Pages 1--52 from CFM13301 OPM 2000

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Mail Handlers Benefit Plan 2000 WE CARE
A Fee for Service Plan with a Preferred Provider Organization
Sponsored by the National Postal Mail Handlers Union a Division of LIUNA AFL CIO
Who may enroll in this Plan All Federal employees and annuitants changes who are eligible to enroll in the Federal Employees Health Benefits Program
For and who are or become members or associate members of the National Postal
in benefits 5 Mail Handlers Union a Division of LIUNA AFL CIO

see pages 4

To become an associate member You may become an associate member by enrolling in this Plan There is no membership charge for members of the
National Postal Mail Handlers Union a Division of LIUNA AFL CIO

Membership dues 42 per year New associate members will be billed for annual dues when the Plan receives notice of enrollment Continuing associate members will be billed by the Mail Handlers Union
for the annual membership

Enrollment codes for this Plan
451 High Option Self Only

452 High Option Self and Family
454 Standard Option Self Only
455 Standard Option Self and Family

Visit the OPM website at http www opm gov insure and
our website at http www mhbp com

Authorized for distribution by the
United States Office of Personnel Management
Retirement and Insurance
RI 71 7 1
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Mail Handlers Benefit Plan 2000
Table of Contents

Page
Introduction 3

Plain Language 3
How To Use This Brochure 3
Section 1 Fee for Service Plans 4
Section 2 How We Change for 2000 4 5
Section 3 How to Get Benefits 6 10
Section 4 What to Do if We Deny Your Claim or Request for Preauthorization 11 12
Section 5 Benefits 13 31
Section 6 How to File a Claim 32 33
Section 7 General Exclusions Things We Don't Cover 34
Section 8 Limitations Rules That Affect Your Benefits 35 39
Section 9 Fee for Service Facts 40 43
Section 10 FEHB Facts 44 46
Department of Defense FEHBP Demonstration Project 47 48
Inspector General Advisory Stop Healthcare Fraud 48
Index 49
Summary of Benefits 50 51

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Mail Handlers Benefit Plan 2000
Introduction

Mail Handlers Benefit Plan
This brochure describes the benefits you can receive from the Mail Handlers Benefit Plan The National Postal Mail Handlers Union a division of LIUNA AFL CIO has entered into contract CS 1146 with the Office of Personnel Management OPM as

authorized by the Federal Employees Health Benefits FEHB law to offer this Plan This Plan is underwritten by Continental Assurance Company

This brochure is the official statement of benefits on which you can rely A person enrolled in this Plan is entitled to the benefits described in this brochure If you are enrolled for Self and Family coverage each eligible family member is also entitled to these
benefits Nothing anyone says can modify or otherwise affect the benefits limitations and exclusions of this brochure
Because OPM negotiates benefits and premiums annually they change each year This brochure describes the only benefits available to you under this Plan in 2000 Benefit changes are effective January 1 2000 and are shown on pages 4 5 You do not have a right

to benefits that were available before January 1 2000 unless those benefits are also contained in this brochure Premiums are listed at the end of this brochure

Plain Language
The President and Vice President are making the Government's communications more responsive accessible and understandable to the public by requiring agencies to use plain language Health plan representatives and Office of Personnel Management staff have
worked cooperatively to make portions of this brochure clearer In it you will find common everyday words except for necessary technical terms you and other personal pronouns active voice and short sentences

We refer to the Mail Handlers Benefit Plan as this Plan throughout this brochure even though in other legal documents you will see a plan referred to as a carrier
Sections one two four and ten are now in plain language as well as portions of sections three and eight We will rewrite the remaining sections of this brochure including the benefits section for year 2001 Please note that the format and organization of this
brochure have changed as well
These changes do not affect the benefits or services we provide We have rewritten this brochure only to make it more understandable

How To Use This Brochure
This brochure has ten sections Each section has important information you should read If you want to compare this Plan's benefits with benefits from other FEHB plans you will find that the brochures have the same format and similar information to make
comparisons easier
1 Fee for Service Plan FFS This Plan is a FFS Plan Turn to this section for a brief description of Fee for Service plans and how they work

2 How We Change for 2000 If you are a current member and want to see how we have changed read this section
3 How to Get Benefits Make sure you read this section it tells you how to get benefits and how we operate
4 What To Do if We Deny Your Claim or Request for Preauthorization This section tells you what to do if you disagree with our decision not to pay for your claim or to deny your request for a service

5 Benefits Look here to see the benefits we will provide as well as specific exclusions and limitations You will also find information about Non FEHB Benefits
6 How to File a Claim Look here to find specific information on how to file claims with us
7 General Exclusions Things we don't cover Look here to see benefits that we will not provide
8 Limitations Rules that affect your benefits This section describes limits that can affect your benefits
9 Fee for Service Facts This section contains information about precertification protection against catastrophic expenses and a definitions section

10 FEHB Facts Read this for information about the Federal Employees Health Benefits FEHB Program

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Mail Handlers Benefit Plan 2000
Section 1 Fee for Service Plans
Fee for service FFS plans reimburse you or your provider for covered services They do not typically provide or arrange for health care Fee for service plans let you choose your own physicians hospitals and other health care providers

The FFS plan reimburses you for your health care expenses usually on a percentage basis These percentages as well as deductibles methods for applying deductibles to families and the percentage of coinsurance you must pay vary by plan The type
and extent of covered services varies by plan There is a detailed explanation of the benefits we offer in this brochure you should read it carefully

This FFS plan offers a preferred provider organization PPO arrangement This arrangement with health care providers gives you enhanced benefits or limits your out of pocket expenses

Section 2 How We Change for 2000
Program Wide Changes This year you have a right to more information about this Plan care management our networks facilities and providers

If you have a chronic or disabling condition or are in the second or third trimester of pregnancy and your specialty provider is leaving our PPO network at our request without cause we will
notify you You may continue to receive our PPO level benefits for your specialty provider's services for up to 90 days after you receive notice We will provide regular non PPO benefits
for the specialty provider's services after the 90 day period expires
You may review and obtain copies of your medical records on request If you want copies of your medical records ask your health care provider for them You may ask that a physician

amend a record that is not accurate not relevant or incomplete If the physician does not amend your record you may add a brief statement to it If they do not provide you your records call us
and we will assist you
If you are age 50 or older all FEHB plans will cover a screening sigmoidoscopy every five years This Plan will cover the screening every two years This screening is for colorectal cancer

Three states are added to the list of medically underserved areas They are Kentucky Missouri and Utah

Changes to This Plan This Plan's High Option Self Only premiums have increased by 16.8 High Option Self and Family premiums have increased by 17
This Plan's Standard Option Self Only premiums have increased by 10 Standard Option Self and Family premiums have increased by 10
If you live in an area that has medical PPO providers available but you do not use a provider in the PPO network your out of pocket expenses will increase The Plan will reimburse your claim
at 70 of the rate it would have paid had you used a medical PPO provider For example if your Non PPO provider charged 100 for a visit and the Plan's PPO rate for the visit is 80 the Plan
will pay 70 of 80 or 56 You are responsible for the difference between 100 and 56 or 44 This applies only when you have access to a medical PPO provider but do not use one
See definition of reasonable and customary page 43 for further details
The Plan has added a 150 per person calendar year deductible for High Option up to a family limit of 450 The calendar year deductible for Standard Option has increased to 200 per

person up to a family limit of 600 This will eliminate the current 100 durable medical equipment deductible the 250 and 300 surgical facilities deductible the 100 deductible on
certain Standard Option outpatient charges and the 50 copayment on surgery and anesthesia The prescription drug deductibles still apply These deductibles do not apply to doctor's
outpatient medical visits
The Plan will reduce the coinsurance rate for professional services under High Option PPO benefits to 90 from 95 or in some cases 100 for inpatient surgical medical and maternity

and outpatient hospital surgical medical and maternity benefits

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Mail Handlers Benefit Plan 2000
Section 2 How We Change for 2000 continued
Changes to This Plan The Plan will change its reimbursement of emergency treatment both illness and accident to pay continued PPO benefits under High and Standard Options at 90 of covered charges subject to the
applicable calendar year deductible For Non PPO benefits under High and Standard Options the Plan pays 70 of reasonable and customary charges subject to the applicable calendar
year deductible
The Plan will add a network of preferred dentists to the High Option only Dental benefits These dentists will provide services at discounted rates

The Plan will increase its reimbursement for outpatient care for mental conditions and substance abuse for Both Options from 50 to 70 of reasonable and customary charges up to the 20
outpatient annual visit limit subject to the applicable calendar year deductible
The Plan will implement drug management programs that will require preauthorization and or limit dispensing quantities of some categories of drugs These categories include growth

hormone acne medications antiemetics migraine medications and drugs used to treat attention deficit disorder and narcolepsy

The Plan will change the mail order prescription drug copayments to the following three tier level Under High Option you will pay a 10 copay per generic a 30 copay per preferred brand
name drug and a 45 copay per non preferred brand name Under Standard Option you will pay a 10 copay per generic a 40 copay per preferred brand name drug and a 55 copay per nonpreferred
brand name Current prescription drug deductibles remain
The Plan will change the retail prescription drug benefit to require you to pay any amount in excess of the cost of a generic drug when a generic drug is available and the physician does not

specify that the prescription must be dispensed as written
The Plan will change the retail prescription drug benefit whereby members who use a PCS network pharmacy but do not present their card at the pharmacy will be reimbursed when a

paper claim is filed at Mail Handlers cost had the member obtained the PCS discount
The Plan will change the retail prescription drug benefit for prescriptions purchased at a non PCS participating pharmacy in the United States The Plan's benefit for such purchases will be limited

to an amount that would have been paid if purchased at a PCS participating pharmacy You may incur greater out of pocket expenses for such purchases

The Plan will increase the catastrophic protection limit from 3,000 to 4,000 for non PPO services under High Option For PPO services under High Option the catastrophic limit will
increase from 2,000 to 2,500 For both PPO and non PPO services under Standard Option the catastrophic limit will increase from 3,000 to 4,000

The Plan will change its coverage for Chelation Therapy to an inpatient only acute care benefit
The Plan will eliminate the current Nurse Advice Triage telephone service
The Plan will change its reimbursement for ambulance and nursing care services under High and Standard Options to pay 70 of the reasonable and customary charges subject to the applicable

calendar year deductible
The Plan has added coverage for allogenic donor bone marrow transplants to treat chronic myelogenous leukemia and for autologous bone marrow transplants to treat chronic lymphocytic

leukemia
The Plan has added PPO vendors for durable medical equipment The Plan will change its reimbursement for these services to pay 90 of the covered charges for PPO vendors and 70

of the reasonable and customary charges for non PPO vendors subject to the applicable calendar year deductible The Plan will also limit benefits for the rental of durable medical equipment to
an amount equal to what would be paid for the purchase of the equipment
The Plan will change its reimbursement for orthopedic and prosthetic appliances under High and Standard Options to pay 90 of the reasonable and customary charges subject to the applicable

calendar year deductible

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Mail Handlers Benefit Plan 2000
Section 3 How to Get Benefits
How do I keep my health care expenses down

You can help FEHB plans are expected to manage their costs prudently All FEHB plans have cost containment measures in place All fee for service plans include two specific provisions in their benefits
packages precertification of inpatient admissions and the flexible benefits option Some include managed care options such as PPOs to help contain costs

As a result of your cooperative efforts the FEHB Program has been able to control premium costs Please keep up the good work and continue to help keep costs down

Precertification Precertification evaluates the medical necessity of proposed admissions and the number of days required to treat your condition You are responsible for ensuring that the precertification
requirement is met You or your doctor must check with the Plan before being admitted to the hospital If that doesn't happen your Plan will reduce benefits by 500 Be a responsible
consumer Be aware of your Plan's cost containment provisions You can avoid penalties and help keep premiums under control by following the procedures specified on pages 40 41
of this brochure

Flexible benefits option Under the flexible benefits option the Plan has the authority to determine the most effective way to provide services The Plan may identify medically appropriate alternatives to traditional care
and coordinate the provision of Plan benefits as a less costly alternative benefit Alternative benefits are subject to ongoing review The Plan may decide to resume regular contract benefits
at its sole discretion Approval of an alternative benefit is not a guarantee of any future alternative benefits The decision to offer an alternative benefit is solely the Plan's and may be
withdrawn at any time It is not subject to OPM review under the disputed claims process

PPO This Plan offers most of its members the opportunity to reduce out of pocket expenses by choosing providers who participate in the Plan's preferred provider organization PPO Consider
the PPO cost savings when you review Plan benefits and check with the Plan to see whether PPO providers are available in your area

How much do I pay for You must share the cost of some services These cost sharing measures include deductibles services coinsurance and copayments These and other measures are described in more detail below
Deductibles A deductible is the amount of expense an individual must incur for covered services and supplies before the Plan starts paying benefits for the expense involved A deductible is not reimbursable
by the Plan and benefits paid by the Plan do not count toward a deductible When a benefit is subject to a deductible only expenses allowable under that benefit count toward the deductible
Each family member must satisfy all applicable deductibles Deductibles do not calculate to the catastrophic protection benefit

Calendar year Calendar year deductible is the amount of expense an individual must incur for certain covered deductible services and supplies each calendar year before the Plan pays benefits for those expenses Only
those expenses covered under each provision may be applied toward that deductible The deductible is 150 per person per year for the High Option and 200 per person per year for the
Standard Option For Family coverage you and your family can also meet this deductible by accumulating up to three times this deductible per family 450 on the High Option and 600 on
the Standard Option

Hospital admission The hospital deductible is 250 per medical maternity and mental conditions substance abuse admission under High Option and 300 per admission under Standard Option If confinement is
in a PPO hospital under High Option the deductible is waived under Standard Option the deductible is reduced to 150

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Mail Handlers Benefit Plan 2000
How much do I pay for services continued

Deductibles continued
Prescription drugs There is a 250 prescription drug deductible per person per calendar year under High Option and a 600 prescription drug deductible per person per calendar year under Standard Option

Carryover If you changed to this Plan during open season from a plan with a deductible and the effective date of the change was after January 1 any expenses that would have applied to that plan's
deductible in the prior year will be covered by your old plan if they are for care you received in January before the effective date of your coverage in this Plan If you have already met the
deductible in full your old plan will reimburse these covered expenses If you have not met it in full your old plan will first apply your covered expenses to satisfy the rest of the deductible and
then reimburse you for any additional covered expenses The old plan will pay these covered expenses according to this year's benefits benefit changes are effective on January 1

Coinsurance Coinsurance is the stated percentage of covered charges you must pay after meeting the applicable deductible The Plan will base this percentage on the negotiated rates for PPO
providers and on the lesser of the billed charge or the reasonable and customary charge for non PPO providers You are required to pay the following coinsurance on benefits under this
Plan If you use a PPO provider you pay 10 of the negotiated rates for chemotherapy radiation therapy hemodialysis machine diagnostic tests and procedures doctors inpatient visits surgery
anesthesia emergency room visits durable medical equipment and obstetrical care If you use non PPO providers you pay 30 of negotiated or reasonable and customary charges for inpatient
mental conditions substance abuse outpatient surgical facilities chemotherapy radiation therapy hemodialysis machine diagnostic tests and procedures doctors visits inpatient and outpatient
surgery anesthesia obstetrical care emergency room visits ambulance nursing visits and durable medical equipment You pay 25 under High Option and 30 under Standard Option
of actual charges for prescription drugs purchased at a PCS network pharmacy You pay 50 of actual charges for prescription drugs purchased at a non PCS network pharmacy

After you meet any deductible the coinsurance is the minimum amount you will have to pay When the Plan pays 70 of reasonable and customary charges for a covered service you are
responsible for the 30 coinsurance In addition you are responsible for any excess charge over the Plan's reasonable and customary allowance under most circumstances For example if the
provider ordinarily charges 100 for a service but the Plan's reasonable and customary allowance is 95 the Plan will pay 70 of the allowance which is 66.50 You must pay the 30
coinsurance which is 28.50 plus the difference between the actual charge and the reasonable and customary allowance which is 5 for a total member payment of 33.50

Copayments A copayment is the stated amount you must pay for certain covered services before the Plan makes its payment For instance when you visit a PPO provider for a covered out of hospital
visit after you pay the 15 copayment the Plan will pay the remainder of the covered charge for the visit

