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Insurance Services Programs

Guide to Federal Employees Health Benefits Plans

For Federal Deposit Insurance Corporation Employees

RI 70-14

Revised November 2003

Note: The rates in this Guide do not apply to FDIC Presidential Appointees or Retirees


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OFFICE OF THE DIRECTOR

UNITED STATES
OFFICE OF PERSONNEL MANAGEMENT
WASHINGTON, DC 20415-1000

Dear Federal Employees Health Benefits Program Participant:

It is hard to believe that a year has passed and the Federal Employees Health Benefits (FEHB) Open Season is here again. This is your annual opportunity to evaluate your personal needs and, if necessary, change health plans. I am pleased to present the 2004 FEHB Guide to help you with your evaluation.

It takes a lot of information to help a consumer make wise healthcare decisions. The information in this Guide and our web-based resources make it easier than ever to get information about premiums, to compare benefits, to read customer service satisfaction ratings for the national and local plans that may be of interest, and to learn about quality information from the National Committee for Quality Assurance, the Joint Commission on Accreditation of Healthcare Organizations, and URAC.

The FEHB Program continues to be an enviable national model that offers exceptional choice, and uses private-sector competition to keep costs reasonable, ensure high-quality care, and spur innovation. The Program, which began in 1960, is sound and has stood the test of time. It enjoys one of the highest levels of customer satisfaction of any healthcare program in the country. President Bush has chosen the FEHB as a model for modernizing and improving Medicare.

I continue to take aggressive steps to keep the FEHB Program on the cutting edge of employer-sponsored health benefits. We demand cost-effective quality care from our FEHB carriers and we have encouraged Federal agencies and departments to pay the full FEHB health benefit premium for their employees called to active duty in the Reserve and National Guard so they can continue FEHB coverage for themselves and their families. Our carriers have also responded to my request to help our members to be prepared by making additional supplies of medications available for emergencies as well as call-up situations and you can help by getting an Emergency Preparedness Guide at www.opm.gov. OPM's HealthierFeds campaign is another way the carriers are working with us to ensure Federal employees and retirees are informed on healthy living and best-treatment strategies. You can help to contain healthcare costs and keep premiums down by living a healthy life style.

Open Season is your opportunity to review your choices and to become a better educated consumer to meet your healthcare needs. Use this Guide, the health plan brochures, and the web resources at www.opm.gov/insure to make your choice an informed one. Finally, if you know someone interested in Federal employment, refer them to www.usajobs.gov.

Sincerely,

Kay Coles James
Director


Table of Contents



Things to Remember
  • The plan you choose can make a difference in your health.
  • Be aware of benefit changes for 2004.
  • Check the premium for 2004.

The information in this Guide gives you an overview of the FEHB Program and its participating plans. Read the plan brochures before you make any final decisions about health plans.


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Picking a Health Plan

Step 1: What type of health plan is best for you? You have some basic questions to answer about how you pay for and access medical care. This is because Fee-for-Service (FFS) plans -- with and without a Preferred Provider Organization (PPO), Health Maintenance Organizations (HMO), Point-of-Service (POS) plans, and Consumer-Driven plans all operate differently.

 

Fee-for-Service
w/PPO

Fee-for-Service
w/o PPO

Health Maintenance Organization

Point-of-Service

Consumer-Driven Plans

Choice of doctors, hospitals, pharmacies, and other providers

You must use the plan's network for full benefits. Not using PPO providers means only some or none of your benefits will be paid.

You may use any doctor, hospital, etc. Benefits are not limited by where you get care.

You generally must use the network; no benefits outside of the network - you pay all costs.

You must use network for full benefits. You may go outside the network but it will cost you more.

You may use network and non-network providers. Not using the network will cost you more.

Specialty care

Referral not required to get full benefits.

Referral not required to get full benefits.

Referral generally required from primary care doctor to get benefits.

Referral required to get full benefits.

Referral not required to get full benefits.

Out-of-pocket costs

You pay fewer costs if you use a PPO provider than if you don't.

You pay regular plan out-of-pocket costs.

Your out-of-pocket costs are generally limited to copayments.

You pay less if you use a network provider than if you don't.

You pay less if you use a network provider than if you don't.

Paperwork

Some if you don't use network providers.

You have to file your own claims.

Little, if any.

Little if you use the network. You will have to file your own claims if you don't use the network.

Some if you don't use network providers.

See Definitions starting on page 7 for a more detailed description of each type of plan.
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Picking a Health Plan

Step 2: What services are important to you and what health care do you expect to use? Refer to your medical and insurance records from last year as a guide to what services you might use this year. Add up the actual costs to you, including premiums. Estimate what you might spend on your health care for deductibles, coinsurance/copayments, and services that are not covered. Are there any annual limits for days or services covered and on the dollar amount the plan will spend on you? What is the maximum you will have to pay out-of-pocket each year?

Consult the health plans' brochures to find this benefit information. Copies of brochures as well as a tool to complete this sheet on-line are on our web site at www.opm.gov/insure/health.


 

Health Plan ___________

Health Plan ___________

Health Plan ___________

Annual premium

 

 

 

Office visit to primary care doctor

 

 

 

Office visit to specialist

 

 

 

Hospital inpatient deductible/ copay/ coinsurance

 

 

 

Hospital room & board charges

 

 

 

Generic drug (local pharmacy)

 

 

 

Brand name drug (local pharmacy)

 

 

 

Catastrophic protection limit

 

 

 

Mental health care visits

 

 

 

Home health care visits

 

 

 

Durable medical equipment

 

 

 

Maternity care

 

 

 

Well-child care

 

 

 

Routine physicals

 

 

 

Accreditation

 

 

 

The following information can be found in the Member Survey Results section in the benefit charts.

Overall member satisfaction with plan

 

 

 

Getting needed care

 

 

 

Getting care quickly

 

 

 

How well doctors communicate

 

 

 

Customer service

 

 

 

Claims processing

 

 

 



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Picking a Health Plan

Step 3: Consider quality. Quality is how well health plans keep their members healthy or treat them when they are sick. Good quality doesn't always mean receiving more care. Good quality health care means doing the right thing at the right time, in the right way, for the right person to achieve the best possible results. We provide two types of quality information in the plan benefit charts: independent evaluations (accreditation) from private organizations and evaluations by enrollees (member survey).

Accreditation evaluations shown in this Guide are performed by the National Committee for Quality Assurance (NCQA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and URAC. The following are the accreditation levels used by each organization. The codes correspond to a plan's accreditation level as shown in the plan comparison section.

