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 11% for Self Only or 11.1% for Self and Family.

• The office visit copay for visits to a primary care physician will increase from $10 to $15 and the copay for visits to a specialist will increase from $15.00 to $30.00. (Section 5(a))

• The hospital emergency room copay will increase from $75.00 to $100.00.

• Members pay $15.00 per office visit for all maternity care visits. (Section 5(a))

• The extended care/skilled nursing facility copay will increase from nothing to $250 per admission.

• The copay for anesthesia services for outpatient services will increase from nothing to $30 per service, inpatient will still be nothing.

• The copay for physical and/or occupational therapy will increase from nothing to $15 per office visit to a primary care physician and $30 per office visit to a specialist.

• The copay for home health services will increase from nothing to $30 per visit.

• The office visit copay under the dental accidental injury benefit will increase from nothing to $30 per visit.

• The urgent care copay will increase from nothing $25 to $35 per visit.

• We have a 4-tier prescription drug benefit. The prescription drug copays will increase to $10.00 for Tier 1, $20.00 for Tier 2, $30.00 for Tier 3, and $50.00 for Tier 4. (Section 5(f))

• Members pay 20% of covered expenses with a maximum out-of-pocket of $2,400 for human growth hormone and other such biotech products. Previously, members paid $100 copay per prescription. (Section 5(a))