If provider waives If a provider routinely waives does not require you to pay your share of the charge for services your share rendered the Plan is not obligated to pay the full percentage of the amount of the provider's
original charge it would otherwise have paid A provider or supplier who routinely waives coinsurance copayments or deductibles is misstating the actual charges This practice may be in
violation of the law The Plan will base its percentage on the fee actually charged For example if the provider ordinarily charges 100 for a service but routinely waives the 30 coinsurance
the actual charge is 70 The Plan will pay 49 70 of the actual charge of 70

Annual maximums There is a 1,500 cumulative annual maximum for outpatient therapy services physical therapy speech therapy occupational therapy chiropractic and acupuncture services
Lifetime maximums There is a 5,000 per person lifetime maximum under both options for inpatient and outpatient hospice care and a 100 per person lifetime maximum under the smoking cessation benefit If a
person changes options in this Plan all benefits paid under the former option and charged against a lifetime maximum will count against the corresponding lifetime maximum under the new option

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Mail Handlers Benefit Plan 2000
How much do I pay for services continued

Do I have to You usually do not have to submit claims to us if you use medical preferred providers If you file submit claims a claim please send us all of the documents for your claim as soon as possible You must submit
claims by December 31 of the year after the year you received the service Either OPM or we can extend this deadline if you show that circumstances beyond your control such as administrative
delay of government or legal incapacity prevented you from filing on time Please see Section 6 How to file a claim for specific information you need to know before you file a claim with us

Who provides my In a Fee for Service Plan you may choose any covered facility or provider health care
Covered facilities
Hospice A facility that
1 provides primarily inpatient care to terminally ill patients
2 is licensed certified by the jurisdiction in which it operates
3 is supervised by a staff of doctors M D or D O with at least one such doctor on call 24 hours a day

4 provides 24 hour a day nursing services under the direction of a registered nurse R N and has a full time administrator and
5 provides an ongoing quality assurance program
Hospital An institution that is accredited as a hospital under the Hospital Accreditation Program of the Joint Commission on Accreditation of Healthcare Organizations JCAHO or any other
institution that is operated pursuant to law under the supervision of a staff of doctors M D or D O and with 24 hour a day nursing services and that is primarily engaged in providing

a general inpatient acute care and treatment of sick and injured persons through medical diagnostic and major surgical facilities all of which facilities must be provided on its
premises or under its control or
b specialized inpatient acute medical care and treatment of sick or injured persons through medical and diagnostic facilities including X ray and laboratory on its premises under its

control or through a written agreement with a hospital or with a specialized provider of those facilities or

c a licensed birthing center
In no event shall the term hospital include any part of a hospital that provides long term care rather than acute care or a convalescent nursing home or any institution or part thereof that

a is used principally as a convalescent facility rest facility nursing facility or facility for the aged or
b furnishes primarily domiciliary or custodial care including training in the routines of daily living or
c is operated as a school or
d is operated as a residential treatment facility regardless of its State licensure or accreditation status

Covered Providers For purposes of this Plan covered providers include 1 a licensed doctor of medicine M D or a licensed doctor of osteopathy D O hereafter referred to as a doctor and 2 for certain
specified services covered by this Plan a licensed doctor of podiatry D P M a licensed dentist a chiropractor a licensed clinical physical therapist a licensed occupational therapist or a
licensed speech therapist Other covered providers include qualified clinical psychologist clinical social worker optometrist audiologist acupuncturist physician's assistant nurse
midwife nurse practitioner clinical specialist and nursing school administered clinic Covered providers must be appropriately licensed or certified as determined by the Plan For purposes of
this FEHB brochure the term doctor includes all of these providers when the services are performed within the scope of their license or certification

Coverage in medicallyunderserved Within States designated as medically underserved areas any licensed medical practitioner will areas be treated as a covered provider for any covered services performed within the scope of that
license For 2000 the States designated as medically underserved are Alabama Idaho Kentucky Louisiana Mississippi Missouri New Mexico North Dakota South Carolina

8 South Dakota Utah and Wyoming 8
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Mail Handlers Benefit Plan 2000
Who provides my health care continued

MultiPlan Participating This Plan has a contract with MultiPlan MultiPlan has entered into contracts with hospitals and Providers doctors who have agreed to discount their charges The Plan will consider these providers as
participating providers and will process their covered inpatient hospital claims at 100 of the negotiated amount subject to the applicable per admission deductible and at 70 of the
negotiated amount for covered outpatient services subject to the applicable calendar year deductible Call the Plan for the names of MultiPlan providers near you

PPO arrangements Benefits under this Plan are available from facilities such as hospitals and from providers doctors and other health care personnel who provide covered services Who these health care providers
are and how benefits are paid for their services are explained below In general it works like this
PPO facilities and providers have agreed to provide services to Plan members at a lower cost than you'd usually pay for a non PPO provider Although PPOs are not available in all locations or for all

services when you use these providers you help contain health care costs and reduce what you pay out of pocket The selection of PPO providers is solely the Plan's responsibility PPO providers are
independent contractors and final decisions about health care are the sole responsibility of the doctor and patient However benefit decisions made by the Plan are dependent upon all the terms of this
brochure Continued participation of any specific provider cannot be guaranteed
PPO benefits apply only when you use a PPO provider Provider networks may be more extensive in some areas than others The availability of every specialty in all areas cannot be

guaranteed If you receive non covered services from a PPO provider the PPO discount will not apply and these services will be excluded from coverage

When you use a PPO hospital keep in mind that the professionals who provide services to you in the hospital such as radiologists emergency room physicians anesthesiologists and pathologists may
not all be preferred providers If they are not they will be paid by this Plan as non PPO providers
Non PPO facilities and providers do not have special agreements with the Plan The Plan will consider the reasonable and customary charges see definition for covered services

and you're responsible for any balance
This Plan's If confinement in a PPO hospital is chosen and precertification of hospital services is obtained medical PPO under High Option the inpatient hospital deductible will be waived under Standard Option the
inpatient hospital deductible will be 150 If PPO doctors are chosen the Plan will pay 100 of the covered charges for outpatient physicians visits after a 15 copayment except for allergen
immunotherapy i e allergy shots where the Plan pays 100 after a 5 copayment If a PPO provider is chosen for inpatient physician visits outpatient X ray and machine tests laboratory
services emergency treatment of illness or injury maternity surgical and anesthesia services and physical therapy chiropractor and acupuncture visits the Plan will pay 90 of the covered
charges Drugs purchased at a pharmacy are not subject to PPO benefits Drugs supplied or administered by a PPO provider are eligible for PPO benefits

PPO hospitals doctors and laboratories will submit Mail Handlers Benefit Plan claims on your behalf and all PPO benefits will be paid directly to the participating hospital doctor or
laboratory Using a PPO hospital doesn't guarantee that all care received will be rendered by a PPO doctor or provider This includes but is not limited to emergency room physicians
pathologists radiologists and anesthesiologists
PPO information including whether or not your city or town is part of a PPO network can be obtained by calling a Customer Relations Associate at the Regional Service Center at

1 800 410 7778 or by visiting the Plan's website www mhbp com Participating hospitals doctors and laboratories are also listed in directories that the Plan sends to its members When
you phone for an appointment please remember to verify that the physician is still a PPO provider
The Plan offers access to a network of dentists who have agreed to provide services at a
This Plan's discounted rate To learn of a preferred dentist in your area call 1 888 788 5702 or visit dental PPO the Plan's website www mhbp com For information about the Plan's benefits call customer

relations at 1 800 410 7778 or visit the Plan's website

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Mail Handlers Benefit Plan 2000
If PPO providers are Effective January 1 2000 it is even more important to use the Plan's PPO network providers available in your area In past years if you did not use PPO providers even though they were available in
and you do not use them your area your expenses were paid as regular Non PPO benefits with the Plan's allowance determined by the reasonable and customary charge see definition on page 43 This has
changed If PPO providers are available in your area and you do not use them your out ofpocket expenses will increase The Plan will base its allowance on a fee schedule that represents

an average of the PPO fee schedules for a particular service in a particular geographic area see definition of reasonable and customary page 43 for further details You can call the Plan
at 1 800 410 7778 for information about the availability of PPO providers in your area or to determine the amount of your out of pocket expenses

Those members who do not have adequate access in terms of distance from where you live to a network provider or those receiving emergency care will not be affected The Plan's allowance
in these cases will be based on the reasonable and customary allowance
What do I do if I'm First call the Plan's Customer Relations Department at 1 800 410 7778 If you are new to the in the hospital when FEHB Program we will reimburse your covered expenses If you are currently in the FEHB

I join this Plan Program and are switching to us your former plan will pay for the hospital stay until You are discharged not merely moved to an alternative care center or

You exhaust the benefits available from your former plan or
The 92nd day after you became a member of this Plan whichever happens first
These provisions only apply to the person who is hospitalized

What if I have a serious Please contact us if you believe your condition is chronic or disabling If it is you may be able to illness and my provider continue seeing your specialty provider for up to 90 days after you receive notice that we are

leaves the Plan or this terminating our contract with the provider unless the termination is for cause If you are in the Plan leaves the Program second or third trimester of pregnancy you may continue to see your OB GYN until the end of your
postpartum care
You may also be able to continue seeing your specialty provider if your plan drops out of the FEHB Program and you enroll in a new FEHB plan Contact the new plan and explain that you have a

serious or chronic condition or are in your second or third trimester Your new plan will pay for or provide your care for up to 90 days after you receive notice that your prior plan is leaving the FEHB
Program If you are in your second or third trimester your new plan will pay for the OB GYN care you receive from your current provider until the end of your postpartum care

If you continue seeing your specialist or OB GYN under these conditions your cost will be no more than you would normally pay for the services covered

How do you decide if a A drug device or biological product is experimental or investigational if the drug device or service is experimental biological product cannot be lawfully marketed without approval of the U S Food and Drug
or investigational Administration FDA and approval for marketing has not been given at the time it is furnished Approval means all forms of acceptance by the FDA
A medical treatment or procedure or a drug device or biological product is experimental or investigational if 1 reliable evidence shows that it is the subject of ongoing phase I II or III
clinical trials or under study to determine its maximum tolerated dose its toxicity its safety its efficacy or its efficacy as compared with the standard means of treatment or diagnosis or
2 reliable evidence shows that the consensus of opinion among experts regarding the drug device or biological product or medical treatment or procedure is that further studies or clinical
trials are necessary to determine its maximum tolerated dose its toxicity its safety its efficacy or its efficacy as compared with the standard means of treatment or diagnosis

Reliable evidence shall mean only published reports and articles in the authoritative medical and scientific literature the written protocol or protocols used by the treating facility or the protocol s of
another facility studying substantially the same drug device biological product or medical treatment or procedure or the written informed consent used by the treating facility or by another facility
studying substantially the same drug device biological product or medical treatment or procedure
If you wish additional information concerning the experimental investigational determination process please contact the Plan

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Mail Handlers Benefit Plan 2000
Section 4 What to Do if We Deny Your Claim or Request for Preauthorization
What should I do before Before you ask us to reconsider your claim you should first check with your provider or facility filing a disputed claim to be sure that the claim was filed correctly For instance did the provider use the correct
procedure code for the services performed surgery laboratory test x ray office visit etc Have your provider indicate any complications of any surgical procedures performed
Your provider should also include copies of an operative or procedure report or any other documentation that supports your claim

If we deny your request for preauthorization or won't pay your claim or a part thereof you may ask us to reconsider our decision Your request must
1 Be in writing
2 Refer to specific brochure wording explaining why you believe our decision is wrong and
3 Be made within six months from the date of our initial denial or refusal We may extend this time limit if you show that you were unable to make a timely request due to reasons beyond

your control
We have 30 days from the date we receive your reconsideration request to
1 Maintain our denial in writing
2 Pay the claim
3 Approve your request for coverage or preauthorization or
4 Ask for more information
If we ask your medical provider for more information we will send you a copy of our request We must make a decision within 30 days after we receive the additional information If we do

not receive the requested information within 60 days we will make our decision based on the information we already have

When may I ask OPM You may ask OPM to review the denial after you ask us to reconsider our initial denial or refusal to review a denial OPM will determine if we correctly applied the terms of our contract when we denied your claim
or request for preauthorization

What if I have a serious Call us at 1 800 410 7778 and we will expedite our review or life threatening
condition and you haven't responded to my request
for preauthorization

What if you have denied If we expedite your review due to a serious medical condition and deny your request we will my request for care and inform OPM so that they can give your claim expedited treatment too Alternatively you can call
my condition is serious or OPM's health benefits Contract Division II at 202 606 3818 between 8 a m and 5 p m Serious life threatening or life threatening conditions are ones that may cause permanent loss of bodily functions or death
if they are not treated as soon as possible

Are there other You must write to OPM and ask them to review our decision within 90 days after we uphold our time limits initial denial or refusal You may also ask OPM to review your claim if
1 We do not answer your request within 30 days In this case OPM must receive your request within 120 days of the date you asked us to reconsider your claim
2 You provided us with additional information we asked for and we did not answer within 30 days In this case OPM must receive your request within 120 days of the date we asked you
for additional information

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Mail Handlers Benefit Plan 2000
What do I send to OPM Your request must be complete or OPM will return it to you You must send the following information
1 A statement about why you believe our decision is wrong based on specific benefit provisions in this brochure

2 Copies of documents that support your claim such as physicians letters operative reports bills medical records and explanation of benefits EOB forms
3 Copies of all letters you sent us about the claim
4 Copies of all letters we sent you about the claim and
5 Your daytime phone number and the best time to call
If you want OPM to review different claims you must clearly identify which documents apply to which claim

Who can make Those who have a legal right to file a disputed claim with OPM are the request
1 Anyone enrolled in the Plan
2 The estate of a person once enrolled in the Plan and
3 Medical providers legal counsel and other interested parties who are acting as the enrolled person's representative They must send a copy of the person's specific written consent to

appeal the denial with the review request

Where should I mail Send your request for review to Office of Personnel Management Office of Insurance my disputed claim Programs Contract Division II P O Box 436 Washington DC 20044
to OPM

What if OPM upholds OPM's decision is final There are no other administrative appeals If OPM agrees with our the Plan's denial decision your only recourse is to sue
If you decide to sue you must file the lawsuit against OPM in Federal court by December 31 of the third year after the year in which you received the disputed services or supplies

What laws apply Federal law governs your lawsuit benefits and payment of benefits See 5 U S C 8901 m 1 if I file a lawsuit and 5 CFR 890 The Federal court will base its review on the record that was before OPM when
OPM made its decision on your claim You may recover only the amount of benefits in dispute
You or a person acting on your behalf may not sue to recover benefits on a claim for treatment services supplies or drugs covered by us until you have completed the OPM review procedure

described above

Your records and Chapter 89 of title 5 United States Code allows OPM to use the information it collects from you the Privacy Act and us to determine if our denial of your claim is correct The information OPM collects during
the review process becomes a permanent part of your disputed claims file and is subject to the provisions of the Freedom of Information Act and the Privacy Act OPM may disclose this
information to support the disputed claim decision If you file a lawsuit this information will become part of the court record

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Mail Handlers Benefit Plan 2000
Section 5 Benefits
All benefits are subject to the definitions limitations and exclusions in this brochure and are payable when determined by the Plan to be medically necessary

Inpatient Hospital Benefits
What is covered The Plan pays for inpatient hospital services as shown below

Precertification The medical necessity of your hospital admission must be precertified for you to receive full Plan benefits Emergency admissions not precertified must be reported within two business days
following the day of admission even if you have been discharged Otherwise the benefits payable will be reduced by 500 If your stay is greater than 23 hours services will be
considered inpatient subject to precertification guidelines See pages 40 41 for details

Waiver This precertification requirement does not apply to persons whose primary coverage is Medicare Part A or another health insurance policy or when the hospital admission is outside the United
States For information on when Medicare is primary see pages 35 37

Room and board Benefits are available for semiprivate room or ward intensive care or progressive care step down or a private room when isolation is required by law or when the Plan determines isolation
is medically necessary to prevent contagion If you are confined in a private room for any other reason the Plan will pay the semiprivate room rate most frequently charged by that hospital

PPO benefit High Option The Plan pays 100 Standard Option After the 150 with no deductible per admission deductible the Plan
pays 100

