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.

• Your share of the non-Postal premium will increase by 12% for Self Only or 12% for Self and Family.

• The copayments for Plan physician services and outpatient laboratory services have been changed to $15 copayment per visit for physician services and no member copayment for outpatient laboratory services.

• Your copayments for some emergency care benefits have been changed:
  • The copayments from Plan Emergency Room Facilities have been changed from 20% of eligible charges to a $50 copayment.
  • The copayments for Plan physician services have been changed from 20% of eligible charges to $15 copayment per visit.
  • The copayments for Plan provider laboratory tests have been changed from 20% of eligible charges to no copayment.

• We clarified that if you are admitted as an inpatient following a visit to an emergency room, hospital inpatient benefits apply.

• Your copayments for drug benefits have been changed:
  • The copayments from Plan Pharmacies for Preferred Brand Name Drugs, Other Brand Insulin and Other Brand Diabetic Supplies have been changed from $15 to $20
  • The copayments from Plan Pharmacies for Other Brand Name Drugs have changed from 50% of eligible charges not less than $15 to 50% of eligible charges not less than $20
  • The copayments from Plan Pharmacies for Other Brand Name Diaphragms have changed from 50% of eligible charges not less than $15 to 50% of eligible charges not less than $10
  • The copayments from non-Plan Pharmacies for Preferred Brand Name Drugs and Other Brand Insulin have been changed from $15 plus 20% of remaining eligible charge and any difference between the actual and eligible charge to $20 plus 20% of remaining eligible charge and any difference between the actual and eligible charge
  • The copayments from non-Plan Pharmacies for Other Brand Name Drugs have changed from 50% of eligible charge not less than $15 plus any difference between the actual and eligible charge to 50% of eligible charge not less than $20 plus any difference between the actual and eligible charge
  • The copayments from non-Plan Pharmacies for Other Brand Diabetic Supplies have been changed from $15 copayment plus any difference between the actual and eligible charge to $20 copayment plus any difference between the actual and eligible charge
  • The copayments from non-Plan Pharmacies for Other Brand Name Diaphragms have changed from 50% of eligible charges not less than $15 plus any difference between the actual and eligible charge to 50% of eligible charges not less than $10 plus any difference between the actual and eligible charge

• We added occupational therapy visits to the list of services requiring precertification. See Section 3 and Section 5(a)

• We changed your copayment for HMSA's Smoking Cessation Program from $25 to no copayment.

• We changed the address for the mailing of disputed claims. See Section 8

• We clarified the definition of homebound. See Section 5(a), Home health services. Homebound means that due to an illness or injury, you are unable to leave home or if you leave home, doing so requires a considerable and taxing effort.

• We clarified information about third party liability under "When others are responsible for injuries". See Section 9