National Committee for Quality Assurance (www.ncqa.org)

Excellent - Levels of service and clinical quality that meet or exceed NCQA's requirements for consumer protection and quality improvement AND achieve health plan performance results that are in the highest range of national or regional performance. Code N1

Commendable - Meets or exceeds NCQA's requirements for consumer protection and quality improvement. Code N2

Accredited - Meets most of NCQA's requirements for consumer protection and quality improvement. Code N3

Provisional - Meets some but not all of NCQA's requirements for consumer protection and quality improvement. Code N4 New Health Plan - Applies to health plans that are less than two years old. Code N6

Joint Commission on Accreditation of Healthcare Organizations (www.jcaho.org)

Accreditation with Full Compliance -
Demonstrates satisfactory compliance with JCAHO standards in all performance areas. Code J1

Accreditation with Requirements for Improvement -
Demonstrates satisfactory compliance with JCAHO standards in most performance areas. Code J2

Provisional - Demonstrates a previously unaccredited plan's satisfactory compliance with a subset of standards. Code J3

Conditional - Demonstrates failure to meet standard (s) or specific policy requirement(s) but is believed capable to do so in a specified time period. Code J4

 

URAC (www.urac.org)

Full Accreditation - Demonstrates full compliance with standards. Code U1

Conditional - Meets most of the standards but needs some improvement before achieving full compliance. Code U2

Provisional -A plan that has otherwise complied with all standards but has been in operation for less than 6 months. Code U3

 

 

Note. This chart shows the accreditation levels available under each accrediting organization listed. It is not intended to draw comparisons among the different accrediting organizations.

Member Survey results, shown in the plan comparison sections, are collected, scored, and reported by an independent organization - not by the health plans. Here is a brief explanation of each survey category.

Overall Plan Satisfaction

How would you rate your overall experience with your health plan?

Getting Needed Care

Were you satisfied with the choices your health plan gave you to select a personal doctor?
Were you satisfied with the time it takes to get a referral to a specialist?

Getting Care Quickly

Did you get the advice or help you needed when you called your doctor during regular office hours?
Could you get an appointment for regular or routine care when you wanted?
How Well Doctors Communicate

Did your doctor listen carefully to you and explain things in a way you could understand?
Did your doctor spend enough time with you?

Customer Service

Was your plan helpful when you called its customer service department?
Did you have paperwork problems?
Were the plan's written materials understandable?

Claims Processing

Did your plan pay your claims correctly and in a reasonable time?


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Preventing Medical Mistakes

An influential report from the Institute of Medicine estimates that up to 98,000 Americans die every year from medical mistakes in hospitals alone. That's about 3,230 preventable deaths in the FEHB Program a year. While death is the most tragic outcome, medical mistakes cause other problems such as permanent disabilities, extended hospital stays, longer recoveries, and even additional treatments. By asking questions, learning more and understanding your risks, you can improve the safety of your own health care, and that of your family members. Take these simple steps:

1. Ask questions if you have doubts or concerns.
  • Ask questions and make sure you understand the answers.
  • Choose a doctor with whom you feel comfortable talking.
  • Take a relative or friend with you to help you ask questions and understand answers.
2. Keep and bring a list of all the medicines you take.
  • Give your doctor and pharmacist a list of all the medicines that you take, including non-prescription medicines.
  • Tell them about any drug allergies you have.
  • Ask about side effects and what to avoid while taking the medicine.
  • Read the label when you get your medicine, including all warnings.
  • Make sure your medicine is what the doctor ordered and know how to use it.
  • Ask the pharmacist about your medicine if it looks different than you expected.
3. Get the results of any test or procedure.
  • Ask when and how you will get the results of tests or procedures.
  • Don't assume the results are fine if you do not get them when expected, be it in person, by phone, or by mail. Call your doctor and ask for your results.
  • Ask what the results mean for your care.
4. Talk to your doctor about which hospital is best for your health needs.
  • Ask your doctor which hospital has the best care and results for your condition if you have more than one hospital to choose from to get the health care you need.
  • Be sure you understand the instructions you get about follow-up care when you leave the hospital.
5. Make sure you understand what will happen if you need surgery.
  • Make sure you, your doctor, and your surgeon all agree on exactly what will be done during the operation. Ask your doctor, "Who will manage my care when I am in the hospital?"
  • Ask your surgeon:
    • Exactly what will you be doing?
    • About how long will it take?
    • What will happen after surgery?
    • How can I expect to feel during recovery?
  • Tell the surgeon, anesthesiologist, and nurses about any allergies, bad reaction to anesthesia, and any medications you are taking.


Want more information on patient safety?

  • www.ahrq.gov/consumer/pathqpack.htm. The Agency for Healthcare Research and Quality makes available a wide-ranging list of topics not only to inform consumers about patient safety but to help choose quality healthcare providers and improve the quality of care you receive.
  • www.npsf.org. The National Patient Safety Foundation has information on how to ensure safer healthcare for you and your family.
  • www.talkaboutrx.org/consumer.html. The National Council on Patient Information and Education is dedicated to improving communication about the safe, appropriate use of medicines.
  • www.leapfroggroup.org. The Leapfrog Group is active in promoting safe practices in hospital care.
  • www.ahqa.org. The American Health Quality Association represents organizations and healthcare professionals working to improve patient safety.


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FEHB Web Resources

The FEHB web site at www.opm.gov/insure/health can help you to choose your health plan and enroll. In addition to the information found in this Guide you will find:

  • An interactive tool that will allow you to find the health plans that service your area and will allow you to make side-by-side comparisons of the costs, benefits, and quality indicators of the plans that interest you.
  • Electronic versions of all plan brochures.
  • An evaluation of how your plan compares to other plans and the FEHB average in important medical areas under the Health Plan Employer Data and Information Set (HEDIS). HEDIS is a set of standardized performance measures that allows users to reliably compare managed care health plan performance across specific clinical areas. The performance measures are related to many significant public health issues such as cancer, heart disease, asthma, and diabetes. Compare plan results at www.opm.gov/insure/health/hedis2002.

  • Information on enrolling, with the ability to enroll online for annuitants and employees of selected agencies.
  • Information on how plans in the FEHB Program coordinate benefit payments with Medicare.
  • A comprehensive set of Frequently Asked Questions and answers on all aspects of the Program.
  • An online version of the FEHB Handbook for detailed guidance on FEHB policies and procedures.