Non PPO benefit High Option After the 250 Standard Option After the 300 per admission deductible per admission deductible
the Plan pays 100 the Plan pays 100

Other charges Benefits are paid in full under both options for charges for all covered hospital services and supplies billed for by the hospital during the hospital confinement including
General nursing care
Drugs and medicines furnished by the hospital
Use of operating room recovery or other treatment rooms
Dressings
X rays
Laboratory and pathology services
Blood and blood plasma
Autologous blood donations
Machine diagnostic tests
Meals and special diets

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Mail Handlers Benefit Plan 2000
Inpatient Hospital Benefits continued
Limited benefits
Organ tissue The maximum benefit for any organ tissue transplant as described on page 16 is 300,000 transplants per occurrence Benefits issued for charges related to complications arising during the transplant

confinement same admission are subject to the 300,000 maximum Included in the 300,000 maximum are hospital surgical and other medical expenses The cost of related outpatient prescription
drugs is not subject to this limit Chemotherapy when supported by a bone marrow transplant or autologous stem cell support is covered only for specific diagnoses listed on page 16

Hospitalization The Plan pays Inpatient Hospital Benefits as shown above in connection with dental procedures for dental work only when a non dental physical impairment exists that makes hospitalization necessary to
safeguard the health of the patient

Related benefits
Pre surgical testing See Other Medical Benefits page 23 for benefits for diagnostic tests and procedures prior to an admission for surgery

Professional charges See page 21 for inhospital doctors visits
What is not covered A hospital admission or portion thereof that is not medically necessary see definition including an admission for medical services that did not require the acute hospital inpatient
overnight setting but could have been provided in a doctor's office the outpatient department of a hospital or some other setting without adversely affecting the patient's condition or the
quality of medical care rendered
Hospital admissions for medical rehabilitation unless the admission is to an approved acute inpatient rehabilitation facility and the patient can actively participate in a minimum of 3 hours

of acute inpatient rehabilitation to include any combination of the following therapies physical occupational speech respiratory therapy per day

Personal comfort items such as radio television telephone guest beds admission kits or other comfort items
Charges by institutions that do not meet the definition of a hospital
Inpatient private duty nursing
Custodial care as defined on page 42 even when provided by a hospital

The non PPO benefits are the regular benefits of this plan PPO benefits apply only when you use a PPO provider When no PPO provider is available non PPO benefits apply

Surgical Benefits
What is covered The Plan pays for covered charges billed by a primary surgeon as follows inpatient or outpatient

PPO benefit High Option The Plan pays 90 Standard Option The Plan pays 90 of the covered charges after the 150 of the covered charges after the 200
per person calendar year deductible per person calendar year deductible has been met has been met

Non PPO benefit High Option The Plan pays 70 Standard Option The Plan pays 70 of the of the reasonable and customary charges reasonable and customary charges after the
after the 150 per person calendar year 200 per person calendar year deductible deductible has been met has been met

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Mail Handlers Benefit Plan 2000
Surgical Benefits continued
Multiple surgical For multiple surgical procedures performed by the same surgeon through the same incision and procedures during the same operative session

PPO benefit High Option The Plan pays 90 of the Standard Option The Plan pays 90 covered charges for the primary procedure of the covered charges for the primary
and 90 of half of the covered charges for procedure and 90 of half of the covered the secondary procedure after the 150 charges for the secondary procedure after
per person calendar year deductible has the 200 per person calendar year deductible been met has been met

Non PPO benefit High Option The Plan pays 70 Standard Option The Plan pays 70 of the reasonable and customary charges of the reasonable and customary charges
for the primary procedure and 70 of half for the primary procedure and 70 of half of the reasonable and customary charges of the reasonable and customary charges
for the secondary procedure after the for the secondary procedure after the 150 per person calendar year deductible 200 per person calendar year deductible
has been met has been met

Co Surgeons For surgical procedures performed by two surgeons the Plan pays each surgeon 50 of what it would pay a single surgeon for the same surgical procedure s

Incidental procedures An incidental procedure e g incidental appendectomy lysis of adhesions excision of previous scar puncture of ovarian cyst can be part of the primary surgery or unrelated to the objective of
the operative session If a surgical procedure is deemed by the Plan to be incidental to the total surgery benefits will not be provided for the incidental portion

Assistant surgeon When the services of an assistant surgeon are required by the primary surgeon and considered by the Plan to be medically necessary
PPO benefit High Option The Plan pays 20 Standard Option The Plan pays 20 of the covered charges for surgery after of the covered charges for surgery after
the 150 per person calendar year the 200 per person calendar year deductible has been met deductible has been met

Non PPO benefit High Option The Plan pays 20 of the Standard Option The Plan pays 20 reasonable and customary charges for of the reasonable and customary charges
surgery after the 150 per person for surgery after the 200 per person calendar year deductible has been met calendar year deductible has been met

Anesthesia
PPO benefit High Option The Plan pays 90 Standard Option The Plan pays 90 of the covered charges after the 150 of the covered charges after the 200

per person calendar year deductible per person calendar year deductible has been met has been met

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Mail Handlers Benefit Plan 2000
Surgical Benefits continued
Organ tissue transplants Benefits will be provided the same as for any other illness or injury for covered expenses and donor expenses incurred for surgical transplant of a body organ tissue as defined below Related donor medical
and hospital expenses are covered when the recipient is covered by the Plan
Surgical transplant of body organ tissue means transfer of a body organ s tissue s from the donor to the recipient allogenic or a bone marrow graft in which the donor and recipient are the

same person autologous For purposes of this Plan body organ tissue includes only the organs and tissues listed below as What is covered

Donor means a person who undergoes a surgical operation for the purpose of donating a body organ s tissue s for transplant surgery Coverage for donor screening tests for organ tissue
transplants is limited to those performed on the actual donor

What is covered Benefits will be provided for the following transplants subject to the limitations shown
Cornea heart kidney liver pancreas heart lung single lung and double lung transplants
Bone marrow and stem cell support as follows
Allogenic donor bone marrow transplants chronic myelogenous leukemia acute leukemia aplastic anemia severe combined immuno deficiency disease Wiscott Aldrich syndrome

advanced Hodgkin's lymphoma advanced non Hodgkin's lymphomas and myelodysplastic syndrome in advanced form

Autologous bone marrow transplants autologous stem cell and peripheral stem cell support for chronic or acute lymphocytic or non lymphocytic leukemia advanced Hodgkin's
lymphoma advanced non Hodgkin's lymphomas resistant or recurrent neuroblastoma testicular mediastinal retroperitoneal and ovarian germ cell tumors breast cancer multiple
myeloma and epithelial ovarian cancer
Related medical and hospital expenses of the donor are covered when the recipient is covered by the Plan

The maximum benefit for any organ tissue transplant s is 300,000 per occurrence Included in the 300,000 maximum are hospital surgical and medical expenses of the recipient but not the
covered expenses of the donor Benefits issued for charges related to complications arising during the transplant confinement same admission are subject to the 300,000 maximum The
cost of outpatient prescription drugs related to the transplant is not subject to the 300,000 limit Chemotherapy when supported by a bone marrow transplant or autologous stem cell support is
covered only for the specific diagnoses listed above

What is not covered Services or supplies for or related to surgical transplant procedures for artificial or human organ tissue transplants not specifically listed as covered Related services or supplies include
administration of chemotherapy when supported by transplant procedures
Donor screening tests for organ tissue transplants except those performed on the actual donor

Oral and maxillofacial The following procedures are covered surgery
Reduction of fractures of the jaws or facial bones
Removal of impacted teeth that are not completely erupted bony partial bony and soft tissue impactions

Surgical correction of cleft lip cleft palate or protruding mandible
Removal of stones from salivary ducts
Excision of tori leukoplakia or malignancies
Temporomandibular joint dysfunction surgery
Other surgical procedures that do not involve the teeth or their supporting structures

Note Procedures that involve the teeth or their supporting structures such as periodontal membrane gingiva and alveolar bone are not considered covered oral surgery These
procedures may be considered as covered dental procedures under the High Option dental
16 benefits There is no coverage for dental implants or related procedures see pages 28 30 16
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Mail Handlers Benefit Plan 2000
Surgical Benefits continued
Mastectomy surgery Women who undergo mastectomies may at their option have this procedure performed on an inpatient basis and remain in the hospital up to 48 hours after the procedure

Related benefits
Pre surgical testing Outpatient diagnostic tests and procedures performed prior to surgery are covered under Outpatient diagnostic laboratory X ray and machine diagnostic tests benefits as described under
Other Medical Benefits page 23

Eyeglasses lenses Eyeglasses or contact lenses to correct an impairment directly caused by an accidental injury or covered intraocular surgery are covered as Additional Benefits on page 25

Casting Services and supplies related to casting are considered under the surgical benefit
Limited benefit
Cosmetic surgery Cosmetic surgery see definition and all services related thereto are limited to surgery necessary to correct a congenital anomaly see definition or to promptly repair an injury caused by an accident

Benefits will be provided for breast reconstruction surgery following a mastectomy including surgery to produce a symmetrical appearance on the other breast Benefits will be provided for
all stages of breast reconstruction following a mastectomy including treatment of any physical complications including lymphedemas and for breast prostheses including surgical bras and
replacements

What is not covered Removal of corns or calluses or trimming of nails including debridement regardless of diagnosis
Eye surgery such as radial keratotomy or laser procedures when the primary purpose is to correct myopia nearsightedness hyperopia farsightedness or astigmatism blurring

Reversal of surgically induced sterilization
Services of a stand by surgeon

The non PPO benefits are the regular benefits of this Plan PPO benefits apply only when you use a PPO provider When no PPO provider is available non PPO benefits apply

Maternity Benefits
What is covered The Plan pays the same benefits for hospital surgery delivery laboratory tests and other medical expenses as for illness or injury The mother at her option may remain in the hospital

up to 48 hours after a regular delivery and 96 hours after a cesarean delivery Inpatient stays will be extended if medically necessary

For Whom Benefits are payable under Self Only enrollments and for family members under Self and Family enrollments
Inpatient hospital
Precertification Precertification is not required for maternity admissions for routine deliveries However if your medical condition requires that you stay more than 48 hours after a regular delivery or 96 hours

after a cesarean section you your physician or the hospital must contact the Plan for certification of the additional days If the certification for additional days is not obtained and a retrospective
medical review determines the additional days were not medically necessary the Plan will not pay for charges incurred on those noncertified days If certification is not obtained but the benefits are
otherwise payable benefits for the admission will be reduced by 500 Newborn confinements that extend beyond the mother's discharge must also be precertified If any of the above are not
done the benefits payable will be reduced by 500 See pages 40 41 for details
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Mail Handlers Benefit Plan 2000
Maternity Benefits continued
Newborn Any additional hospital days for a newborn who requires care beyond the mother's stay must be precertification precertified under the guidelines for emergency admissions

Room and board For semiprivate room and board and other covered hospital services and supplies
PPO benefit High Option The Plan pays 100 Standard Option The Plan pays 100 with no deductible after the 150 per admission deductible

Non PPO benefit High Option The Plan pays 100 Standard Option The Plan pays 100 after the 250 per admission deductible after the 300 per admission deductible
Other charges Bassinet and nursery charges for days when both mother and child are confined are considered maternity expenses of the mother and not expenses of the child Charges incurred by the child
as a result of illness including but not limited to pediatric intensive care charges and neonatal services are considered expenses of the child not the mother and are subject to a separate
inpatient deductible These charges are covered only if the child is covered under a Self and Family enrollment and the deductible and coinsurance may be waived or reduced the same as
the mother's when a PPO is used

Birthing centers Care for delivery in a birthing center is eligible for inpatient benefits
Obstetrical care For obstetrical or midwife charges including pre and post natal visits
PPO benefit High Option The Plan pays 90 Standard Option The Plan pays 90 of the covered charges after the 150 of the covered charges after the 200
per person calendar year deductible per person calendar year deductible has been met has been met

Maternity benefits will be paid at the termination of pregnancy
Anesthesia
PPO benefit High Option The Plan pays 90 Standard Option The Plan pays 90 of the covered charges after the 150 of the covered charges after the 200

per person calendar year deductible per person calendar year deductible has been met has been met

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Mail Handlers Benefit Plan 2000
Maternity Benefits continued

Newborn exam For doctor's initial medical examination of a newborn child
PPO benefit High Option The Plan pays 90 Standard Option The Plan pays 90 of the covered charges after the 150 of the covered charges after the 200
per person calendar year deductible per person calendar year deductible has been met has been met

Related benefits
Outpatient X ray and Outpatient X ray procedures and laboratory tests related to maternity care are covered under laboratory tests Other Medical Benefits see page 23

Diagnosis and Testing related to the diagnosis of infertility is covered under Other Medical Benefits treatment of Prescription drugs for the treatment of infertility are covered as Prescription Drug Benefits
infertility

Voluntary sterilization Benefits for voluntary sterilization are paid under Surgical Benefits see pages 14 17
What is not covered Assisted Reproductive Technology ART procedures such as artificial insemination in vitro fertilization embryo transfer and gamete intrafallopian transfer GIFT as well as services
and supplies related to ART procedures are not covered
A reversal of surgically induced sterilization
Contraceptive drugs except as covered under Prescription Drug Benefits see pages 26 28
Charges for care received after enrollment in this Plan ends
Stand by doctors
Home uterine monitoring devices

The non PPO benefits are the regular benefits of this Plan PPO benefits apply only when you use a PPO provider When no PPO provider is available non PPO benefits apply

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Mail Handlers Benefit Plan 2000
Mental Conditions Substance Abuse Benefits

What is covered Mental Conditions Substance Abuse Benefits are paid instead of other benefits under this Plan for all expenses for treatment of mental conditions and substance abuse as shown on pages 20 21

Inpatient care Inpatient confinements for the diagnosis and treatment of mental conditions and substance abuse in a hospital are covered as follows
Precertification The medical necessity of your admission to a hospital must be precertified for you to receive full Plan benefits Emergency admissions must be reported within two business days following the
day of admission even if you have been discharged Otherwise the benefits payable will be reduced by 500 See pages 40 41 for details

PPO benefit High Option The Plan pays 70 of the Standard Option The Plan pays 70 covered inpatient charges up to 45 days of the covered inpatient charges after the
per calendar year 150 per admission deductible up to 45 days per calendar year

Non PPO benefit High Option The Plan pays 70 of the Standard Option The Plan pays 70 of the covered inpatient charges up to 45 days covered inpatient charges up to 45 days per
per calendar year after the 250 per calendar year after the 300 per admission admission deductible deductible

Related Benefit
Doctors inhospital High Option The Plan pays 70 of the Standard Option The Plan pays 70 of the visits reasonable and customary charges after the reasonable and customary charges after the

150 per person calendar year deductible 200 per person calendar year deductible has been met has been met

Outpatient care The Plan covers outpatient visits for diagnosis and treatment of mental conditions and substance abuse One day in a partial hospitalization day treatment program is considered as
one outpatient visit

High Option The Plan pays 70 Standard Option The Plan pays 70 of the reasonable and customary charges of the reasonable and customary charges
limited to 20 outpatient visits per year limited to 20 outpatient visits per year subject to the 150 per person calendar subject to the 200 per person calendar
year deductible year deductible

Related Benefit Electroshock therapy diagnostic tests and laboratory procedures
High Option The Plan pays 70 Standard Option The Plan pays 70 of the of the reasonable and customary charges reasonable and customary charges after the
after the 150 per person calendar year 200 per person calendar year deductible deductible has been met has been met

What is not covered A hospital admission or portion thereof when in the Plan's judgement the confinement is not medically necessary i e the care provided did not require an acute hospital inpatient setting
but could have been provided in some other setting without adversely affecting the patient's condition or the quality of the care rendered For example substance abuse rehabilitation
admissions which do not require medical management for a safe detoxification are considered to be subacute care and the room and board charge for the admission or a portion of the stay
will not be covered

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Mail Handlers Benefit Plan 2000
Mental Conditions Substance Abuse Benefits continued
What is not Services rendered or billed by institutions that do not meet the definition of a hospital covered continued including licensed residential treatment centers or facilities that are accredited by JCAHO as
freestanding mental health care organizations
Services by pastoral counselors family marital counselors alcohol substance abuse counselors and other non covered providers

