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.

• For High Option Enrollees, codes VT1 and VT2, your share of the non-Postal premium will decrease by 49.3% for Self Only and by 49.8% for Self and Family.

• For Standard Option enrollees who are being moved from codes VT4 and VT5 to VT1 and VT2, your share of the non-Postal premium will increase by 21.8% for Self Only or 23.2% for Self and Family.

• For both High Option and Standard Option the following apply:

  • We have added Clark, Cowlitz, Island, Lewis, Pacific, San Juan, Skagit, Skamania, Snohomish, Wahkiakum and Whatcom counties to our service area — see Section 1

  • We have added Neurodevelopmental Therapies benefit information — see Section 5(a)

  • We have added a Special Features section — see Section 5(g)

  • We have added Section 5(i), Point-of-Service (POS) benefits

  • We have added the Providence Preferred Provider Organization to our provider network — see Section 1

  • We have added the Walgreens Pharmacy mail order program for prescription drugs — see Section 5(f)

  • We have added five days of inpatient hospice care — see Section 5(c)

  • We have increased chiropractic and acupuncture treatments from 12 to 18 per calendar year — see Section 5(a)

  • We have added "master of social work" (M.S.W.), licensed massage therapists, occupational therapist and naturopaths to our list of Plan providers to comply with the Washington State "Every Category of Provider" law — see Sections 3 and 5(a)

  • We have increased full mouth or panorex X-rays coverage from once every five years to once every three years — see Section 5(h)

  • We have increased bitewing X-rays coverage from once a year to twice per calendar year — see Section 5(h)

  • We have decreased the combined lifetime maximum for orthopedic and prosthetic devices and durable medical equipment from $50,000 to $10,000 — see Section 5(a)

  • We have added osteoporosis screening for women 65 and older — see Section 5(a)

  • We have added surgical treatment for Temporomandibular Joint Disorders (TMJ) and removed the $1,000 limit — see Section 5(a)

• For High Option the following apply:

  • We have changed the High Option out-of-pocket maximum from $1,000 per family member to $5,000 per person or per family — see Section 4

  • We have increased office visit copayments from $10 to $15 — see Sections 5(a), 5(d) and 5(e)

  • We have added a $25 office visit copayment for specialty care — see Section 5(a)

  • We have changed the at home physician care benefit from a $15 copayment to 20% coinsurance — see Section 5(a)

  • We have changed the maternity care benefit from a $100 per day copayment with a $1,000 maximum per calendar year to 20% coinsurance — see Section 5(a)

  • We have changed most benefits that had 100% coverage to 20% coinsurance — see Sections 5(a), 5(b), 5(c) and 5(d)

  • We have changed the home health services benefit from 100% coverage to a $15 copayment per visit — see Section 5(a)

  • We have changed benefits with a $10 copayment to 20% coinsurance — see Sections 5(a) and 5(e)

  • We have changed the inpatient hospital room and board benefit from a $100 per day copayment with a $1,000 maximum per calendar year to 20% coinsurance — see Section 5(c)

  • We have increased the Emergency Room copayment from $25 to $75 — see Section 5(d)

  • We have decreased the temporomandibular joint disorders (TMJ) benefit from 100% coverage to 20% coinsurance

  • We have removed the deductible for Tier 2 and Tier 3 prescription drugs — see Section 5(f)

  • We have added a $20 copayment for Tier 2 prescription drugs and a $100 copayment or 50% coinsurance (whichever is less) for Tier 3 prescription drugs — see Section 5(f)

  • We have added separate prescription drug copayments on Tier 1 and Tier 2 prescription drugs for those with Medicare Parts A & B — see Section 5(f)

  • We have added Preventive and Basic dental care — see Section 5(h)

• For Standard Option the following apply:

  • We have changed the Standard Option out-of-pocket maximum from $3,000 per person or $6,000 per family to $5,000 per person or per family — see Section 4

  • We have increased the annual deductible from $200 to $350 per person and from $400 to $700 per family — see Section 4

  • We have changed the Preventive care, adult benefit from 20% coinsurance to 100% up to $500 — see Section 5(a)

  • We have changed the Preventive care, children benefit from 100% unlimited to 100% up to $500 — see Section 5(a)

  • We have changed the primary care office visit benefit from a flat $20 copayment to a $15 copayment for the first three visits then deductible and 20% coinsurance apply to all subsequent visits — see Section 5(a)

  • We have changed some benefits from 20% coinsurance to a $15 copayment for the first three visits — see Section 5(a)

  • We have added a $100 per day copayment up to a $500 maximum per admission to the inpatient hospital room and board benefit — see Section 5(c)

  • We have changed emergency care in a doctor's office or urgent care center (in or out of our service area) from a $20 copayment to 20% coinsurance — see Section 5(d)

  • We have increased the Tier 1 prescription drug copayment from $5 to $10 and Tier 2 from $20 to $30 — see Section 5(f)

  • We have changed Tier 3 prescription drug coverage from $100 or 50% whichever is less to 50% with a $40 minimum prescription price — see Section 5(f)

  • Basic dental care is no longer a benefit; preventive care only is covered — see Section 5(g)