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Program Features

  • No Waiting Periods. You can use your benefits as soon as your coverage becomes effective. There are no pre-existing condition limitations even if you change plans.
  • A Choice of Coverage. Choose between Self Only or Self and Family.
  • A Choice of Plans and Options. Select from Fee-For-Service (with the option of a Preferred Provider Organization), Health Maintenance Organization, Point of Service, or Consumer-Driven plans.
  • An Employer Contribution For 2004, the FDIC will pay 85 percent of the average premium toward the total cost of your premium, but not more that 88.75 percent of the total premium for any individual plan. If you continue FEHB coverage as a retiree, the contribution made on your behalf will be different than an active FDIC employee. The government contribution will be 72 percent of the average premium, but not more than 75 percent of the total premium for any individual plan.
  • Salary Deduction. For 2004, all eligible FDIC employees who elect FEHB health plan coverage, including permanent, temporary, full-time employees, will pay the biweekly premium shown under the "Your Share" column of the plan comparison chart in this Guide. If you continue FEHB coverage as a retiree, you will pay the same premium cost as other non-FDIC Federal government retirees, which is different than the FDIC share that is paid for active employees.
  • Annual Enrollment Opportunity. Each year you can enroll or change your health plan enrollment. This year the Open Season runs from November 10, 2003, through December 8, 2003. Other events allow for certain types of changes throughout the year; see your Human Resources office for more details.
  • Continued Group Coverage. Eligibility for you or your family members may continue following retirement, divorce, death, or changes in employment status. Employees assigned to the Office of the Inspector General should call the OIG Human Resources Branch at 202-416-2098. All other employees should contact the Benefits Hotline at 1-877-334-3092 for more information.
  • Coverage after FEHB Ends. You or your family members may be eligible for temporary continuation of FEHB coverage or for conversion to non-group (private) coverage when FEHB coverage ends. Employees assigned to the Office of the Inspector General should call the OIG Human Resources Branch at 202-416-2098. All other employees should contact the Benefits Hotline at 1-877-334-3092 for more information.
  • Choice of Tax Treatment. Your share of the premium may be withheld from your biweekly salary payment on a pre-tax basis. Premiums are automatically withheld on a pre-tax basis unless you submit a waiver of your participation in the FDIC Premium Conversion Plan. Your waiver will remain in effect until you submit a request to restore pre-tax payment of your health insurance premiums.

  • Consumer Protections. Go to www.opm.gov/insure/health/consumers to see your appeal rights to OPM if you and your plan have a dispute over a claim; to read the Patients' Bill of Rights and the FEHB Program; and to learn about your privacy protections when it comes to your medical information.


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Definitions

Accreditation - The status granted to a health care organization following a rigorous and comprehensive evaluation performed by independent organizations. The evaluation also includes an assessment of the care and service plans are delivering in important areas of public concern such as immunization rates, mammography rates, and member satisfaction.

Brand name drug - A prescription drug that is protected by a patent, supplied by a single company, and marketed under the manufacturer's brand name.

Coinsurance - The amount you pay as your share of the medical services you receive, like for a doctor's visit. Coinsurance is a percentage of the cost of the service (e.g., you pay 20%).

Consumer-Driven Plans - Describes a wide range of approaches to give you more incentive to control the cost of either your health benefits or health care. You have greater freedom in spending health care dollars up to a designated amount, and you receive full coverage for in-network preventive care. In return, you assume significantly higher cost sharing expenses after you have used up the designated amount. The catastrophic limit is usually higher than those common in other plans. Common features include full or partial employee responsibility for several thousand dollars in expenses, and catastrophic coverage covering costs above a certain level, usually higher than those common in other plans.

Copayment - The amount you pay as your share of the medical services you receive, like for a doctor's visit. Copayment is a fixed dollar amount (e.g., you pay $15).

Fee-For-Service (FFS) - Health coverage in which doctors and other providers receive a fee for each service such as an office visit, test, procedure, or other health care service. The health plan will either pay the medical provider directly or reimburse you for covered services after you have paid the bill and filed an insurance claim. When you need medical attention, you visit the doctor or hospital of your choice.

Formulary - A list of both generic and brand name drugs that are preferred by your health plan. Many prescription drugs produce the same results. Health plans choose formulary drugs that are medically safe and cost effective. A team including pharmacists and physicians meet to review the formulary and make changes as necessary.

Generic drug - A prescription that is not protected by a drug patent. A generic medication is basically a copy of the brand name drug. A generic drug may have a different color or shape than its brand name counterpart, but it must have the same active ingredients, strength, and dosage form (i.e., pill, liquid, or injection), and provide the same effectiveness and safety. Generics generally cost less than brand name drugs.


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Definitions

Health Maintenance Organization (HMO) - A health plan that provides care through contracted or employed physicians and hospitals located in particular geographic or service areas. HMOs emphasize prevention and early detection of illness. Your eligibility to enroll in an HMO is determined by where you live or, in some plans, where you work.

In-Network - You receive treatment from the doctors, clinics, health centers, hospitals, medical practices, and other providers with whom your plan has an agreement to care for its members. Examples include a Fee-For-Service plan's PPO or a Health Maintenance Organization. Members have fewer out-of-pocket costs when they use in-network providers.

Out-of-Network - You receive treatment from doctors, hospitals, and medical practitioners other than those with whom the plan has an agreement, and pay more to do so. Members in a PPO-only option who receive services outside the PPO network generally pay all charges.

Point of Service (POS) - A product offered by an HMO or FFS plan that has both in-network and out-of-network features. In a POS you don't have to use the plan's network of providers for every service, but you generally pay more out of network.

Preferred Provider Organization (PPO) - The PPO is similar to FFS insurance except it uses a network of providers. PPOs give you the choice of using doctors and other providers in the network or using non-network providers. You don't have to use the PPO, but there are advantages if you do. (Be aware, however, that some of the services provided in a PPO hospital may not be covered by PPO arrangements. Room and board will be covered, but anesthesia and radiology, for instance, may be covered under non-PPO benefits.) Note that some FFS plans may offer an enrollment option that is "PPO-only." You must use network providers to receive benefits from a PPO-only plan.

Provider - A doctor, hospital, health care practitioner, pharmacy, or health care facility.


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The Federal Long Term Care Insurance Program

It's important protection.