Counseling or therapy for marital family educational behavioral or sexual problems
The non PPO benefits are the regular benefits of this Plan PPO benefits apply only when you use a PPO provider When no PPO provider is available non PPO benefits apply

Other Medical Benefits
What is covered
Physician services The Plan covers doctor's hospital home and office visits and consultations at the benefits levels shown below except for those related to normal post operative care which are covered under

Surgical Benefits This benefit applies to visits related to chemotherapy X ray or radium treatment for cancer and dialysis treatment Also payable under this benefit are venipunctureblood
drawing and adult immunizations In addition professional services related to cortisone injection therapy are considered under this benefit Covered prescription drugs and supplies
administered or dispensed during a visit or consultation are also payable
Hospital visits

PPO benefit High Option The Plan pays 90 Standard Option The Plan pays 90 of the covered charges after the 150 of the covered charges after the 200

per person calendar year deductible per person calendar year deductible has been met has been met

Out of hospital visits medical visits
when you are not hospitalized

PPO benefit Both Options The Plan pays 100 of the covered charges after a 15 copayment per visit

Non PPO benefit Both Options The Plan pays 70 of the reasonable and customary charges
For additional services provided during an office visit see outpatient diagnostic X ray laboratory and machine tests on page 23

Other outpatient visits For outpatient physical speech occupational therapy chiropractic services and acupuncture
PPO benefit High Option The Plan pays 90 Standard Option The Plan pays 90 of the covered charges after the 150 of the covered charges after the 200
per person calendar year deductible per person calendar year deductible has been met has been met

Non PPO benefit High Option The Plan pays 70 of the Standard Option The Plan pays 70 of the reasonable and customary charges after the reasonable and customary charges after the
150 per person calendar year deductible 200 per person calendar year deductible has been met has been met
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Mail Handlers Benefit Plan 2000
Other Medical Benefits continued
Other outpatient There is one 1,500 annual maximum per person for both PPO and non PPO benefits related to visits continued any combination of outpatient therapy chiropractic and acupuncture services The Plan will not
pay in excess of the 1,500 annual maximum for these services even from the Catastrophic Protection Benefit

For additional services provided during a visit see outpatient diagnostic X ray laboratory and machine tests on page 23

Allergy injections For professional services related to the administration of allergy serum
PPO benefit Both Options The Plan pays 100 of the covered charges after a 5 copayment
Non PPO benefit Both Options The Plan pays 70 of the reasonable and customary charges
Hospital outpatient care
Surgical facility Under both options when a member undergoes a covered outpatient surgical procedure the services Plan pays the surgical facility charge for related services and supplies rendered on that day and

billed by the outpatient department of a hospital or surgi center as shown below If the stay is greater than 23 hours services will be considered as inpatient care subject to precertification
requirements see pages 40 41 Note For services rendered and billed by the surgeon and or anesthetist see Surgical Benefits on pages 14 17

PPO benefit High Option The Plan pays 100 Standard Option The Plan pays 100 of the covered charges after the 150 of the covered charges after the 200
per person calendar year deductible per person calendar year deductible has been met has been met

Non PPO benefit High Option The Plan pays 70 Standard Option The Plan pays 7 of the reasonable and customary charges of the reasonable and customary charges
after the 150 per person calendar year after the 200 per person calendar year deductible has been met deductible has been met

Other outpatient care Under both options the Plan pays outpatient cancer treatment chemotherapy X rays or radium therapy dialysis services hemodialysis or peritoneal dialysis and hyperbaric oxygen therapy
ordered by a doctor and provided by a hospital as an outpatient or clinic as follows

Note Retail pharmacy charges for chemotherapy and prescriptions to treat the side effects of chemotherapy are covered under Prescription Drug Benefits as described on pages 26 28

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Mail Handlers Benefit Plan 2000
Other Medical Benefits continued
Emergency treatment For accidental injury The Plan pays charges as described below for covered services and supplies furnished to an outpatient in connection with emergency treatment or surgery performed
within 72 hours of an accident Related follow up care received after 72 hours is payable under the physician services benefit Emergency treatment that results in an admission is payable under
the inpatient hospital physician services benefits
For illness The Plan pays charges as described below for covered services and supplies furnished to an outpatient in connection with emergency treatment of illness or mental

conditions substance abuse performed within 72 hours of the occurrence Services must be rendered in a hospital emergency room or urgent care center Charges for either initial or
follow up treatment rendered in a doctor's office will be paid under the physician services benefit

Outpatient diagnostic For covered diagnostic X ray laboratory and machine diagnostic tests related to a covered illness X ray laboratory or injury
and machine tests
PPO benefit High Option The Plan pays 90 Standard Option The Plan pays 90 of the covered charges after the 150 of the covered charges after the 200

per person calendar year deductible per person calendar year deductible has been met has been met

Performance Lab The Plan offers a laboratory services benefit that is strictly voluntary In order to take advantage of this benefit you must present your Mail Handlers Benefit Plan identification card and request
that your physician send the lab order and specimen to LabCorp As long as the testing is performed by LabCorp you will not have to file any claims and will not be subject to a
deductible and or copayment or coinsurance If you have this Plan as your primary insurance you can take advantage of this non emergency outpatient laboratory testing service at no cost
to you To learn of a location nnear you call 1 888 522 2677 or visit the Plan's website www mhbp com

Both Options The Plan pays 100 of the covered charges

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Mail Handlers Benefit Plan 2000
Other Medical Benefits continued
Routine services The following routine screening services including associated office visits are covered the same as any other lab or diagnostic service see Outpatient diagnostic X ray laboratory and
machine tests described above

Breast cancer screening Mammograms are covered for women age 35 and older as follows
From ages 35 through 39 one mammogram screening during this five year period
From ages 40 through 64 one mammogram screening every calendar year
At age 65 or over one mammogram screening every two consecutive calendar years

Cervical cancer Annual coverage of one Pap smear for women age 18 and older screening

Colorectal cancer Annual coverage of one fecal occult blood stool test for members age 40 and older screening
Coverage for screening sigmoidoscopy once every two 2 years for members age 50 and older

Prostate cancer Annual coverage of one PSA Prostate Specific Antigen test for men age 40 and older screening

Limited benefits
Childhood Childhood immunizations recommended by the American Academy of Pediatrics are covered for immunizations eligible members under age 22

PPO benefit Both Options The Plan pays 100 of the covered charges
Non PPO benefit Both Options The Plan pays 100 of the reasonable and customary charges
Smoking cessation The Plan will pay up to 100 for enrollment in one smoking cessation program per member per benefit lifetime All claims for smoking cessation benefits will be paid directly to you Prescription
drugs for smoking cessation are paid under Prescription Drug Benefits and their cost does not count toward the 100 limit see pages 26 28

Well child care Well child office visits to a doctor those not related to an illness or injury for covered dependents up to age eighteen 18 are paid as follows
PPO benefit Both Options After a 15 copayment per visit the Plan pays up to 100 per year per child
Non PPO benefit Both Options The Plan pays up to 75 per year per child
What is not covered Routine physical examinations except for well child care visits
Routine X ray and laboratory tests except for routine mammograms screening sigmoidoscopy an annual routine Pap smear an annual PSA test and an annual stool test for occult blood

Chelation therapy except if the covered services and supplies are provided during a precertified inpatient admission
Charges for thermography and related visits
Chemotherapy supported by a bone marrow transplant or with stem cell support for any diagnosis not listed as covered on page 16

Laboratory handling charges
Office visits and related services in connection with orthoptics
Routine foot care

The non PPO benefits are the regular benefits of this Plan PPO benefits apply only when you use a PPO provider When no
PPO provider is available non PPO benefits apply

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Mail Handlers Benefit Plan 2000
Additional Benefits

Ambulance benefit The Plan pays for professional local ambulance service to the first hospital where treated from that hospital to the next nearest one if necessary treatment is not available or suitable at the first
hospital and from the hospital to another medical facility if required for the patient to receive necessary treatment Air ambulance is covered to the nearest hospital where treatment is
available and is only covered if no emergency ground transportation is available or suitable and the patient's condition warrants immediate evacuation

High Option The Plan pays 70 of the Standard Option The Plan pays 70 of the reasonable and customary charges after the reasonable and customary charges after the
150 per person calendar year deductible 200 per person calendar year deductible has been met has been met

Durable medical The Plan pays for the outpatient rental or purchase at the Plan's option if less expensive of equipment and durable medical equipment and for the purchase of orthopedic and prosthetic appliances see
orthopedic definitions when recommended by an M D or D O and prosthetic
The Plan will limit its benefit for the rental of durable medical equipment to an amount no greater appliances than what it would have paid if the equipment had been purchased For instance if the

equipment could be purchased for 150 but the rental cost is 50 per month the Plan will not pay for more than 3 months rental

The Plan will also pay for necessary repairs or adjustments to purchased medical equipment and supplies used solely in connection with the durable medical equipment This provision also
includes coverage for wheelchairs hospital beds oxygen equipment and other items determined by the Plan to be durable medical equipment

Call the Plan at 1 800 410 7778 to get information about durable medical equipment PPO vendors

PPO Benefit High Option The Plan pays 90 of the Standard Option The Plan pays 90 of the covered rental or purchase price for each covered rental or purchase price for each
item after the 150 per person calendar year item after the 200 per person calendar year deductible has been met deductible has been met

Non PPO Benefit High Option The Plan pays 70 of Standard Option The Plan pays 70 of the reasonable and customary rental or the reasonable and customary rental or
purchase price for each item after the purchase price for each item after the 150 per person calendar year deductible 200 per person calendar year deductible
has been met has been met

Orthopedic For orthopedic and prosthetic appliances see definitions when recommended by an M D or D O and prosthetic
appliances High Option The Plan pays 90 of Standard Option The Plan pays 90 of
the reasonable and customary charges the reasonable and customary charges after the 150 per person calendar year after the 200 per person calendar year

deductible has been met deductible has been met

Eyeglasses lenses The Plan pays up to 50 for one set of eyeglasses or 100 for contact lenses including examination after the 150 per person calendar year deductible for High Option or the 200 per
person calendar year deductible for Standard Option if required to correct an impairment directly caused by an accidental ocular injury or covered intraocular surgery This benefit is available up
to one year following the accident or surgery provided you are still enrolled in this Plan

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Mail Handlers Benefit Plan 2000
Additional Benefits continued
Hearing aid The Plan pays up to 200 for one hearing aid per ear including examination after the 150 per person calendar year deductible for High Option or the 200 per person calendar year deductible for
Standard Option if required to correct an impairment directly caused by an accident This benefit is available up to 120 days following the accident provided you are still enrolled in this Plan

Hospice care program The Plan pays actual charges up to a lifetime maximum of 5,000 per person for any combination of inpatient and outpatient hospice care
Nursing care services The Plan pays for the outpatient services of a registered graduate nurse R N or a licensed practical nurse L P N if recommended by an M D or D O up to an annual maximum of 700
There is a 700 annual maximum per person related to nursing care services The Plan will not pay in excess of the 700 annual maximum for these services even from the Catastrophic
Protection Benefit

Rabies shots The Plan pays in full for rabies shots and related services
What is not covered Durable medical equipment replacements provided less than three years after the last one for which benefits were paid
Charges for service contracts for purchased durable medical equipment
Items that are not durable medical equipment see definitions such as wheelchair ramps outpatient exercise equipment including treadmills and exercise bicycles air conditioners air

purifiers humidifiers ultraviolet lighting except for the treatment of psoriasis and motorized scooters see definition computer story boards light talkers enhanced vision system or
other communication aids for communication impaired individuals prone standers computer switchboards lifts such as seat chair or van lifts safety and hygienic equipment

Podiatric foot orthotics orthopedic appliances devices that can be placed in or on the shoe such as arch supports metatarsal bars metatarsal pads heel pads heel cups or corrective
orthopedic shoes unless attached to a brace
Wigs
Supportive devices such as elastic stockings corsets elastic bandages or trusses
Dental appliances used to treat sleep apnea
Ambulance or other transportation services used for the purposes of receiving non emergency outpatient care

Routine eye and ear exams

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Mail Handlers Benefit Plan 2000
Prescription Drug Benefits

What is covered The following medications and supplies are covered when prescribed by a doctor and furnished by a pharmacy or mail order program this Plan administers an open formulary
Drugs and medicines that by Federal law of the United States require a doctor's written prescription including chemotherapy and drugs used to treat the side effects of chemotherapy
Disposable needles and syringes alcohol swabs and ostomy supplies
Insulin and related testing material
Hormone based contraceptives including Norplant Norplant insertions are covered under Surgical Benefits

Smoking deterrents

Note The Plan requires preauthorization and may limit dispensing quantities for some categories of drugs These categories include growth hormone acne medications antiemetics antinausea
drugs migraine medications drugs used to treat Attention Deficit Disorder and narcolepsy
Related benefits

Chemotherapy See page 22 for benefits for chemotherapy rendered in an outpatient facility

What is not covered Outpatient medical supplies that do not require a prescription except those listed above
Vitamins and nutritional supplements except those requiring a prescription by law
Anorexiants appetite suppressants or prescription drugs for weight loss
Supplies for parenteral nutrition
Drugs prescribed for sexual dysfunction or sexual inadequacies
Prescription Drug Benefits as a secondary payor in cases when members have other prescription drug coverage

Any amount in excess of the cost of a generic drug when a generic is available and the physician has not specified that the pharmacist dispense the brand name drug only
Any amount in excess of a network pharmacy's best price when you use a PCS participating pharmacy but do not present your Mail Handlers Benefit Plan ID card

PCS participating Present your Mail Handlers Benefit Plan ID card to the pharmacy with your prescription and pharmacy and drug pay the applicable deductible or coinsurance If you do not present your ID card you will not
claims from foreign receive the PCS best price for that prescription The PCS participating pharmacy files your claim pharmacies if you live and is reimbursed by the Plan Do not send a copy of the claim to the Plan Call the Plan at
outside the United States 1 800 410 7778 to find out the names of PCS participating pharmacies in your area or visit the plan's website www mhbp com Note In most cases refills cannot be obtained until 75 of the
drug has been used

High Option After the 250 Standard Option After the 600 deductible per person the Plan pays deductible per person the Plan pays
75 of the covered charge 70 of the covered charge

Non PCS participating Non PCS participating pharmacies in the United States and home health agencies are paid pharmacy excluding drug as follows
claims from outside the United States
High Option After the 250 deductible Standard Option After the 600 deductible per person the Plan pays 50 of the price per person the Plan pays 50 of the price

a PCS participating pharmacy would have a PCS participating pharmacy would have charged for the same prescription charged for the same prescription

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Mail Handlers Benefit Plan 2000
Prescription Drug Benefits continued
Non PCS participating To file a prescription drug claim for prescriptions obtained from a non PCS participating pharmacy including drug pharmacy complete a prescription drug claim form attach the original receipt document
claims from outside the supplied by the pharmacy and send it to the address below The original receipt document from United States purchased the pharmacy must contain the following information pharmacy name patient name date filled
by United States residents the date the prescription was purchased prescription number drug name and strength the continued name of the drug prescribed and the dosage amount dispensed for example the number of
pills prescribing doctor's name and the total prescription charge dollar amount paid for the prescription The claim will not be processed unless the information is complete

After completing a claim form and attaching proper documentation send claims to
PCS Health Systems Inc Attn MHBP Claims

P O Box 52151 Phoenix AZ 85072 2151

Do not include any medical or dental claims with your claims for drug benefits

Mail Order Program for The Plan and PCS Health Systems provide a mail service program for enrollees who take Maintenance Medications maintenance medications Maintenance drugs are typically prescribed to treat long term medical
conditions such as diabetes high blood pressure and asthma To obtain additional information about the Mail Order Maintenance Drug Program and learn which drugs are on the preferred
brand list call the Plan at 1 800 410 7778

High Option After the 250 deductible Standard Option After the 600 deductible per person the Plan pays 100 after a per person the Plan pays 100 after a
10 copayment per generic prescription 10 copayment per generic prescription a 30 copayment per preferred brand a 40 copayment per preferred brand
prescription and 45 per non preferred prescription and 55 per non preferred brand prescription brand prescription

