to 25% of the Plan allowance and the difference between the allowance and the billed amount.

• Non-PPO inpatient care for substance abuse benefit has changed to a $300 copayment per hospital confinement, payable at 70% of covered charges up to a combined lifetime maximum of $25,000.

• The coinsurance for Non-PPO outpatient care for substance abuse has changed to a 25% of the Plan allowance and the difference between the allowance and the billed amount, up to a combined lifetime maximum of $25,000.

• Non-PPO inpatient and outpatient care for alcoholism and drug abuse benefit has changed to a lifetime maximum benefit of $25,000.

• The retail generic drug copayments have changed from $10 to $5; for formulary brand name from $20 to $25; and for non-formulary brand name from 30% or $30 whichever is greater to 30% or $40 whichever is greater.

• The mail order drug copayments have changed from $20 to $10 for generic; from $40 to $45 for formulary brand name; and from 30% or $45 whichever is greater to 30% or $55 whichever is greater, for non-formulary brand name.

• The number of days covered in a skilled nursing facility, semiprivate room, board, services and supplies has changed from 30 days to 45 days.