Here's why you should consider enrolling in the Federal Long Term Care Insurance Program:

  • FEHB plans do not cover the cost of long term care. Also called "custodial care," long term care is help you receive when you need assistance performing activities of daily living - such as bathing or dressing yourself. This need can strike anyone at any age and the cost of care can be substantial.
  • The Federal Long Term Care Insurance Program can help protect you from the potentially high cost of long term care. This coverage gives you control over the type of care you receive and where you receive it. It can also help you remain independent so you won't have to worry about being a burden to your loved ones.
  • It's to your advantage to apply sooner rather than later. Long term care insurance is something you must apply for and pass a medical screening (called underwriting) in order to be enrolled. Certain medical conditions will prevent some people from being approved for coverage. By applying while you're in good health, you could avoid the risk of having a change in health disqualify you from obtaining coverage. Also, the younger you are when you apply the lower your premiums.
  • You don't have to wait for an open season to apply. The Federal Long Term Care Insurance Program accepts applications from eligible persons at any time. You will have to complete a full underwriting application, which asks a number of questions about your health. However, if you are a new or newly eligible employee, you (and your spouse, if applicable) have a limited opportunity to apply using the abbreviated underwriting application, which asks fewer questions. If you marry, your new spouse will also have a limited opportunity to apply using abbreviated underwriting. Qualified relatives are also eligible to apply with full underwriting.

To find out more or to request an application

Call 1-800-LTC-FEDS (1-800-582-3337) (TTY 1-800-843-3557) or visit www.ltcfeds.com.


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Stop Health Care Fraud!

Fraud increases the cost of health care for everyone and increases your Federal Employees Health Benefits Program (FEHBP) premium. OPM's Office of the Inspector General investigates all allegations of fraud, waste, and abuse in the FEHBP regardless of the agency that employs you or from which you retired.

Protect Yourself From Fraud - Here are some things you can do to prevent fraud:

  • Be wary of giving your health plan identification number over the telephone or to people you do not know, except to your doctor, other provider, or authorized plan or OPM representative.
  • Let only appropriate medical professionals review your medical record or recommend services.
  • Avoid health care providers who say that an item or service is not usually covered, but they know how to bill your health plan to get it paid.
  • Carefully review explanations of benefits (EOBs) that you receive from your health plan.
  • Do not ask your doctor to make false entries on certificates, bills or records in order to get your health plan to pay for an item or service.
  • If you suspect that a provider has charged you for services you did not receive, billed you twice for the same service, or misrepresented any information, do the following:
    • Call the provider and ask for an explanation. There may be an error.
    • If the provider does not resolve the matter, call your health plan and explain the situation.
    • If they do not resolve the issue:

CALL -- THE HEALTH CARE FRAUD HOTLINE

202-418-3300

OR WRITE TO:

The United States Office of Personnel Management
Office of the Inspector General Fraud Hotline
1900 E Street, NW, Room 6400
Washington, DC 20415

  • Remember, FEHB covered family members may not include:
    • your former spouse after a divorce decree or annulment is final (even if a court orders it); or
    • your child over age 22 unless he/she is incapable of self support.
  • If you have any questions about the eligibility of a dependent, check with your Human Resource office if you are employed or with OPM if you are retired.
  • You can be prosecuted for fraud and your agency may take action against you if you falsify a claim to obtain FEHBP benefits or try to obtain services for someone who is not an eligible family member or who is no longer enrolled in the Plan.


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FDIC Premium Conversion

Section 125 of the Internal Revenue Code allows an employer to provide a portion of an employee's salary in benefits rather than cash. Instead of paying a certain amount to an employee as taxable income, the employer uses it to purchase benefits for the employee. Several years ago, the Federal Deposit Insurance Corporation (FDIC) established the Premium Conversion Plan as a tax-savings benefit for its employees. The FDIC Premium Conversion Plan enables employees to pay their share of Federal Employees Health Benefits (FEHB) Program premiums on a pre-tax basis, which reduces an employee's taxable income by the amount of health insurance premiums. As a result, taxes are calculated on a lower income base.

This feature is offered and administered by the FDIC and is not a provision of the FEHB Program's Premium Conversion Plan. FDIC employees will continue to be covered by the FDIC-sponsored premium conversion plan. Both plans comply with plan requirements under Section 125 of the Internal Revenue Code and provide the same benefit of lower tax liability. For specific details about the FDIC Premium Conversion Plan, employees assigned to the Office of the Inspector General should call the OIG Human Resources Branch at 202-416-2098. All other employees should contact the Benefits Hotline at 1-877-334-3092.

Open Season Dates

November 10, 2003 - December 8, 2003

Effective Date

Your change in tax treatment of your health insurance premiums will become effective December 14, 2003. (Pay date of January 08, 2004)

Eligibility

All employees who are eligible for and elect FEHB coverage. (By law, the Premium Conversion Plan is not available to retirees.) FEHB premiums are withheld on a pre-tax basis automatically, unless you waive this provision.

Elections

If you would like to have your 2004 FEHB premiums paid with after-tax money, you must submit a Premium Conversion Waiver/Election form to your servicing benefits representative during this open season. OIG employees should submit the waiver form to the OIG Human Resources Branch 801 17th St, Washington, DC 20434. All other employees should submit the waiver form to the Benefits Center 3501 Fairfax Dr., Arlington, VA 22226. Premium Conversion Plan waiver/Election forms may be obtained from your servicing benefits representative.

How does PCP Work?

Under the health insurance premium conversion arrangement, your taxable income is reduced by the amount of health insurance premiums withheld for basic pay. The FEHB premium deduction will be withheld from pay as "pre-tax money," which means the premium amount is not subject to income, Social Security, or Medicare taxes. You save on Federal income taxes, and where applicable, also on state and local income taxes. This premium conversion feature applies only to health insurance premiums you pay under the FEHB Program. Dental and vision insurance premiums are withheld on a pre-tax basis under the Flexible Cafeteria Benefits Plan - "FDIC Choice."


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FDIC Premium Conversion

Impact of Premium Conversion on Benefits

Paying for health insurance premiums on a pre-tax basis does not affect your other benefit programs; it only changes the way you pay for your share of the FEHB premium cost. Other benefits such as life insurance and retirement will continue to be based on adjusted basic salary before biweekly premiums are deducted.

Most employees prefer paying their premiums with pre-tax money because they save on taxes. However, there are two possible disadvantages to paying your premiums with pre-tax money that you should balance against the tax savings you receive. Those possible disadvantages are:

  • Paying your premiums with pre-tax money reduces the earnings reported to the Social Security Administration. When you retire and begin to collect Social Security, you may receive a slightly lower Social Security benefit. Your medicare, life insurance, retirement plan, and both the Thrift Savings Plan and the FDIC Savings Plan benefits will not be affected.
  • There are some Internal Revenue Service (IRS) restrictions on the ability to reduce your health insurance coverage outside of an open season if you pay your premium contributions with pre-tax money. These are explained in detail in the "IRS Guidelines for Reducing Coverage" section below. If you pay premiums with after-tax money you will not be affected by the IRS guidelines that restrict reductions in coverage. You may cancel your level of health insurance coverage at any time of year without having a qualified life status change.