Note Not all maintenance prescription drugs are available through this program In addition to the normal Plan exclusions certain classes of drugs are not available under this
program The excluded classes of drugs are all injectables except for Diabetic supplies and MS agents Betaseron Avonex and Copaxine narcotics hospital solutions and certain drugs
such as antipsychotic agents and AIDS therapies and other drugs for which state or federal laws or medical judgement limit the dispensing amount to less than 90 days However these excluded
drugs are covered under the retail prescription drug program

High Option Dental Benefits
What is covered High Option pays actual charges up to amounts specified in the schedule of dental allowances for covered dental procedures up to a maximum benefit of 800 per person and 1,600 per family

per calendar year There is no deductible for dental benefits For covered dental procedures not shown the Plan will pay subject to the limits provided amounts consistent with procedures
which are shown
The Plan is unable to return dental X rays Remind your dentist not to submit X rays
If in the construction of a denture or any prosthetic dental appliance the patient and the dentist decide on personalized restoration or to employ special techniques as opposed to standard

procedures the benefit provided will be limited to the amount payable for the standard procedures
Charges for crowns bridges and dentures are usually incurred when they are ordered The Plan pays benefits to cover such charges even if the enrollee later rejects the denture or appliance

The following is a partial schedule of dental allowances

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Mail Handlers Benefit Plan 2000
High Option Dental Benefits continued

What is covered ADA continued CODE DESCRIPTION OF SERVICE ALLOWANCE
DIAGNOSTIC 00120 Periodic oral examination limit one per year 7.50
00210 Intraoral complete series including bitewings of X rays limit one per year 22.00 00220 Intraoral periapical first film 3.25
00230 Intraoral each additional film 2.25 00240 Intraoral occlusal film 7.50
00270 Bitewing single film 2.75 00290 Posterior anterior or lateral skull and facial bone survey 13 00
00330 Panoramic film 22.00
PREVENTIVE dollar amount shown is limit per calendar year 01110 Prophylaxis adult age 13 and over 14.25

01120 Child to age 13 12.00 01203 Topical application of fluoride prophylaxis not included child 7.50
01204 Adult 7.50 01351 Sealant per tooth 7.50
01510 Space maintainer fixed unilateral 34.00
RESTORATIVE SERVICES includes liners bases and local anesthesia 02140 1 surface permanent 13.00

02150 2 surfaces permanent 20.75 02160 3 surfaces permanent 27.50
02951 Reinforcement pins each pin 8.25
ENDODONTICS includes local anesthesia 03110 Pulp cap direct 16.50

03310 Root canal therapy one canal 96.75 03320 Root canal therapy two canals 136.25
03330 Root canal therapy three canals 178.00 03410 Apicoectomy 55.00

PERIODONTICS includes local anesthesia 04320 Provisional splinting 81.25
04341 Periodontal scaling and root planing per quadrant 13.00 04910 Periodontal maintenance procedures 13.00

CROWN AND BRIDGE includes local anesthesia 02510 Inlay metallic one surface 68.00
02710 Crown resin laboratory 108.75 02720 Crown resin with high noble metal 178.00
02740 Crown porcelain ceramic substrate 136.25 02750 Crown porcelain fused to high noble metal 178.00
02752 Crown porcelain fused to noble metal 178.00 02790 Crown full cast high noble metal 149.50
02810 Crown 3 4 cast metallic 102.25 02952 Cast post and core in addition to crown 68.00
02954 Prefabricated post and core in addition to crown 34.00 02980 Crown repair 13.00
02920 Recement crown 27.50
PONTICS includes local anesthesia 06210 Cast high noble metal 82.50

06240 Porcelain fused to high noble metal 136.25
DENTURES prosthetics 05110 Complete denture maxillary including necessary adjustments within 6 months 239.75

05120 Complete denture mandibular including necessary adjustments within 6 months 239.75 05130 Immediate denture maxillary 272.50
05140 Immediate denture mandibular 272.50 05211 Maxillary partial denture resin base 217.75
05510 Repair broken complete denture base 20.75 05520 Replace missing or broken teeth complete denture each tooth 9.75

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Mail Handlers Benefit Plan 2000
High Option Dental Benefits continued

What is covered ADA continued CODE DESCRIPTION OF SERVICE ALLOWANCE
DENTURES continued 05630 Replace or repair broken clasp 40.50
05640 Replace broken teeth per tooth 13.00 05650 Add tooth to existing partial denture 34.00
05660 Additional clasp to existing denture 40.50 05710 Rebase complete maxillary denture 68.00

ORAL SURGERY includes local anesthesia 04210 Gingivectomy or gingivoplasty per quadrant 102.50
04260 Osseous surgery including flap entry and closure per quadrant 137.50 07110 Extraction of single tooth 15.00
07120 Each additional tooth at same session 12.00 07210 Surgical extraction of erupted tooth 23.00
07285 Biopsy of oral hard tissue 34.00 07310 Alveoplasty in conjunction with extraction per quadrant 44.00
07450 Removal of odontogenic cyst or tumor lesion diameter up to 1.25 cm 66.00 07510 Incision and drainage of abscess intraoral soft tissue 13.00
07960 Frenulectomy frenectomy or frenotomy separate procedure 61.50
MISCELLANEOUS SERVICES 09110 Palliative treatment of dental pain minor procedure 7.50

09220 General anesthesia first 30 minutes 8.75 09221 Each additional 15 minutes 4.38
09310 Consultation by other than the attending dentist 20.75

Related benefits
PPO Benefit The Plan offers access to a network of dentists who have agreed to provide services at a discounted rate To learn of a preferred dentist in your area contact 1 888 788 5702 or visit the

Plan's website www mhbp com For information about the Plan's benefits call customer relations at 1 800 410 7778 or visit the Plan's website

Hospitalization for Inpatient hospital benefits are available in connection with dental procedures only as provided on dental treatment pages 13 14 and with precertification
Accidental injury Repair of sound natural teeth following accidental injury including but not limited to expenses for X rays crowns bridgework or dentures performed within 12 months of the accident is
covered under Surgical Benefits and Other Medical Benefits This benefit for accidental injury to sound natural teeth is available to members enrolled under both the High and Standard Options
Masticating chewing incidents are not considered to be accidental injuries See Emergency Treatment on page 23 for coverage of services related to accidental dental injury within 72 hours
of an injury There will be no exceptions to the 72 hour time limit

Oral and maxillofacial For coverage of oral and maxillofacial surgery including coverage for removal of impacted teeth surgery see pages 14 17

What is not covered Charges related to orthodontia
Oral hygiene instruction
Denture replacements if benefits were provided by this Plan within the last five years
Temporary dental services
Dental implants or related surgical benefits
Hospital charges for covered dental procedures unless the covered oral surgery was preauthorized
Orthotics and other occlusal appliances used to treat temporomandibular joint dysfunction and or sleep apnea

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Mail Handlers Benefit Plan 2000
Non FEHB Benefits Available to Plan Members

The benefits described on this page are neither offered nor guaranteed under the contract with the FEHB Program but are made available to all enrollees and family members of this Plan The cost of the benefits described on this page is not included in the
FEHB premium any charges for these services do not count toward any FEHB deductibles out of pocket maximums copay charges etc These benefits are not subject to the FEHB disputed claims procedure

Vision One Eyecare Program provides Plan enrollees and eligible dependents the ability to obtain eye exams frames eyeglasses and contact lenses at reduced prices from Vision One providers For more information concerning the Vision One
Eyecare Program you may call 1 800 424 1155 for the name of the eye care center closest to you
Miracle Ear Hearing Program provides Plan enrollees and eligible dependents the ability to obtain free hearing tests and evaluations free counseling free check up and cleaning of instruments and a discount off of suggested retail prices of Miracle Ear
hearing aid products Consult your Yellow Pages for the Miracle Ear Center Miracle Ear at Montgomery Ward Sears Hearing Aid Center or simply call the Miracle Ear Consumer Affairs Department at 1 800 456 6801 for the location nearest you

SDV Vitamins Discount Program provides enrollees and eligible family members the ability to obtain vitamins minerals herbal formulas weight management products and over the counter pharmaceuticals at a 5 discount off the prices shown in the
SDV Vitamins Catalogue You may call toll free 1 800 738 8482 to order a catalogue or to place an order Be sure to mention code MHP02 to obtain the discount

Mail Handlers Benefit Plan enrollees who reside in the United States are all eligible for supplemental plans which are underwritten by CNA Insurance Companies underwriter of the Mail Handlers Benefit Plan
Hospital Money Plan provides daily cash benefits for hospitalization Cash payments of up to 100 per day are paid directly to enrollees when they or a covered family member are hospitalized for any covered sickness or accident If confinement is for
intensive care benefits of up to 200 per day are paid The money is paid directly to the enrollee and may be spent in any way For additional information concerning the Hospital Money Plan you may call 1 800 621 0839

Off Work Accident Disability Plan provides 150 a week when an enrollee is totally disabled by an off work injury The program also provides up to 25,000 for accidental death benefits If the enrollee has children up to 10,000 in educational
benefits for each eligible child is provided if death occurs as a result of a covered injury For more information about the Off Work Accident Disability Plan you may call 1 800 621 0839

Dental Supplement Plan offers increased dental coverage to High Option enrollees and covered dependents The Dental Supplement Plan will automatically increase benefits for covered diagnostic preventive and periodontal services by 60 benefits
for all other covered services will increase by 30 Enrollees and covered dependents will also receive benefits for a second annual cleaning and exam There is no deductible for this plan and no extra claim forms For more information about the Dental
Supplement Plan you may call 1 800 621 0839
Short Term Disability Income Protection provides up to 500 or 1,000 per month to enrollees to replace lost income for a period of up to 12 or 24 months as a result of a disability due to a covered illness injury or complications of pregnancy
The benefit choice and period is up to the enrollee All enrollees under the age of 60 are guaranteed acceptance in this plan as long as they actively work at least 30 hours a week and have not been hospitalized in the last six months For more information about
this program call 1 800 621 0839
Group Long Term Care Program is designed to help people cope with the potentially devastating costs associated with long term care The Mail Handlers Group Long Term Care Program lets enrollees choose the type of care they receive and where
they receive it either in a nursing home community setting or at home Long Term Care benefits are typically not provided by regular group health insurance and Medicare benefits are limited so coverage for long term care expenses can be an important
financial decision Complete information on the Mail Handlers Group Long Term Care Program including a full explanation of rates and benefits can be requested by visiting the MHBP website www mhbp com or a kit can be requested by calling
1 800 522 0100 This program is underwritten by Continental Casualty Company a CNA company Not available in AR AZ MD and PA

Benefits on this page are not part of the FEHB contract
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Mail Handlers Benefit Plan 2000
Section 6 How to File a Claim
Claim forms If you do not receive your identification card s within 60 days after the effective date of your identification cards enrollment call the Plan at 1 800 410 7778 to report the delay In the meantime use your copy
and questions of the SF 2809 enrollment form or your annuitant confirmation letter from OPM as proof of enrollment when you obtain services This is also the number to call for claim forms or advice
on filing claims
If you have a question concerning Plan benefits contact the Plan at 1 800 410 7778 or you may write to the Plan at Mail Handlers Benefit Plan P O Box 45118 Jacksonville FL 32232 5118

If you made your open season change by using Employee Express and have not received your new ID card by the effective date of your enrollment call the Employee Express HELP number
to request a confirmation letter Use that letter to confirm your new coverage with providers

How to file claims Claims filed by your doctor that include an assignment of benefits to the doctor are to be filed on the form HCFA 1500 Health Insurance Claim Form Claims submitted by enrollees may be
submitted on the HCFA 1500 or a claim form that includes the information shown below All claims should be completed in ink or type that is readable by an optic scanner Non readable
claims will be returned unprocessed Bills and receipts should be itemized and show
Name of patient and relationship to enrollee
Plan identification number of the enrollee
Name address and provider or employer tax identification number of person or firm providing the service or supply

Dates that services or supplies were furnished
Type of each service or supply and the charge
Diagnosis
In addition
A copy of the explanation of benefits EOB from any primary payor such as Medicare or a group health insurance plan must be sent with your claim

Bills for outpatient private duty nurses must show that the nurse is a registered or licensed practical nurse and must include nursing notes
Claims for rental or purchase of durable medical equipment outpatient private duty nursing and physical occupational and speech therapy require a written statement from the doctor
specifying the medical necessity for the service or supply and the length of time needed
Claims for overseas foreign services should include an English translation Charges should be converted to U S dollars using the exchange rate applicable at the time the expense was

incurred The Plan applies the exchange rate published for the date the services were rendered
All foreign claims payments will be made directly to the enrollee except for services rendered to beneficiaries of the Department of Defense third party collection program

Cancelled checks cash register receipts or balance due statements are not acceptable
After completing a claim form and attaching proper documentation send claims to
Mail Handlers Benefit Plan P O Box 45118

Jacksonville FL 32232 5118
For prescription drug claims see pages 26 28

Records Keep a separate record of the medical expenses of each covered family member as deductibles and maximum allowances apply separately to each person Save copies of all medical bills
including those you accumulate to satisfy a deductible In most instances they will serve as evidence of your claim The Plan will not provide duplicates or year end statements

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Mail Handlers Benefit Plan 2000
How to file claims continued

Submit claims promptly Claims should be filed promptly after the expense is incurred for which the claim is being made The Plan will not accept a claim submitted later than December 31st of the calendar year
following the one in which the service or supply was received unless timely filing was prevented by administrative operations of Government or legal incapacity provided the claim was submitted
as soon as reasonably possible Once benefits have been paid there is a three year limitation on the reissuance of uncashed checks

Direct payment to Claims for inhospital confinements that are submitted by the hospital will be paid directly to the hospital or provider hospital with the exception of foreign claims You may authorize direct payment to any other
of care provider of care by signing the assignment of benefits section on the claim form or by using the assignment form furnished by the provider of care The provider of care's Tax Identification
Number must accompany the claim The Plan reserves the right to make payment directly to you and to decline to honor the assignment of payment of any health benefits claim to any

person or party
Claims submitted by PPO hospitals and medical providers will be paid directly to the hospital or provider

Note Benefits for services provided at Department of Defense Veterans Administration or Indian Health Service facilities will be paid directly to the facility

When more information Reply promptly when the Plan requests information in connection with a claim If you do not is needed respond the Plan may delay processing or limit the benefits available

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Mail Handlers Benefit Plan 2000
Section 7 General Exclusions Things We Don't Cover
The exclusions in this section apply to all benefits Although we may list a specific service as a benefit we will not cover it unless we determine it is medically necessary to prevent diagnose or treat your illness or condition The fact that one of our covered
providers has prescribed recommended or approved a service or supply does not make it medically necessary or eligible for coverage under this Plan We do not cover the following

Services drugs or supplies that are not medically necessary
Services not required according to accepted standards of medical dental or psychiatric practice in the United States

Experimental or investigational procedures treatments drugs or devices
Services drugs and supplies related to abortions except when the life of the mother would be endangered if the fetus were carried to term or when the pregnancy is the result of an act of

rape or incest
Services drugs and supplies related to sex transformations sexual dysfunction or sexual inadequacy penile prosthesis

Services or supplies you receive from a provider or facility barred from the FEHB Program
Expenses you incurred while you were not enrolled in this Plan
Services and supplies for which there would be no charge if the covered individual had no health insurance coverage

Services and supplies furnished without charge while in active military service or required for illness or injury sustained on or after the effective date of enrollment 1 as the result of an act
of war within the Unites States its territories or possessions or 2 during combat
Services and supplies furnished by household members or immediate relatives such as spouse parents grandparents children brothers or sisters by blood marriage or adoption

Services and supplies furnished or billed by a non covered facility except that medically necessary prescription drugs are covered
Services drugs and supplies associated with care that is not covered though they may be covered otherwise e g Inpatient Hospital Benefits are not payable for non covered cosmetic surgery
Any portion of a provider's fee or charge ordinarily due from the enrollee but that has been waived If a provider routinely waives does not require the enrollee to pay a deductible or
coinsurance the Plan will calculate the actual provider fee or charge by reducing the fee or charge by the amount waived

Charges which the enrollee or Plan has no legal obligation to pay such as excess charges for an annuitant age 65 or older who is not covered by Medicare Parts A and or B see pages 38 39
doctor's charges exceeding the amount specified by the Department of Health Human Services when benefits are payable under Medicare limiting charge see pages 35 37 or
State premium taxes however applied
Services drugs and supplies for weight control or treatment of obesity except surgery for documented morbid obesity

