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 10.1% for Self Only and for Self and Family.

• Coverage for treatment received at an outpatient hospital or ambulatory surgical center will be covered at 100%. (Section 5(c))

• Coverage for preventive dental benefits will be eliminated. A non-FEHB dental program will be offered in its place. (Section 5(i))

• Diabetic supplies and equipment will be covered as a Durable Medical Equipment (DME) benefit for a $10 copay. Coverage will continue to be provided for diabetic supplies and equipment under prescription drug benefits. (Section 5(a))

• Coverage for nutritional formula and low-protein modified food products for PKU or other inherited disease of amino and organic acids will be covered as a DME benefit for members through age 5 only. (Section 5(a))

• A referral from your primary care physician is no longer needed to receive most outpatient mental health and substance abuse treatment from network providers. However, precertification is still needed for inpatient, residential care, and certain outpatient treatment. (Section 5(e))

• We clarified that preauthorization is needed for certain outpatient diagnostic services, including MRI (magnetic resonance imaging), MRA (magnetic resonance angiography) and PET (positron emission tomography) procedures. (Section 3 and Section 5(a))

• We clarified that coverage is provided for sonograms in addition to ultrasound testing. We also clarified that we do not cover ultrasound/sonogram tests for routine purposes, except one routine ultrasound/sonogram for a normal pregnancy; nor do we cover a routine ultrasound/sonogram to determine fetal age, size or sex. (Section 5(a))

• We clarified that we cover osteoporosis screening as part of diagnostic and treatment services for preventive care for adults. (Section 5(a))

• We clarified that we will cover sacral nerve stimulators when medically necessary to treat urge incontinence, urge frequency or urinary retention without mechanical obstruction. (Section 5(a))

• We clarified that Human Leukocyte Antigen (HLA) testing is covered, where the member is recipient. (Section 5(b))

• We clarified that our formulary for covered medications and supplies is updated throughout the year, and may be obtained by calling Client Services at 1-800-932-4480 or by checking our Web site, www.bcbsmo.com .

• We added information about two value-added programs: for disease management, the congestive heart failure program; and for our postpartum depression screening program. (Section 5 (g))

• We clarified the coverage and exclusions for care associated with phase III or IV clinical trials for cancer treatment. (Section 5(a) and Section 6)