IRS Guidelines For Reducing Coverage

When your premium deductions are withheld on a pre-tax basis, certain IRS rules affect your ability to change coverage. You may elect to reduce your coverage, that is, to cancel your health insurance enrollment, or change from family to self only coverage, during the health insurance open season or following one of the life status changes listed below:

  • Marriage or divorce
  • Birth of a child or addition of a qualified dependent
  • Death of your spouse or loss of a qualified dependent
  • Start or end of your spouse's employment
  • Change in your spouse's employment status from either full-time to part-time, (or the reverse)
  • Start or end of your spouse's unpaid leave of absence
  • Significant changes in your (or your spouse's) health coverage because of your spouse's employment
  • Completion of a full pay period in non-pay status, e.g., leave without pay.


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FDIC Premium Conversion

If you want to reduce your health insurance coverage outside the FEHB open season, the change must be consistent with your qualified life status change. For example, if you have a new baby, you can not change from a self and family to a self-only enrollment.

To reduce your coverage outside of a FEHB open season, complete and submit a Health Benefits Registration Form (SF-2809) to your servicing benefits representative no later than 60 calendar days after a qualified like status change has occurred, and provide any necessary supporting documentation.

If you are the only person remaining in your self and family enrollment as a result of a change in marital or family status (death of a spouse, divorce, child marries or becomes age 22), you must elect to reduce the enrollment (self only or cancel) within 60 calendar days of such a life status change. Otherwise, the self and family enrollment will continue until another event (life status change or FEHB Open Season) occurs that will allow an election to reduce coverage. The effective date of change from family to self-only will be the first day of the pay period that follows the pay period in which your enrollment form is received.

Information in this section serves as the FDIC Premium Conversion Plan Summary Plan Description.
If you need additional information, employees assigned to the office of the Inspector General should call the OIG/Human Resources Branch for assistance at 202-416-2098.
All other employees should contact the Benefits Hotline at 1-877-334-3092,


Page 14   To Next Page   To Previous Page

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Page 15   To Next Page   To Previous Page

Plan Comparisons
Nationwide Fee-For-Service Plans
Open to All

(Pages 16 through 19)

Fee-For-Service (FFS) Plans with a Preferred Provider Organization (PPO) — A FFS option that allows you to see medical providers who reduce their charges to the plan; you pay less money out-of-pocket when you use a PPO provider. When you visit a PPO you usually won't have to file claims or paperwork. However, going to a PPO hospital does not guarantee PPO benefits for all services received within that hospital. For instance, lab work and radiology services from independent practitioners within the hospital may not be covered by the PPO agreement.

Fee-For-Service (FFS) Plans (non-PPO) — An FFS plan that either pays the medical provider directly or reimburses you for covered medical expenses. When you need medical attention, you visit the doctor or hospital of your choice.

In PPO-only options, you must use PPO providers to receive benefits.

Consumer-Driven Plans — Describes a wide range of approaches to give you more incentive to control the cost of either your health benefits or health care. You have greater freedom in spending health care dollars up to a designated amount, and you receive full coverage for in-network preventive care. In return, you assume significantly higher cost sharing expenses after you have used up the designated amount. The catastrophic limit is usually higher than those common in other plans.


Page 16   To Next Page   To Previous Page

Nationwide Fee-for-Service Plans Open to All

How to read this chart:

The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. The chart does not show all of your possible out-of-pocket costs.

The Deductibles shown are the amount of covered expenses that you pay before your health plan begins to pay.

Calendar Year deductibles for families are two or more times the per person amount shown.

In some plans your combined Prescription Drug purchases from Mail Order and local pharmacies count toward the deductible. In other plans only purchases from local pharmacies count. Some plans require each family member to meet a per person deductible.

The Hospital Inpatient deductible is what you pay each time you are admitted to a hospital.

Your share of Hospital Inpatient Room and Board covered charges is shown.

The Generic drug figure is the copayment or coinsurance most commonly paid by members of this health plan for a Generic formulary drug.

Continue this description.

Plan name

Telephone number

Enrollment code

Your Share

FDIC Share

Self only

Self & family

Self only

Self & family

Self only

Self & family

APWU Health Plan-High

800/222-2798

471

472

35.00

64.22

143.32

327.12

APWU Health Plan-Std

800/222-2798

474

475

17.53

40.81

138.26

321.98

Blue Cross and Blue Shield Service Benefit Plan-Std

Local phone #

104

105

26.98

62.85

143.32

327.12

Blue Cross and Blue Shield Service Benefit Plan-Basic

Local phone #

111

112

17.10

40.05

134.88

315.93

GEHA Benefit Plan-High

800/821-6136

311

312

54.32

103.02

143.32

327.12

GEHA Benefit Plan-Std

800/821-6136

314

315

13.61

30.94

107.39

244.06

Mail Handlers-High

800/410-7778

451

452

73.67

130.58

143.32

327.12

Mail Handlers-Std

800/410-7778

454

455

14.47

31.42

114.17

247.83

NALC

888/636-6252

321

322

29.76

42.75

143.32

327.12

PBP Health Plan-High

800-544-7111

361

362

161.14

329.75

143.32

327.12

PBP Health Plan-Std

800-544-7111

364

365

45.98

101.67

143.32

327.12


Page 17   To Next Page   To Previous Page

Brand Name/Non-formulary is what you pay for a manufacturer's Brand name drug on this health plan's formulary. You pay the Brand name amount if you or your doctor requests the Brand name or if a Generic is not available. The figure in this column is the copayment or coinsurance most commonly paid by members of this health plan for a Brand name formulary drug. If a Non-formulary drug is prescribed and the cost to you is different than the Brand name, you pay the second amount if listed.

Mail Order Discounts. If your plan has a Mail Order program and that program is superior to the purchase of medications at the pharmacy (e.g., you get a greater quantity or pay less through Mail Order), your plan's response is "yes." If the plan does not have a Mail Order program or it is not superior to its pharmacy benefit, the plan's response is "no."

The prescription drug copayments or coinsurances described in this chart do not represent the complete range of cost-sharing under these plans. Many plans have variations in their prescription drug benefits (e.g., you pay the greater of a dollar amount or a percentage, or you pay one amount for your first prescription and then a different amount for refills). The prescription drug figures in this chart show what most plan members pay for their medications under each plan. You must read the plan brochure for a complete description of prescription drug and all other benefits.