Outpatient nutritional supplies that do not require a prescription and are not furnished in connection with a covered professional service or in connection with covered durable medical equipment
Educational recreational or milieu therapy whether in or out of the hospital
Services and supplies for cosmetic purposes except as provided under Surgical Benefits Limited Benefits Cosmetic Surgery

Biofeedback
Cardiac rehabilitation
Eyeglasses contact lenses and hearing aids except as provided under Additional Benefits
Orthotics and appliances used to treat temporomandibular joint dysfunction
Custodial care see definition or domiciliary care
Travel even if prescribed by a doctor except as provided under the Ambulance Benefit
Handling Charges Administrative Charges or late charges including interest billed by providers of care and

Services and or supplies not listed as covered in this brochure
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Mail Handlers Benefit Plan 2000
Section 8 Limitations Rules That Affect Your Benefits
Medicare Tell us if you or a family member is enrolled in Medicare Part A or B Medicare and this Plan will determine who is responsible for paying for medical services and we will coordinate the
payments On occasion you may need to file a Medicare claim form
If you are eligible for Medicare you may enroll in a Medicare Choice plan and also remain enrolled with us

If you are an annuitant or former spouse you can suspend your FEHB coverage and enroll in a Medicare Choice plan when one is available in your area For information on suspending your
FEHB enrollment and changing to a Medicare Choice plan contact your retirement office If you later want to re enroll in the FEHB Program generally you may do so only at the next
Open Season
If you involuntarily lose coverage or move out of the Medicare Choice service area you may re enroll in the FEHB Program at any time

If you do not have Medicare Part A or B you can still be covered under the FEHB Program and your benefits will not be reduced We cannot require you to enroll in Medicare
For information on Medicare Choice plans contact your local Social Security Administration SSA office or call SSA at 1 800 638 6833

Coordinating benefits The following information applies only to enrollees and covered family members who are entitled to benefits from both this Plan and Medicare You must disclose information about Medicare
coverage including your enrollment in a Medicare prepaid plan to the Plan this applies whether or not you file a claim under Medicare You must also give the Plan authorization to obtain
information about benefits or services denied or paid by Medicare when they request it It is also important that you inform the Plan about other coverage you may have as this coverage may
affect the primary secondary status of this Plan and Medicare see pages 35 37
This Plan covers most of the same kinds of expenses as Medicare Part A hospital insurance and Part B medical insurance except that Medicare does not cover prescription drugs

The following rules apply to enrollees and their family members who are entitled to benefits from both a FEHB plan and Medicare

This Plan is primary if 1 You are age 65 or over have Medicare Part A or Parts A and B and are employed by the Federal Government
2 Your covered spouse is age 65 or over and has Medicare Part A or Parts A and B and you are employed by the Federal Government
3 The patient you or a covered family member is within the first 30 months of eligibility to receive Medicare Part A benefits due to End Stage Renal Disease ESRD except when
Medicare based on age or disability was the patient's primary payor on the day before he or she became eligible for Medicare Part A due to ESRD or

4 The patient you or a covered family member is under age 65 and eligible for Medicare solely on the basis of disability and you are employed by the Federal Government
For purposes of this section employed by the Federal Government means you are a Federal employee and you do not hold an appointment described under Rule 6 of the following
Medicare is primary section

Medicare is primary if 1 You are an annuitant age 65 or over covered by Medicare Part A or Parts A and B and are not employed by the Federal Government
2 Your covered spouse is age 65 or over and has Medicare Part A or Parts A and B and you are not employed by the Federal Government

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Mail Handlers Benefit Plan 2000
Medicare continued
Medicare is primary if continued 3 You are age 65 or over and a you are a Federal judge who retired under title 28 U S C

b you are a Tax Court judge who retired under Section 7447 of title 26 U S C or c you are the covered spouse of a retired judge described in a or b

4 You are an annuitant not employed by the Federal Government and either you or a covered family member who may or may not be employed by the Federal Government is under
age 65 and eligible for Medicare on the basis of disability
5 You are enrolled in Part B only regardless of your employment status
6 You are age 65 or over and employed by the Federal Government in an appointment that excludes similarly appointed nonretired employees from FEHB coverage and have Medicare

Part A or Parts A and B
7 You are a former Federal employee receiving workers compensation and the Office of Workers Compensation has determined that you are unable to return to duty

8 The patient you or a covered family member has completed the 30 month ESRD coordination period and is still eligible for Medicare due to ESRD or
9 The patient you or a covered family member becomes eligible for Medicare due to ESRD after Medicare assumed primary payor status for the patient under rules 1 through 7 above

When Medicare When Medicare is primary all or part of your Plan deductibles and coinsurance will be waived is primary as follows
When Medicare Part A hospital is primary the Plan will waive applicable deductibles and coinsurance for Inpatient Hospital Benefits and Inpatient Mental Conditions Substance Abuse
Benefits
When Medicare Part B medical is primary the Plan will waive applicable copayments and coinsurance for Surgical Benefits Other Medical Benefits Durable Medical Equipment

Orthopedic and Prosthetic Appliances and Ambulance services The calendar year deductible will be waived

The calendar year deductible will be waived but the coinsurance will not be waived for Nursing Benefits and Outpatient Mental Conditions Substance Abuse Benefits
The deductible coinsurance and copayments for prescription drugs will not be waived
When Medicare is the primary payor this Plan will limit its payment to an amount that supplements the benefits that would be payable by Medicare regardless of whether or not

Medicare benefits are paid However the Plan will pay its regular benefits for emergency services to an institutional provider such as a hospital that does not participate with Medicare
and is not reimbursed by Medicare
If you are enrolled in Medicare you may be asked by a physician to sign a private contract agreeing that you can be billed directly for services that would ordinarily be covered by

Medicare Should you sign such an agreement Medicare will not pay any portion of the charges and you may receive less or no payment for those services under this Plan

When you also When you are enrolled in a Medicare pre paid plan while you are a member of the Plan you may enroll in a Medicare continue to obtain benefits from this Plan If you submit claims for services covered by this Plan
pre paid plan that you receive from providers that are not in the Medicare plan's network the Plan will not waive any deductibles or coinsurance when paying these claims

Medicare's payment If you are covered by Medicare Part B and it is primary you should be aware that your out ofpocket and this Plan costs for services covered by both this Plan and Medicare Part B will depend on whether
your doctor accepts Medicare assignment for the claim
Doctors who participate with Medicare accept assignment that is they have agreed not to bill you for more than the Medicare approved amount for covered services Some doctors who do not

participate with Medicare accept assignment on certain claims If you use a doctor who accepts Medicare assignment for the claim the doctor is permitted to bill you after the Plan has paid only
when the Medicare and Plan payments combined do not total the Medicare approved amount

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Mail Handlers Benefit Plan 2000
Medicare continued
Medicare's payment Doctors who do not participate with Medicare are not required to accept direct payment or and this Plan assignment from Medicare Although they can bill you for more than the amount Medicare would

continued pay Medicare law the Social Security Act 42 U S C sets a limit on how much you are obligated to pay This amount called the limiting charge is 115 of the Medicare approved amount Under
this law if you use a doctor who does not accept assignment for the claim the doctor is permitted to bill you after the Plan has paid only if the Medicare and Plan payments combined do not total

the limiting charge Neither you nor your FEHB Plan is liable for any amount in excess of the Medicare limiting charge for charges of a doctor who does not participate with Medicare The
Medicare Summary Notice MSN form will have more information about this limit
If your doctor does not participate with Medicare asks you to pay more than the limiting charge and he or she is under contract with this Plan call the Plan If your doctor is not a Plan doctor

ask the doctor to reduce the charge or report him or her to the Medicare carrier that sent you the MSN form In any case a doctor who does not participate with Medicare is not entitled to
payment of more than 115 of the Medicare approved amount

How to claim benefits In most cases when services are covered by both Medicare and this Plan Medicare is the primary payor if you are an annuitant and this Plan is the primary payor if you are an employee
When Medicare is the primary payor your claims should first be submitted to Medicare After Medicare has paid its benefits this Plan will consider the balance of any covered expenses To be
sure your claims are processed by this Plan you must submit the MSN form from Medicare and duplicates of all bills along with a completed claim form This Plan will not process your claim
without knowing whether you have Medicare and if you do without receiving the MSN

Other Group Insurance When anyone has coverage with us and with another group health plan it is called double Coverage and Automobile coverage You must tell us if you or a family member has double coverage You must also send
Insurance us documents about other insurance even if we don't ask for them When there is double coverage one plan normally pays its benefits in full as the primary payor
and the other plan pays a reduced benefit as the secondary payor When this Plan is the secondary payor it will pay the lesser of 1 its benefits in full or 2 a reduced amount that when added to
the benefits payable by the other coverage will not exceed 100 of covered expenses
The determination of which coverage is primary pays its benefits first is made according to guidelines provided by the National Association of Insurance Commissioners NAIC When

benefits are payable under automobile insurance including no fault the automobile insurer is primary pays its benefits first if it is legally obligated to provide benefits for health care
expenses without regard to other health benefits coverage the enrollee may have
The provision applies whether or not a claim is filed under the other coverage When applicable authorization must be given to this Plan to obtain information about benefits or services available

from the other coverage or to recover overpayments from other coverages

Liability insurance and Subrogation applies when you are sick or injured as a result of the act or omission of another third party actions person or party The Plan has the right to be reimbursed for benefits paid or payable on behalf of
a Plan enrollee or a covered family member as the result of an illness or injury caused by a third party even if you were not made whole When a Plan enrollee or a covered family member

makes a damage claim against a third party or his or her uninsured or underinsured auto policy as a result of an injury or illness the Plan may assert a lien on the proceeds of that claim in order to
reimburse itself to the full amount of benefits it is called upon to pay The Plan's lien will apply to any and all recoveries for such claim whether by court order or out of court settlement A Plan
enrollee or covered family member must cooperate in the assertion of the Plan's lien by giving an assignment of claim proceeds to the Plan and by accepting the Plan's lien for the full amount of
benefits paid or payable on behalf of the Plan enrollee or covered family member

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Mail Handlers Benefit Plan 2000
Liability insurance and The Plan will provide necessary forms including a Reimbursement Agreement and insist on written third party actions confirmation of the lien before paying any benefits on account of the illness or injury Payment of
continued benefits prior to the Plan being advised of the third party claim does not waive the Plan's right to withhold benefits where an enrollee or covered family member has not cooperated in protecting the
Plan's lien No reduction in the Plan's lien can occur without the Plan's written consent Failure to notify the Plan promptly of the claim for damages or to cooperate with the Plan's reimbursement

efforts may result in an overpayment by the Plan subject to recoupment If you need more information about subrogation the Plan will provide you with its subrogation procedures

TRICARE TRICARE is the health care program for members eligible dependents and retirees of the military TRICARE includes the CHAMPUS program If both TRICARE and this Plan cover
you we are the primary payer See your TRICARE Health Benefits Advisor if you have questions about TRICARE coverage

Workers compensation We do not cover services that
You need because of a workplace related disease or injury that the Office of Workers Compensation Programs OWCP or a similar Federal or State agency determine they

must provide
OWCP or a similar agency pays for through a third party injury settlement or other similar proceeding that is based on a claim you filed under OWCP or similar laws

Once the OWCP or similar agency has paid its maximum benefits for your treatment we will provide your benefits

Medicaid We pay first if both Medicaid and this Plan cover you

Other Government We do not cover services and supplies that a local State or Federal Government agency directly Agencies or indirectly pays for
Overpayments The Plan will make reasonably diligent efforts to recover benefit payments made erroneously but in good faith and may apply subsequent benefits otherwise payable to offset any overpayments
Vested Rights An enrollee does not have a vested right to the benefits in this brochure in 2001 or later years and does not have a right to benefits available prior to 2000 unless those benefits are contained in
the brochure

Limit on your costs if The information in the following paragraphs applies to you when 1 you are not covered by either you're age 65 or older Medicare Part A hospital insurance or Part B medical insurance or both 2 you are enrolled in
and don't have Medicare this Plan as an annuitant or as a former spouse or family member covered by the family enrollment of an annuitant or former spouse and 3 you are not employed in a position which
confers FEHB coverage

Inpatient hospital care If you are not covered by Medicare Part A are age 65 or older or become age 65 while receiving inpatient hospital services and you receive care in a Medicare participating hospital the law
5 U S C 8904 b requires the Plan to base its payment on an amount equivalent to the amount Medicare would have allowed if you had Medicare Part A This amount is called the equivalent
Medicare amount After the Plan pays the law prohibits the hospital from charging you for covered services after you have paid any deductibles coinsurance or copayments you owe under
the Plan Any coinsurance you owe will be based on the equivalent Medicare amount not the actual charges You and the Plan together are not legally obligated to pay the hospital more than
the equivalent Medicare amount

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Mail Handlers Benefit Plan 2000
Limit on your costs if you're age 65 or
older and don't have Medicare continued

Inpatient hospital The Plan's explanation of benefits EOB will tell you how much the hospital can charge you in care continued addition to what the Plan paid If you are billed more than the hospital is allowed to charge ask
the hospital to reduce the bill If you have already paid more than you have to pay ask for a refund If you cannot get a reduction or refund or are not sure how much you owe call the Plan
at 1 800 410 7778 for assistance

Physician services Claims for physician services provided for retired FEHB members age 65 and older who do not have Medicare Part B are processed in accordance with 5 U S C 8904 b This law mandates the
use of Medicare Part B limits for covered physician services for those members who are not covered by Medicare Part B

The Plan is required to base its payment on the Medicare approved amount which is the Medicare fee schedule for the service or the actual charges whichever is lower
If your physician is not a Plan PPO doctor but participates with Medicare the Plan will base its regular benefit payment on the Medicare approved amount For instance under this Plan's High
Option physician services benefit the Plan will pay 70 of the Medicare approved amount You will only be responsible for the coinsurance equal to 30 of the Medicare approved amount

If your physician does not participate with Medicare the Plan will still base its payment on the Medicare approved amount However in most cases you will be responsible for any coinsurance
or copayment amount and any balance up to the limiting charge amount 115 of the Medicareapproved amount

Since a physician who participates with Medicare is only permitted to bill you up to the Medicare approved amount even if you do not have Medicare Part B it is generally to your
financial advantage to use a physician who participates with Medicare
The Plan's explanation of benefits EOB will tell you how much the physician can charge you in addition to what the Plan paid If you are billed more than the physician is allowed to charge ask

the physician to reduce the bill If you have already paid more than you have to pay ask for a refund If you cannot get a reduction or refund or are not sure how much you owe call the Plan
at 1 800 410 7778

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Mail Handlers Benefit Plan 2000
Section 9 Fee for Service Facts

Precertification
Precertify before Precertification is not a guarantee of benefit payments Precertification of an inpatient admission admission is a predetermination that based on the information given the admission meets the medical

necessity requirements of the Plan It is your responsibility to ensure that precertification is obtained If precertification is not obtained and benefits are otherwise payable benefits for the
admission will be reduced by 500

To precertify a scheduled You your representative your doctor or your hospital must call the Plan at least two working admission days before admission The toll free number is 1 800 410 7778
Provide the following information enrollee's name and Plan identification number patient's name birth date and phone number reason for hospitalization proposed treatment or surgery
name of hospital or facility name and phone number of admitting doctor and number of planned days of confinement

The Plan will then tell the doctor and hospital the number of approved days of confinement for the care of the patient's condition Written confirmation of the Plan's certification decision will
be sent to you your doctor and the hospital If the length of stay needs to be extended follow the procedures below

Need additional days A review coordinator will contact your doctor before the certified length of stay ends to determine if you will be discharged on time or if additional inpatient days are medically
necessary If the admission is precertified but you remain confined beyond the number of days certified as medically necessary the Plan will not pay for inpatient room and board charges
incurred on any extra days that are determined to not be medically necessary by the Plan during the claim review All maternity claims admissions that are not certified for additional days
beyond 48 hours after a regular delivery or 96 hours after cesarean section will be subject to the precertification penalty

You don't need to certify Medicare Part A or another group health insurance policy is the primary payor for the hospital an admission when confinement see pages 35 37 Precertification is required however when Medicare hospital
benefits are exhausted prior to using Lifetime Reserve Days
You are confined in a hospital outside the United States
Your stay is less than 23 hours
When the discharge for your maternity admission is within 48 hours after a regular delivery or within 96 hours after a cesarean section delivery

Emergency admissions When there is an emergency admission due to a condition that puts the patient's life in danger or could cause serious damage to bodily function you your representative the doctor or the
hospital must telephone 1 800 410 7778 within two business days following the day of admission even if the patient has been discharged from the hospital Otherwise inpatient
benefits otherwise payable for the admission will be reduced by 500
Newborn confinements that extend beyond the mother's discharge date must also be certified You your representative the doctor or hospital must request certification for the newborn's

continued confinement within two business days following the day of the mother's discharge

Other considerations An early determination of need for confinement precertification of the medical necessity of inpatient admission is binding on the Plan unless the Plan is misled by the information given
to it After the claim is received the Plan will first determine whether the admission was precertified and then provide benefits according to all of the terms of this brochure

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Mail Handlers Benefit Plan 2000
Precertification continued
If you do not precertify If precertification is not obtained before admission to the hospital or after 48 hours after a regular delivery or 96 hours after a cesarean section delivery or within two business days following the
day of an emergency admission or in the case of a newborn the mother's discharge a medical necessity determination will be made at the time the claim is filed If the Plan determines that the
hospitalization was not medically necessary the inpatient hospital room and board benefits will not be paid However medically necessary hospital services and supplies otherwise payable will
be considered by the Plan at 70 of actual charges
If the claim review determines that the admission was medically necessary any benefits payable according to all of the terms of this brochure will be reduced by 500 for failing to have the

admission precertified
If the admission is determined to be medically necessary but part of the length of stay was found not to be medically necessary inpatient room and board hospital benefits will not be paid for the

portion of the confinement that was not medically necessary However medically necessary services and supplies otherwise payable will be considered by the Plan at 70 of actual charges

Protection Against Catastrophic Costs
Catastrophic protection The Plan pays 100 of reasonable and customary eligible charges for the remainder of the calendar year when out of pocket expenses in that calendar year exceed 4,000 under High and

Standard Option for you and any covered family members Under family coverage out of pocket expenses for family members accumulate towards one 4,000 maximum

PPO Providers When your eligible out of pocket expenses from using PPO providers when the services are eligible to be received from PPO providers exceed 2,500 under the High Option
the Plan pays 100 of its covered charges for covered expenses when you continue to select PPO providers for the remainder of the calendar year Whether or not you use PPO providers your
share of out of pocket expenses will not exceed 4,000 in a calendar year
Out of pocket expenses eligible charges for the purposes of this benefit are
The 30 Non PPO coinsurance you pay for surgery including obstetrical care anesthesia doctors inpatient and outpatient medical visits outpatient diagnostic laboratory tests X rays

and machine tests outpatient accidental injury and emergency illness treatment ambulance outpatient surgical facility charges outpatient chemotherapy X ray or radium treatment
hemodialysis peritoneal dialysis and hyperbaric oxygen therapy durable medical equipment and dental work if required for repair of an accidental injury

The 10 PPO coinsurance you pay for surgery including obstetrical care anesthesia doctors inpatient medical visits outpatient diagnostic laboratory tests X rays and machine
tests outpatient accidental injury and emergency illness treatment outpatient chemotherapy X ray or radium treatment hemodialysis peritoneal dialysis and hyperbaric oxygen therapy
durable medical equipment and dental work if required for repair of an accidental injury

The following cannot be included in the accumulation of out of pocket expenses or covered under this benefit
Copayments
Coinsurance for chiropractor visits physical speech occupational and acupuncture therapy nursing services

Deductibles
Non covered services and supplies
Expenses in excess of reasonable and customary charges or benefit maximums
Expenses for diagnosis treatment of mental conditions or substance abuse hospice care nursing care prescription drugs or dental care

Any amounts you pay because benefits have been reduced for non compliance with the Plan's precertification requirements

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Mail Handlers Benefit Plan 2000
Definitions

Accidental injury An injury caused by an external force such as a blow or a fall that requires immediate attention Also included are animal bites poisonings and dental care required as a result of an accidental injury to
sound natural teeth An injury to the teeth while eating is not considered an accidental injury
Admission The period from entry admission into a hospital or other covered facility until discharge In counting days of inpatient care the date of entry and the date of discharge are counted as the
same day
Assignment An authorization by an enrollee or spouse for the Plan to issue payment of benefits directly to the provider The Plan reserves the right to pay the member directly for all covered services

Calendar year January 1 through December 31 of the same year For new enrollees the calendar year begins on the effective date of their enrollment and ends on December 31 of the same year
Congenital anomaly A condition existing at or from birth which is a significant deviation from the common form or norm For purposes of this Plan congenital anomalies include protruding ear deformities cleft
lips cleft palates birthmarks webbed fingers or toes and other conditions that the Plan may determine to be congenital anomalies In no event will the term congenital anomaly include
conditions relating to teeth or intraoral structures supporting the teeth
Cosmetic surgery Any operative procedure or any portion of a procedure performed primarily to improve physical appearance and or treat a mental condition through change in bodily form

Custodial care Treatment or services regardless of who recommends them or where they are provided that could be rendered safely and reasonably by a person not medically skilled or that are designed mainly to
help the patient with daily living activities These activities include but are not limited to
1 personal care such as help in walking getting in and out of bed bathing eating by spoon tube or gastrostomy exercising dressing

2 homemaking such as preparing meals or special diets
3 moving the patient
4 acting as companion or sitter
5 supervising medication that can usually be self administered or
6 treatment or services that any person may be able to perform with minimal instruction including but not limited to recording temperature pulse and respirations or administration

and monitoring of feeding systems
The Plan determines which services are custodial care

Durable medical Equipment and supplies that equipment
1 are prescribed by your attending doctor
2 are medically necessary
3 are primarily and customarily used only for a medical purpose
4 are generally useful only to a person with an illness or injury
5 are designed for prolonged use and
6 serve a specific therapeutic purpose in the treatment of an illness or injury

Effective date The date the benefits described in this brochure are effective
1 January 1 for continuing enrollments and for all annuitant enrollments
2 the first day of the first full pay period of the new year for enrollees who change plans or options or elect FEHB coverage during the open season for the first time or

3 for new enrollees during the calendar year but not during the open season the effective date of enrollment as determined by the employing office or retirement system

Group health coverage Health care coverage that a member is eligible for because of employment by membership in or connection with a particular organization or group that provides payment for hospital medical
or other health care services or supplies or that pays a specific amount for each day or period of hospitalization if the specified amount exceeds 200 per day including extension of any of these
benefits through COBRA 42 42
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Mail Handlers Benefit Plan 2000
Definitions continued

Hospice care program A formal program directed by a doctor to help care for a terminally ill person The services may be provided through either a centrally administered medically directed and nurse coordinated
program that provides primarily home care services 24 hours a day seven days a week by a hospice team that reduces or abates mental and physical distress and meets the special stresses of a
terminal illness dying and bereavement or through confinement in a hospice care program The hospice team must include a doctor and a nurse R N and also may include a social worker
clergyman counselor volunteer clinical psychologist physical therapist or occupational therapist
Medically necessary Services drugs supplies or equipment provided by a hospital or covered provider of health care services that the Plan determines

1 are appropriate to diagnose or treat the patient's condition illness or injury
2 are consistent with standards of good medical practice in the United States
3 are not primarily for the personal comfort or convenience of the patient the family or the provider

4 are not a part of or associated with the scholastic education or vocational training of the patient and
5 in the case of inpatient care cannot be provided safely on an outpatient basis
The fact that a covered provider has prescribed recommended or approved a service supply drug or equipment does not in itself make it medically necessary

Mental conditions Conditions and diseases listed in the most recent edition of the International Classification of substance abuse Diseases ICD as psychoses neurotic disorders or personality disorders other nonpsychotic mental
disorders listed in the ICD to be determined by the Plan or disorders listed in the ICD requiring treatment for abuse of or dependence upon substances such as alcohol narcotics or hallucinogens

Morbid obesity A condition in which an individual weighs 100 pounds or 100 over his or her normal weight in accordance with current underwriting standards Eligible members must be age 18 or over
Orthopedic appliance Any fitted external device used to support align prevent or correct deformities or to restore or improve function
Prosthetic appliance An artificial substitute for a missing body part such as an arm eye or leg This appliance may be used for a functional or cosmetic reason or both
Reasonable and The medical benefits of this Plan are limited to and based on reasonable and customary charges customary except for negotiated rates with PPO providers network retail pharmacies and an average PPO
schedule for services and supplies where access to a PPO network provider i e the negotiated rate was available but not utilized

The reasonable and customary charge for any Non PPO services or supplies generally is the lesser of either a the usual charge made by the provider for the service or supply in the absence
of insurance or b the charge that the Plan determines to be in the 80th percentile of the prevailing charges made for the service or supply in the geographic area in which it is furnished
The prevailing charge data is collected by the Plan's underwriter For certain services exceptions to the general method of determining reasonable and customary may exist

The average PPO schedule for any Non PPO services or supplies is based on the average of the medical PPO provider negotiated fee schedules in a particular geographic area for a particular
service or supply The average PPO fee schedule applies in cases where adequate access to a PPO network provider i e the negotiated rate was available to the patient but the patient did
not use a medical PPO provider to perform the service or provide the supply
Scooters A power operated vehicle chair or cart with a base that may extend beyond the edge of the seat a tiller type control mechanism which is usually center mounted and an adjustable seat that may
or may not swivel

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Mail Handlers Benefit Plan 2000
Section 10 FEHB Facts
You Have a Right to the Following Information
OPM requires that all FEHB plans comply with the Patients Bill of Rights which gives you the right to information about your health plan its networks providers and facilities You can also
find out about care management which includes medical practice guidelines disease management programs and how we determine if procedures are experimental or investigational
OPM's website http www opm gov lists the specific types of information that we must make available to you

If you want specific information about us call 1 800 410 7778 or write to the Mail Handlers Benefit Plan P O Box 45118 Jacksonville FL 32232 5118 You may also visit our website
http www mhbp com

Where do I get Your employing or retirement office can answer your questions and give you a Guide to Federal information about Employees Health Benefits Plans brochures for other plans and other materials you need to make
enrolling in the an informed decision about FEHB Program
When you may change your enrollment

How you can cover your family members
What happens when you transfer to another Federal agency go on leave without pay enter military service or retire

When your enrollment ends and
The next Open Season for enrollment
We don't determine who is eligible for coverage and in most cases cannot change your enrollment status without information from your employing or retirement office

When are my benefits and The benefits in this brochure are effective on January 1 If you are new to this plan your premiums effective coverage and premiums begin on the first day of your first pay period that starts on or after
January 1 Annuitants premiums begin January 1

What happens When you retire you can usually stay in the FEHB Program Generally you must have been when I retire enrolled in the FEHB Program for the last five years of your Federal service If you do not meet
this requirement you may be eligible for other forms of coverage such as Temporary Continuation of Coverage which is described later in this section

What types of coverage Self Only coverage is for you alone Self and Family coverage is for you your spouse and your are available for me unmarried dependent children under age 22 including any foster or step children your employing
and my family or retirement office authorizes coverage for Under certain circumstances you may also get coverage for a disabled child 22 years of age or older who became incapable of self support
before 22
If you have a Self Only enrollment you may change to a Self and Family enrollment if you marry give birth or add a child to your family You may change your enrollment 31 days before

to 60 days after you give birth or add the child to your family The benefits and premiums for your Self and Family enrollment begin on the first day of the pay period in which the child is
born or becomes an eligible family member
Your employing or retirement office will not notify you when a family member is no longer eligible to receive health benefits nor will we Please tell us immediately when you add or

remove family members from your coverage for any reason including divorce
If you or one of your family members is enrolled in one FEHB plan that person may not be enrolled in or receive benefits from another FEHB plan

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Mail Handlers Benefit Plan 2000
You Have a Right to the Following Information continued
Are my medical We will keep your medical and claims information confidential Only the following will have and claims records access to it
confidential OPM this Plan and our subcontractors when they administer this contract
This Plan and appropriate third parties such as other insurance plans and the Office of Workers Compensation Programs OWCP when coordinating benefits and subrogating claims

Law enforcement officials when investigating and or prosecuting alleged civil or criminal actions
OPM and the General Accounting Office when conducting audits
Individuals involved in bona fide medical research or education that does not disclose your identity
OPM when reviewing a disputed claim or defending litigation about a claim or
PCS Health International First Health or any other subcontractor of the Plan who is engaged in helping the Plan measure healthcare quality and customer satisfaction The data they gather

will be used solely in the administration of the Plan

Information for New Members
Identification cards We will send you an Identification ID card Use your copy of the Health Benefits Election Form SF 2809 or the OPM annuitant confirmation letter until you receive your ID card

You can also use an Employee Express confirmation letter

What if I paid a deductible Your old plan's deductible continues until our coverage begins under my old FEHB plan

Pre existing conditions We will not refuse to cover the treatment of a condition that you or a family member had before you enrolled in this Plan solely because you had the condition before you enrolled
When You Lose Benefits
What happens if my You will receive an additional 31 days of coverage for no additional premium when enrollment in this
Your enrollment ends unless you cancel your enrollment or Plan ends
You are a family member no longer eligible for coverage
You may be eligible for former spouse coverage or Temporary Continuation of Coverage

What is former spouse If you are divorced from a Federal employee or annuitant you cannot continue to get benefits coverage under your spouse's enrollment But you may be eligible for your own FEHB coverage under
the spouse equity law If you are recently divorced or are anticipating a divorce contact your exspouse's employing or retirement office to get more information about your coverage choices

What is TCC Temporary Continuation of Coverage TCC If you leave Federal service or if you lose coverage because you no longer qualify as a family member you may be eligible for TCC For example
you can receive TCC if you are not able to continue your FEHB enrollment after you retire You may not elect TCC if you are fired from your Federal job due to gross misconduct

Get the RI 79 27 which describes TCC and the RI 70 5 the Guide to Federal Employees Health Benefits Plans for Temporary Continuation of Coverage and Former Spouse Enrollees from your
employing or retirement office

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Mail Handlers Benefit Plan 2000
When You Lose Benefits continued
Key points about TCC You can pick a new plan
If you leave Federal service you can receive TCC for up to 18 months after you separate
If you no longer qualify as a family member you can receive TCC for up to 36 months
Your TCC enrollment starts after regular coverage ends
If you or your employing office delay processing your request you still have to pay premiums from the 32nd day after your regular coverage ends even if several months have passed

You pay the total premium and generally a 2 percent administrative charge The government does not share your costs
You receive another 31 day extension of coverage when your TCC enrollment ends unless you cancel your TCC or stop paying the premium
You are not eligible for TCC if you can receive regular FEHB Program benefits

How do I enroll in If you leave Federal service your employing office will notify you of your right to enroll under TCC TCC You must enroll within 60 days of leaving or receiving this notice whichever is later
Children You must notify your employing or retirement office within 60 days after your child is no longer an eligible family member That office will send you information about enrolling in
TCC You must enroll your child within 60 days after they become eligible for TCC or receive this notice whichever is later

Former spouses You or your former spouse must notify your employing or retirement office within 60 days of one of these qualifying events
Divorce
Loss of spouse equity coverage within 36 months after the divorce
Your employing or retirement office will then send your former spouse information about enrolling in TCC Your former spouse must enroll within 60 days after the event which qualifies

him or her for coverage or receiving the information whichever is later
Note Your child or former spouse loses TCC eligibility unless you or your former spouse notify your employing or retirement office within the 60 day deadline

How can I convert to You may convert to an individual policy if individual coverage
Your coverage under TCC or the spouse equity law ends If you canceled your coverage or did not pay your premium you cannot convert

You decided not to receive coverage under TCC or the spouse equity law or
You are not eligible for coverage under TCC or the spouse equity law
If you leave Federal service your employing office will notify you if individual coverage is available You must apply in writing to us within 31 days after you receive this notice However if

you are a family member who is losing coverage the employing or retirement office will not notify you You must apply in writing to us within 31 days after you are no longer eligible for coverage