Plan

Benefit type

Medical Surgical - You Pay

Deductible

Copay ($)/Coinsurance (%)

Per Person

Hospital inpatient

Doctors

Hospital Inpatient Room & Board

Prescription Drugs

Calendar Year

Prescription Drug

Office Visits

Inpatient Surgical Services

Generic

Brand Name/Non-Formulary

Mail Order Discounts

APWU-High

PPO

$275

None

None

$18

10%

10%

$8

25%

No

Non-PPO

$500

None

$300

30%

30%

30%

50%

50%

No

APWU

PPO

$600

None

None

15%

15%

15%

25%

25%/25%

No

Non-PPO

$600

None

None

40%

40%

40%

N/A

N/A

No

BCBS -Std

PPO

$250

None

$100

$15

10%

Nothing

25%

25%

Yes

Non-PPO

$250

None

$300

25%

25%

30%

45%+

45%+

No

BCBS -Basic

PPO

None

None

$100/day x 5

$20/$30

$100

Nothing

$10

$25/$35 or 50%

No

GEHA -High

PPO

$350

None

$100

$20

10%

Nothing

$5

$25

Yes

Non-PPO

$350

None

$300

25%

25%

Nothing

$5

$25

Yes

GEHA -Std

PPO

$450

None

None

$10

15%

15%

$5

50%

Yes

Non-PPO

$450

None

None

35%

35%

35%

$5

50%

Yes

MH -High

PPO

$250

$200

$100

$20/$10

10%

Nothing

$10

$25/$40

Yes

Non-PPO

$300

$200

$300

30%

30%

30%

50%

50%

Yes

MH -Std

PPO

$300

$400

$200

$20/$10

10%

Nothing

$10

$30/$45

Yes

Non-PPO

$350

$400

$400

30%

30%

30%

50%

50%

Yes

NALC

PPO

$250

$25

None

$20

10%

10%

25%

25%

Yes

Non-PPO

$300

$25

$100

30%

30%

30%

50%

50%+

Yes

PBP -High

PPO

$200

$90

None

10%

10%

10%

$3

$25 or 20%/$40 or 20%

Yes

Non-PPO

$500

$90

$150

20%

25%

25%

20%+

20%+

Yes

PBP -Std

PPO

$250

$90

None

$8

9%

9%

$4

$30 or 20%/$40 or 20%

Yes

Non-PPO

$600

$90

$250

30%

30%

30%

30%+

30%+

Yes


Page 18   To Next Page   To Previous Page

Nationwide Fee-for-Service Plans Open to All

Member Survey results, shown in the plan comparison sections, are collected, scored, and reported by an independent organization - not by the health plans. Here is a brief explanation of each survey category.

Overall Plan Satisfaction

How would you rate your overall experience with your health plan?

Getting Needed Care

Were you satisfied with the choices your health plan gave you to select a personal doctor?
Were you satisfied with the time it takes to get a referral to a specialist?

Getting Care Quickly

Did you get the advice or help you needed when you called your doctor during regular office hours?
Could you get an appointment for regular or routine care when you wanted?
How Well Doctors Communicate

Did your doctor listen carefully to you and explain things in a way you could understand?
Did your doctor spend enough time with you?

Customer Service

Was your plan helpful when you called its customer service department?
Did you have paperwork problems?
Were the plan's written materials understandable?

Claims Processing

Did your plan pay your claims correctly and in a reasonable time?

Plan name

Member Survey Results

Plan code

Overall plan satisfaction

Getting needed care

Getting care quickly

How well doctors communicate

Customer service

Claims processing

APWU Health Plan-High

47

Above Average

Average

Above Average

Above Average

Above Average

Above Average

APWU Health Plan-Consumer driven

47

Above Average

Average

Above Average

Above Average

Above Average

Above Average

Blue Cross and Blue Shield Service Benefit Plan-Std

10

Average

Average

Average

Average

Below Average

Average

Blue Cross and Blue Shield Service Benefit Plan-Basic

11

Below Average

Below Average

Below Average

Below Average

Below Average

Below Average

GEHA Benefit Plan-High

31

Above Average

Average

Average

Average

Above Average

Above Average

GEHA Benefit Plan-Std

31

Above Average

Average

Average

Average

Above Average

Above Average

Mail Handlers-High

45

Below Average

Average

Below Average

Average

Average

Average

Mail Handlers-Std

45

Below Average

Average

Below Average

Average

Average

Average

NALC

32

Above Average

Above Average

Above Average

Above Average

Above Average

Above Average

PBP Health Plan-High

36

Average

Average

Above Average

Above Average

Below Average

Below Average

PBP Health Plan-Std

36

Average

Average

Above Average

Above Average

Below Average

Below Average


Page 19   To Next Page   To Previous Page

Fee-For-Service Plans Blue Cross and Blue Shield Service Benefit Plan Member Survey Results for Select States

This year we are providing more detailed information regarding the quality of services provided by our health plans. We are including the results of the Member Satisfaction survey at the state level for eight local Blue Cross Blue Shield (BCBS) Plans. In the past, BCBS has conducted a single survey representing all of its members nation-wide. This year, however, we are able to provide local member satisfaction results for both the Standard Option plan and the Basic Option plan.

In the future, we expect to increase the number of plans conducting local or regional Member Satisfaction surveys. We look forward to making those results available to help you select quality health plans.

Below are Member Survey ratings for local BCBS plans by location:

Plan Name

Location

Member Survey Results

Plan Code

Overall plan satisfaction

Getting needed care

Getting care quickly

How well doctors communicate

Customer service

Claims processing

Blue Cross and Blue Shield Service Benefit Plan

Standard

Arizona

10

Above

Below

Below

Below

Average

Above

Basic

11

Below

Below

Below

Below

Below

Below

Blue Cross and Blue Shield Service Benefit Plan

Standard

California

10

Above

Below

Average

Average

Average

Above

Basic

11

Below

Below

Below

Below

Below

Below

Blue Cross and Blue Shield Service Benefit Plan

Standard

District of Columbia

10

Average

Average

Below

Average

Average

Average

Basic

11

Below

Below

Below

Below

Below

Average

Blue Cross and Blue Shield Service Benefit Plan

Standard

Florida

10

Above

Average

Below

Below

Average

Above

Basic

11

Below

Below

Below

Below

Below

Average

Blue Cross and Blue Shield Service Benefit Plan

Standard

Illinois

10

Average

Above

Average

Average

Average

Average

Basic

11

Below

Below

Below

Below

Below

Below

Blue Cross and Blue Shield Service Benefit Plan

Standard

Maryland

10

Average

Average

Average

Average

Below

Average

Basic

11

Below

Below

Below

Below

Below

Below

Blue Cross and Blue Shield Service Benefit Plan

Standard

Texas

10

Above

Average

Average

Above

Average

Average

Basic

11

Below

Below

Below

Below

Below

Below

Blue Cross and Blue Shield Service Benefit Plan

Standard

Virginia

10

Above

Average

Average

Average

Above

Above

Basic

11

Below

Below

Below

Below

Average

Above


Page 20   To Next Page   To Previous Page

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Page 21   To Next Page   To Previous Page