Your benefits and rates will differ from those under the FEHB Program however you will not have to answer questions about your health and we will not impose a waiting period or limit your
coverage due to pre existing conditions

How can I get a If you leave the FEHB Program we will give you a Certificate of Group Health Plan Coverage Certificate of Group that indicates how long you have been enrolled with us You can use this certificate when getting
Health Plan Coverage health insurance or other health care coverage You must arrange for the other coverage within 63 days of leaving this Plan Your new plan must reduce or eliminate waiting periods limitations
or exclusions for health related conditions based on the information in the certificate
If you have been enrolled with us for less than 12 months but were previously enrolled in other FEHB plans you may request a certificate from them as well

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Mail Handlers Benefit Plan 2000
Department of Defense FEHBP Demonstration Project
What is the Department The National Defense Authorization Act for 1999 Public Law 105 261 established the of Defense DoD FEHBP DoD FEHBP Demonstration Project It allows some active and retired military members and
Demonstration Project their dependents to enroll in the FEHB Program The demonstration will last for three years beginning with the 1999 Open Season for the year 2000 Open Season enrollments will be
effective January 1 2000 DoD and OPM have set up some special procedures to successfully implement the Demonstration Project noted below Otherwise the provisions described in this

brochure apply

Who is eligible DoD determines who is eligible to enroll in FEHBP You may enroll if
You are an active or retired uniformed service member and are eligible for Medicare
You are a dependent of an active or retired uniformed service member and are eligible for Medicare
You are a qualified former spouse of an active or retired uniformed service member and you have not remarried or

You are a survivor dependent of a deceased active or retired uniformed service member and
You live in one of the eight geographic demonstration areas
If you are eligible to enroll in a plan under the regular Federal Employees Health Benefits Program you are not eligible to enroll under the DoD FEHBP Demonstration Project

Where are the Dover AFB DE demonstration
Commonwealth of Puerto Rico areas
Fort Knox KY
Greensboro Winston Salem High Point NC
Dallas TX
Humboldt County CA area
Naval Hospital Camp Pendleton CA
New Orleans LA

When can I join Your first opportunity to enroll will be during the 1999 Open Season November 8 1999 through December 13 1999 Your coverage will begin January 1 2000 DoD has set up an Information
Processing Center IPC in Iowa to provide you with information about how to enroll IPC staff will verify your eligibility and provide you with FEHB Program information plan
brochures enrollment instructions and forms The toll free phone number for the IPC is 1 877 DOD FEHBP 1 877 363 3342

You may select coverage for yourself self only or for you and your family self and family during the 1999 2000 and 2001 Open Seasons Your coverage will begin January 1 of the year
following the Open Season that you enrolled
If you become eligible for the DoD FEHBP Demonstration Project outside of Open Season contact the IPC to find out how to enroll and when your coverage will begin

DoD has a website devoted to the Demonstration Project You can view information such as their Marketing Beneficiary Education Plan Frequently Asked Questions demonstration area locations
and zip code lists at www tricare osd mil fehbp You can also view information about the demonstration project including The 2000 Guide to Federal Employees Health Benefits Plans
Participating in the DoD FEHBP Demonstration Project on the OPM website at www opm gov

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Mail Handlers Benefit Plan 2000
Department of Defense FEHB Demonstration Project continued
Am I eligible for See Section 10 FEHB Facts for information about TCC Under this Demonstration Project the Temporary Continuation only individual eligible for TCC is one who ceases to be eligible as a member of family under
of Coverage TCC your self and family enrollment This occurs when a child turns 22 for example or if you divorce and your spouse does not qualify to enroll as an unremarried former spouse under title
10 United States Code For these individuals TCC begins the day after their enrollment in the DoD FEHB Demonstration Project ends TCC enrollment terminates after 36 months or the end

of the Demonstration Project whichever occurs first You your child or another person must notify the IPC when a family member loses eligibility for coverage under the DoD FEHBP
Demonstration Project
TCC is not available if you move out of a DoD FEHBP Demonstration Project area you cancel your coverage or your coverage is terminated for any reason TCC is not available when the

demonstration project ends

Do I have the 31 Day These provisions do not apply to the DoD FEHBP Demonstration Project Extension and Right
To Convert

Inspector General Advisory Stop Health Care Fraud
Fraud increases the cost of health care for everyone If you suspect that a physician pharmacy or hospital 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 us at 1 800 410 7778 and explain the situation
If we do not resolve the issue call or write

THE HEALTH CARE FRAUD HOTLINE
202 418 3300
U S Office of Personnel Management Office of the Inspector General Fraud Hotline

1900 E Street NW Room 6400 Washington DC 20415

Penalties for Fraud
Anyone who falsifies a claim to obtain FEHB Program benefits can be prosecuted for fraud Also the Inspector General may
investigate anyone who uses an ID card if they

Try to obtain services for a person who is not an eligible family member or
Are no longer enrolled in the Plan and try to obtain benefits
Your agency may also take administrative action against you

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Mail Handlers Benefit Plan 2000
Index

Abortion 34 Emergency treatment 23 Ostomy supplies 26
Accidental injury 17 23 30 41 42 Exclusions 34 Other Medical Benefits 14 15 17
Acupuncture 8 9 21 22 41 Experimental 10 34 19 21 24 30 36
Additional Benefits 17 25 26 34 Explanation of benefits 4 11 32 38 39 Out of pocket expenses 4 6 41
Allergy injections 22 Eyeglasses 17 25 31 34 Oxygen 22 25
Ambulance 7 25 26 34 36 Fecal occult blood stool test 24 Pap smear 24
Anesthesia 7 9 15 18 29 30 41 Flexible benefits option 6 Performance Lab 23
Assignment 33 36 37 42 General exclusions 2 3 34 Physical examination 24
Assistant surgeon 15 General Limitations 35 39 Physical therapist 9
Autologous stem cell support 16 Hearing aid 26 31 34 Physical therapy speech therapy
Birthing centers 18 Hospice care 8 26 41 43 occupational therapy chiropractic
Blood and blood plasma 13 Hospital 4 7 10 13 23 8 9 21 22 32
Breast cancer screening 24 25 28 30 31 33 36 38 41 50 51 Physician 4 5 7 9 12 17 21
Immunizations 21 24 23 27 36 39 48 Breast reconstruction surgery Plan Changes January 2000 4 5

following mastectomy 17 Infertility 19
Cardiac Rehabilitation 34 Inpatient Hospital Benefits 13 14 30 Precertification 6 9 13 17 18
34 36 20 22 30 40 41 Carryover 7 Preferred provider organization PPO 4 9

Catastrophic protection 41 Insulin 26
Laboratory and pathology services 8 9 Prescription drugs 7 13 16 19 21 22 Chelation therapy 24 24 27 28 34 36 41

Chemotherapy 13 16 21 22 24 27 13 17 19 21 24 41 Licensed practical nurse 26 32 Private room 13
Chiropractic 8 9 21 22 41 Prostate Cancer Screening 24
Coinsurance 7 41 Lifetime maximum 8 26 Machine tests 7 9 13 17 21 23 41 Prosthetic appliance 25 36 43
Colorectal cancer screening 24 Psychologist 9
Confidentiality 45 Mail order prescription drugs 5 26 28 Mammograms 23 24 Radiation therapy 7
Congenital anomaly 17 42 Reasonable and Customary 7 14 15
Consultation 21 30 Maternity 4 7 9 17 19 40 18 26 41 43 49
Contraceptive 19 27 Medicaid 38 Registered nurse 8 26
Coordination of benefits 35 Medically necessary 13 15 17 20 Room and board 13 18 20 40 41
Copayment 4 7 9 21 24 28 36 34 40 41 43 Medically underserved areas 9 Semiprivate 13 18
38 39 40 41 Smoking cessation 8 24

Cosmetic surgery 17 34 42 Medicare 13 32 34 40 47 Members 1 5 6 9 10 19 24 27 Social worker 9
Covered charges 7 9 14 15 Speech therapist 9 21
18 19 21 24 26 41 30 31 34 37 41 45 47 52 Mental conditions Sterilization 17 19

Covered provider 8 9 21 34 43 Subrogation 37 38
Deductible 4 7 9 13 15 18 23 substance abuse 20 21 36 43
25 28 31 32 34 36 38 41 45 Miracle Ear hearing aid program 31 Substance abuse 7 20 21

Definitions 42 43 Multiple surgical procedures 15 Surgical 4 7 9 11 13 17 20 Non FEHB Benefits 31 21 22 30 34 36 41
Dental 14 16 26 28 31 34 41 42 Syringes 26
Dependent 9 24 31 38 44 47 Nurse midwife 9 Nurse practitioner 9 TCC 44 46 48
Dialysis 21 22 41 Temporary continuation of converage
Disputed claim 11 12 31 45 Nursery charges 18 Nursing school administered clinic 9 44 46 48
Divorce 44 46 48 Transplants 14 16
DoD FEHB Demonstration Project 47 48 Obstetrical care 7 18 41 Occupational therapist 9 Vision One Eyecare Program 31
Donor expenses 16 Well child care 24
Durable medical equipment 25 26 42 Ocular injury 25 Office visit 11 21 23 24 Workers Compensation 36 38 45
Effective date of enrollment 42 X ray 8 9 13 17 19 21 24 28 30 41
Emergency admission 13 20 40 Oral and maxillofacial surgery 16 29 30

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Mail Handlers Benefit Plan 2000
Summary of Standard Option Benefits for the Mail Handlers Benefit Plan 2000
Do not rely on this chart alone All benefits are subject to the definitions limitations and exclusions set forth in the brochure This chart merely summarizes certain important expenses covered by the Plan If you wish to enroll or change your enrollment

in this Plan be sure to indicate the correct enrollment code on your enrollment form codes appear on the cover of this brochure All items below with an asterisk are subject to the 200 per person calendar year deductible

Standard Option pays Page
Inpatient Hospital PPO benefit After 150 per admission deductible 100 of covered charges 13 14 care Non PPO benefit After 300 per admission deductible 100 of covered charges 13 14

Surgical PPO benefit 90 of covered charges 14 17 Non PPO benefit 70 of R C charges 14 17
Medical PPO benefit 90 of covered charges 21 24 Non PPO benefit 70 of R C charges 21 24
Maternity Same benefits as illness or injury 17 19
Mental Conditions PPO benefit After 150 per admission deductible 70 of covered charges Substance Abuse up to 45 days per calendar year 20 21

Non PPO benefit After 300 per admission deductible 70 of covered charges up to 45 days per calendar year 20 21

Outpatient Hospital PPO 90 of covered charges for facility charges related to chemotherapy care hemodialysis and radiation therapy 21 22
Non PPO 70 of R C charges for facility charges related to chemotherapy hemodialysis and radiation therapy 21 22

Surgical PPO benefit 90 of covered charges billed by primary surgeon 100 of covered charges billed by surgery facility 22
Non PPO benefit 70 of R C charges billed by primary surgeon 70 of covered charges billed by surgery facility 22

Medical PPO benefit 100 of covered charges after a 15 copayment for doctors medical visits and a 5 copayment for allergy injections 90 of covered charges for
diagnostic X rays laboratory services and other outpatient visits 21 24 Non PPO benefit 70 of R C charges for doctors medical visits 70 of R C
charges for diagnostic X ray laboratory services and other outpatient visits 21 24 Performance Lab 100 of covered charges for services provided under the
Performance Lab Program 23
Maternity Same benefits as illness or injury 17 19
Home Health Care No current benefit
Mental Conditions 70 of R C charges limited to 20 visits per year 20 21 Substance Abuse

Emergency care PPO benefit 90 of covered charges for outpatient treatment of accidental injury or medical emergency within 72 hours of the occurrence 23
Non PPO benefit 70 of reasonable and customary charges for outpatient treatment of accidental injury or medical emergency within 72 hours of the occurrence 23

Prescription drugs After 600 per person calendar year prescription drug deductible PCS 70 of PCS charges Non PCS 50 of PCS charges
Mail Order 10 copayment per generic prescription 40 preferred brand 55 non preferred brand 26 28

Dental care No current benefit
Additional Benefits Eyeglasses following accident or surgery hospice ambulance hearing aid following accident durable medical equipment home nursing services orthopedic and

prosthetic devices rabies shots 25 26
Catastrophic protection 100 of covered charges when applicable coinsurance reaches 4,000 per calendar year 41

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50 Page 51 52
Mail Handlers Benefit Plan 2000
Summary of High Option Benefits for the Mail Handlers Benefit Plan 2000
Do not rely on this chart alone All benefits are subject to the definitions limitations and exclusions set forth in the brochure This chart merely summarizes certain important expenses covered by the Plan If you wish to enroll or change your enrollment

High Option pays Page
Inpatient Hospital PPO benefit 100 of covered charges no deductible 13 14 care Non PPO benefit After 250 per admission deductible 100 of covered charges 13 14

Surgical PPO benefit 90 of covered charges 14 17 Non PPO benefit 70 of R C charges 14 17
Medical PPO benefit 90 of covered charges 21 24 Non PPO benefit 70 of R C charges 21 24
Maternity Same benefits as illness or injury 17 19
Mental Conditions PPO benefit 70 of covered charges up to 45 days per calendar year 20 21 Substance Abuse Non PPO benefit After 250 per admission deductible 70 of covered charges

up to 45 days per calendar year 20 21
Outpatient Hospital PPO benefit 90 of covered charges for facility charges related to care chemotherapy hemodialysis and radiation therapy 21 22

Non PPO benefit 70 of R C charges for facility charges related to chemotherapy hemodialysis and radiation therapy 21 22

Medical PPO benefit 100 of covered charges after a 15 copayment for doctors medical visits and a 5 copayment for allergy injections 90 of covered charges
for diagnostic X rays laboratory services and other outpatient visits 21 24 Non PPO benefit 70 of R C charges for doctors medical visits 70 of R C
charges for diagnostic X ray laboratory services and other outpatient visits 21 24 Performance Lab 100 of covered charges for services provided under the
Performance Lab Program 23
Maternity Same benefit as illness or injury 17 19
Home Health Care No current benefit
Mental Conditions 70 of R C charges limited to 20 visits per year 20 21 Substance Abuse

Prescription drugs After 250 per person calendar year prescription drug deductible PCS 75 of PCS charges Non PCS 50 of PCS charges
Mail Order 10 copayment per generic prescription 30 preferred brand 45 non preferred brand 26 28

Dental care Up to amount stated in the schedule of dental allowances maximum benefit of 800 per person 1,600 per family each calendar year 28 30
Additional Benefits Eyeglasses following accident or surgery hospice ambulance hearing aid following accident durable medical equipment home nursing services
orthopedic and prosthetic devices rabies shots 25 26
Catastrophic protection 100 of covered charges when applicable coinsurance reaches 2,500 per calendar year when PPO providers are used and 4,000 when they are not 41

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51 Page 52
Mail Handlers Benefit Plan 2000
2000 Rate Information for Mail Handlers Benefit Plan
Non Postal rates apply to most non Postal enrollees If you are in a special enrollment category refer to the FEHB Guide for that category or contact the agency that maintains your health benefits enrollment
Postal rates apply to most U S Postal Service employees In 2000 two categories of contribution rates referred to as Category A rates and Category B rates will apply for certain career employees If you are a career employee who is not a
member of a special postal employment class refer to the category definitions in The Guide to Federal Employees Health Benefits Plans for United States Postal Service Employees RI 70 2 to determine which rates applies to you

Postal rates do not apply to non career postal employees postal retirees certain special postal employment classes or associate members of any postal employee organization Such persons not subject to postal rates must refer to the applicable
Guide to Federal Employees Health Benefits Plans

Non Postal Premium Postal Premium A Postal Premium B
Biweekly Monthly Biweekly Biweekly

Type of Code Gov't Your Gov't Your USPS Your USPS Your
Enrollment Share Share Share Share Share Share Share Share

High Option
Self Only 451 78.83 45.43 170.80 98.43 93.06 31.20 93.26 31.00

High Option 452 175.97 86.13 381.27 186.61 207.74 54.36 201.02 61.08
Self and Family

Standard Option
Self Only 454 63.25 21.08 137.04 45.68 74.84 9.49 74.84 9.49

Standard Option 455 137.28 45.76 297.44 99.15 162.45 20.59 162.45 20.59
Self and Family

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