Plan Comparisons

Nationwide Fee-For-Service Plans Open Only to Specific Groups (Pages 22 through 24)

Fee-For-Service (FFS) Plans with a Preferred Provider Organization (PPO) — An FFS plan that allows you to see medical providers who reduce their charges to the plan; you pay less money out-of-pocket when you use a PPO provider. When you visit a PPO you usually won't have to file claims or paperwork. However, going to a PPO hospital does not guarantee PPO benefits for all services received within that hospital. For instance, lab work and radiology services from independent practitioners within the hospital are frequently not covered by the PPO agreement.

Fee-For-Service (FFS) Plans (non-PPO) — An FFS plan that either pays the medical provider directly or reimburses you for covered medical expenses. When you need medical attention, you visit the doctor or hospital of your choice.


Page 22   To Next Page   To Previous Page

Nationwide Fee-for-Service Plans Open Only to Specific Groups

How to read this chart:

The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. The chart does not show all of your possible out-of-pocket costs.

The Deductibles shown are the amount of covered expenses that you pay before your health plan begins to pay.

Calendar Year deductibles for families are two or more times the per person amount shown.

In some plans your combined Prescription Drug purchases from Mail Order and local pharmacies count toward the deductible. In other plans, only purchases from local pharmacies count. Some plans require each family member to meet a per person deductible.

The Hospital Inpatient deductible is what you pay each time you are admitted to a hospital.

Doctors shows what you pay for inpatient surgical services and for office visits.

Your share of Hospital Inpatient Room and Board covered charges is shown.

The Generic drug figure is the copayment or coinsurance most commonly paid by members of this health plan for a Generic formulary drug.

Plan name

Telephone number

Enrollment code

Your Share

FDIC Share

Self only

Self & family

Self only

Self & family

Self only

Self & family

Association Benefit Plan

800/634-0069

421

422

36.84

87.89

143.32

327.12

Foreign Service Benefit Plan

202/833-4910

401

402

19.36

66.88

143.32

327.12

Panama Canal Area Benefit Plan

800/548-8969

431

432

17.12

35.74

135.09

281.98

Rural Carrier Benefit Plan

800/638-8432

381

382

56.62

79.70

143.32

327.12

SAMBA

800/638-6589

441

442

48.79

125.30

143.32

327.12

Secret Service Employees Health Association

800/424-7474

Y71

Y72

32.42

89.38

143.32

327.12


Page 23   To Next Page   To Previous Page

Brand Name/Non-formulary is what you pay for a manufacturer's Brand name drug on this health plan's formulary. You pay the Brand name amount if you or your doctor requests the Brand name or if a Generic is not available. The figure in this column is the copayment or coinsurance most commonly paid by members of this health plan for a Brand name formulary drug. If a Non-formulary drug is prescribed and the cost to you is different than the Brand name, you pay the second amount if listed.

Mail Order Discounts. If your plan has a Mail Order program and that program is superior to the purchase of medications at the pharmacy (e.g., you get a greater quantity or pay less through Mail Order), your plan's response is "yes." If the plan does not have a Mail Order program or it is not superior to its pharmacy benefit, the plan's response is "no."

The prescription drug copayments or coinsurances described in this chart do not represent the complete range of cost-sharing under these plans. Many plans have variations in their prescription drug benefits (e.g., you pay the greater of a dollar amount or a percentage, or you pay one amount for your first prescription and then a different amount for refills). The prescription drug figures in this chart show what most plan members pay for their medications under each plan. You must read the plan brochure for a complete description of prescription drug and all other benefits.

Plan

Benefit type

Medical Surgical - You Pay

Deductible

Copay ($)/Coinsurance (%)

Per Person

Hospital inpatient

Doctors

Hospital Inpatient Room & Board

Prescription Drugs

Calendar Year

Prescription Drug

Office Visits

Inpatient Surgical Services

Generic

Brand Name/Non-Formulary

Mail Order Discounts

ABP

PPO

$300

None

$100

$10

10%

Nothing

$5

$25/$40

No

Non-PPO

$300

None

$300

30%

30%

30%

$5

$25/$40

No

FS

PPO

$300

None

Nothing

10%

10%

Nothing

$10/25%

$20/25%/N/A

Yes

Non-PPO

$300

None

$200

30%

30%

20%

$10/25%

$20/25%/N/A

Yes

PCA

POS

None

$400

$50

$10

Nothing

Nothing

50%

50%/50%

N/A

FFS

None

$400

$125

50%

50%

50%

50%

50%/50%

N/A

Rural

PPO

$350

$200

$100

$20

10%

Nothing

30%

30%/30%

Yes

Non-PPO

$400

$200

$300

25%

20%

20%

30%

30%/30%

Yes

SAMBA

PPO

$350

None

$200

$20

10%

Nothing

$10

$25/$40

Yes

Non-PPO

$350

None

$300

30%

30%

30%

$10

$25/$40

Yes

SSEHA

Par

$200

None

$100

20%

20%

Nothing

$10

$20/$20

Yes

Non-Par

$200

None

$100+any diff.

20%+diff.

20%+diff.

20%+diff.

All chgs.

All chgs./All chgs.

No

*The Panama Canal Area Plan provides a point-of-service product within the Republic of Panama.


Page 24   To Next Page   To Previous Page

Nationwide Fee-for-Service Plans Open Only to Specific Groups

Member Survey results, shown in the plan comparison sections, are collected, scored, and reported by an independent organization - not by the health plans. Here is a brief explanation of each survey category.

Overall Plan Satisfaction

How would you rate your overall experience with your health plan?

Getting Needed Care

Were you satisfied with the choices your health plan gave you to select a personal doctor?
Were you satisfied with the time it takes to get a referral to a specialist?

Getting Care Quickly

Did you get the advice or help you needed when you called your doctor during regular office hours?
Could you get an appointment for regular or routine care when you wanted?
How Well Doctors Communicate

Did your doctor listen carefully to you and explain things in a way you could understand?
Did your doctor spend enough time with you?

Customer Service

Was your plan helpful when you called its customer service department?
Did you have paperwork problems?
Were the plan's written materials understandable?

Claims Processing

Did your plan pay your claims correctly and in a reasonable time?

Plan name

Member Survey Results

Plan code

Overall plan satisfaction

Getting needed care

Getting care quickly

How well doctors communicate

Customer service

Claims processing

Association Benefit Plan

42

Above Average

Average

Above Average

Average

Above Average

Above Average

Foreign Service Benefit Plan

40

Average

Below Average

Below Average

Below Average

Below Average

Below Average

Panama Canal Area Benefit Plan

43

Below Average

Above Average

Average

Above Average

Above Average

Below Average

Rural Carrier Benefit Plan

38

Above Average

Above Average

Above Average

Average

Above Average

Above Average

SAMBA

44

Above Average

Below Average

Average

Average

Average

Above Average

Secret Service Employees Health Association

Y7

Below Average

Average

Below Average

Below Average

Below Average

Below Average


Page 25   To Next Page   To Previous Page

Plan Comparisons

Health Maintenance Organization Plans, Plans Offering a Point of Service Product, and Local Consumer-Driven Plans

(Pages 26 through 55)

Health Maintenance Organization (HMO) - A health plan that provides care through a network of physicians and hospitals in particular geographic or service areas. HMOs coordinate the health care service you receive and free you from completing paperwork or being billed for covered services. Your eligibility to enroll in an HMO is determined by where you live or, for some plans, where you work. Some HMOs are affiliated with or have arrangements with HMOs in other service areas for non-emergency care if you travel or are away from home for extended periods (reciprocity). Plans that offer reciprocity discuss it in their brochure.

  • The HMO provides a comprehensive set of services - as long as you use the doctors and hospitals affiliated with the HMO. HMOs charge a copayment for primary physician and specialist visits and generally no deductible or coinsurance for inhospital care.
  • Most HMOs ask you to choose a doctor or medical group to be your primary care physician (PCP). Your PCP provides your general medical care. In many HMOs, you must get authorization or a referral from your PCP to see other providers. The referral is a recommendation by your physician for you to be evaluated and/or treated by a different physician or medical professional. The referral ensures that you see the right provider for the care most appropriate to your condition.
  • Care received from a provider not in the plan's network is not covered unless it's emergency care or the plan has a reciprocity arrangement.

Plans Offering a Point of Service (POS) Product - A product similar to an HMO and FFS plan.

The POS product lets you use providers who are not part of the HMO network. However, you pay more for using these non-network providers. You usually pay higher deductibles and coinsurances than you pay with a plan provider. You will also need to file a claim for reimbursement, like in a FFS plan. The HMO plan wants you to use its network of providers, but recognizes that sometimes enrollees want to choose their own provider.

The POS plans have two rows for In Network and Out of Network benefits. In Network shows what you pay if you go to the plan's providers; Out of Network shows what you pay if you decide not to go to the plan's providers.

Consumer-Driven Plans - Describes a wide range of approaches to give you more incentive to control the cost of either your health benefits or health care. You have greater freedom in spending health care dollars up to a designated amount and you receive full coverage for in-network preventive care. In return, you assume significantly higher cost sharing expenses after you have used up the designated amount. The catastrophic limit is usually higher than those common in other plans.


Page 26   To Next Page   To Previous Page

Health Maintenance Organization (HMO) and Point of Service (POS) Plans

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs.

Primary Care Specialist/Office Copay shows what you pay for each office visit to your primary care doctor and specialist. Contact your plan to find out what providers it considers specialists.

Hospital per Stay Deductible is the amount you pay when you are admitted into a hospital.

Plan name - Location

Telephone Number

Enrollment Code

Your Share

FDIC Share

Accredited

Self only

Self & family

Self only

Self & family

Self only

Self & family

Alabama

HealthSpring of Alabama, Inc. - Birmingham/Other areas

800/947-5093

DF1

DF2

29.35

114.91

143.32

327.12

 

Arizona

Aetna Health Inc. - Phoenix/Tucson Areas

800/537-9384

WQ1

WQ2

12.99

35.69

102.50

281.54

NCQA 2

Health Net of Arizona, Inc. - Maricopa/Pima/Other AZ counties

800/289-2818

A71

A72

15.93

40.37

125.70

318.48

NCQA 2

Humana CoverageFirst (Consumer Driven Plan) - Phoenix

888/393-6765

DB1

DB2

10.27

23.61

81.00

186.30

 

PacifiCare Desert Region (AZ & NV) - Maricopa, Pima County & Apache Junction

800-531-3341

A31

A32

14.44

35.96

113.94

283.72

NCQA 1

California

Aetna Health Inc. - Los Angeles and San Diego Areas

800/537-9384

2X1

2X2

12.18

29.70

96.09

234.29

NCQA 2

Aetna HealthFund (Consumer Driven Plan) - Northern/Central Valley/Southern CA

888/238-6240

221

222

14.56

33.49

114.88

264.24

 

Blue Cross- HMO - Most of California

800/235-8631

M51

M52

17.38

54.00

137.14

327.12

NCQA 1

Blue Shield of CA Access+ - Most of California

800/880-8086

SJ1

SJ2

15.17

37.64

119.70

296.91

NCQA 1

Health Net of California - Most of California

800/522-0088

LB1

LB2

16.08

38.07

126.87

300.33

NCQA 1

Kaiser Permanente - Northern California

800/464-4000

591

592

17.77

49.95

140.20

327.12

NCQA 1

Kaiser Permanente - Southern California

800/464-4000

621

622

16.67

38.54

131.54

304.00

NCQA 1

PacifiCare of California - Most of California

800-531-3341

CY1

CY2

13.49

31.31

106.46

246.98

NCQA 1

UHP Healthcare - LA/Orange/San Bernardino Counties

800/544-0088

C41

C42

12.11

25.79

95.56

203.49

JCAHO 1

Universal Care - Southern California

800/635-6668

6Q1

6Q2

12.39

32.71

97.75

258.03

NCQA 2

Colorado

Kaiser Permanente - Denver/Colorado Springs areas

800/632-9700

651

652

16.09

41.88

126.93

327.12

NCQA 1

PacifiCare of Colorado - Denver/Colorado Springs/Ft.Collins

800/877-9777

D61

D62

17.55

45.71

138.44

327.12

NCQA 1


Page 27   To Next Page   To Previous Page

Prescription Drugs - Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. You pay the Brand name amount if you or your doctor requests the Brand name or if a Generic is not available. The figure in the Brand name/Non-formul