Serving
Most of Washington State and parts of Idaho
Enrollment in this Plan is limited see page 5 for requirements
Enrollment code 8F1 Self Only
8F2 Self and Family
This Plan has full accreditation
from the NCQA See the 2000 Guide
for more information on NCQA
Visit the OPM website at http www opm gov insure
and
our website at http www premera com
Authorized for distribution by the
United States Office of
Personnel Management
and Insurance Service
RI 73 790
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Premera HealthPlus 2000
Table of Contents
Introduction 1
Plain language 1
How to use this brochure 2
Section 1 Health Maintenance Organizations 3
Section 2 How we change for 2000 4
Section 3 How to get benefits 5
Section 4 What to do if we deny your claim or request for service 8
Section 5 Benefits 10
Section 6 General exclusions Things we don't cover 18
Section 7 Limitations Rules that affect your benefits 19
Section 8 FEHB FACTS 21
Inspector General Advisory Stop Healthcare Fraud 25
Summary of benefits Inside Back Cover
Premiums Back Cover
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Premera HealthPlus 2000
Introduction
Premera HealthPlus a PREMERA Health Plan 7001 220 th Street SW Mountlake Terrace WA 98403 2124
This brochure describes the benefits you can receive from Premera HealthPlus under its contract CS2850 with the Office of
Personnel Management OPM as authorized by the Federal Employees Health Benefits FEHB law 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
OPM negotiates benefits and premiums with each plan annually There are no benefit changes effective January 1 2000
Premiums are listed on the back cover at the end of this brochure
Plain Language
The President and Vice President are making the Government's communication 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 Premera HealthPlus as this Plan throughout this brochure even though in other legal documents you will see a plan
referred to as a carrier
These changes do not affect the benefits or services we provide We have rewritten this brochure only to make it more
understandable
We have not re written the Benefits section of this brochure You will find new benefits language next year
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Premera HealthPlus 2000
How To Use This Brochure
This brochure has eight 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 Health Maintenance Organizations HMO This Plan is an HMO Turn to this section for a brief description of HMOs
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 services and how we operate
4 What to do if we deny your claim or request for service 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
6 General exclusions Things we don't cover Look here to see benefits that we will not provide
7 Limitations Rules that affect your benefits This section describes limits that can affect your benefits
8 FEHB FACTS Read this for information about the Federal Employees Health Benefits FEHB Program
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Premera HealthPlus 2000
Section 1 Health Maintenance Organizations
Health maintenance organizations HMOs are health plans that require you to see Plan providers specific physicians hospitals
and other providers that contract with us These providers coordinate your health care services The care you receive includes
preventative care such as routine office visits physical exams well baby care and immunizations as well as treatment for illness
and injury
When you receive services from our providers you will not have to submit claim forms or pay bills However you must pay
copayments and coinsurance listed in this brochure
When you receive emergency services you may have to submit claim forms
You should join an HMO because you prefer the plan's benefits not because a particular provider is available You cannot
change plans because a provider leaves our Plan We cannot guarantee that any one physician hospital or other provider will be
available and or remain under contract with us Our providers follow generally accepted medical practice when prescribing any
course of treatment
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Premera HealthPlus 2000
Section 2 How we change for 2000
Program wide To keep your premium as low as possible OPM has set a minimum copay of 10 for all primary
changes care office visits
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 and your provider leaves the Plan at our request
you may continue to see your specialist for up to 90 days If your provider leaves the Plan and
you are in the second or third trimester of pregnancy you may be able to continue seeing your
OB GYN until the end of your postpartum care You have similar rights if this Plan leaves the
FEHB program See Section 3 How to get benefits for more information
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 over age 50 all FEHB plans will cover a screening sigmoidoscopy every five years
This screening is for colorectal cancer
Changes to this Plan There are no benefit changes
Our name has changed from HealthPlus to Premera HealthPlus
Your share of the non postal premium will increase by 11.8 for Self Only or 4.5 for Self and
Family
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Premera HealthPlus 2000
Section 3 How to get benefits
What is this To enroll with us you must live in our service area This is where our providers practice Our service
Plan's service area includes the following areas In Washington all zip codes in the following counties Adams
area Asotin Benton Clallam Columbia Douglas Franklin Garfield Grant Island King Kitsap Lewis Lincoln Mason Okanogan Pierce San Juan Skamania Snohomish Spokane Thurston Walla Walla
Whitman Yakima and the indicated zip codes in the following counties Chelan 98801 98804 98807
98811 98815 17 98821 22 98826 98828 98831 98836 98847 Cowlitz 98581 98611 98645
98649 Ferry 99129 99140 99166 Grays Harbor 98541 98557 98559 98568 Klickitat 98602
98613 98617 98619 98620 98623 98628 98635 98650 98672 98673 Pacific 98554 98560
Pend Oreille 99119 99139 99156 99880 Skagit 98221 98232 33 98235 98237 38 98255 98257
98263 98273 98284 98292 Stevens 99013 99040 99101 99109 10 99127 99148 99173 99181
In Idaho all zip codes in Kootenai County and the indicated zip codes in the following counties
Bonner 83804 83809 83813 83821 22 838325 83840 41 83848 83852 83856 83860 83864 65
Latah 83535 83823 83832 83834 83843 83855 83857 83871 Nez Perce 838501 83524 83540
41 83551 Shoshone 83839 83850 83868
Ordinarily you must get your care from providers who contract with us If you receive care outside our
service area we will pay only for emergency care Follow up care must be approved by the Plan or be
received from Plan providers
If you or a covered family member move outside of our service area you can enroll in another plan If
your dependents live out of the area for example if your child goes to college in another state you
should consider enrolling in a fee for service plan or an HMO that has agreements with affiliates in
other areas Premera HealthPlus participates in HMO USA a nationwide network of HMOs In many
cases you and your family members can receive care from a participating HMO on the same basis as
from your plan at home Contact us for more information on HMO USA If you or a family member
move you do not have to wait until Open Season to change plans Contact your employing or
retirement office
How much do I You must share the cost of some services This is called either a copayment a set dollar amount or
pay for coinsurance a set percentage of charges Please remember you must pay this amount when you receive
services services
Do I have to You normally won't have to submit claims to us unless you receive emergency services from a provider
submit claims who doesn't contract with us If you file 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
prevented you from filing on time
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Premera HealthPlus 2000
Who provides Premera HealthPlus is a mixed model HMO with an extensive network of participating primary care
my health care physicians specialty care providers and health care facilities Most primary care physicians are part of a group practice of participating providers and have arrangements with health care facilities such as
hospitals and laboratories When you need specialty services your primary care physician will usually
make arrangements with that group of specialists or facilities to provide the care you need
The first and most important decision each member must make is the selection of a primary care
physician The decision is important since it is through this doctor that all other health services
particularly those of specialists are obtained It is the responsibility of your primary care physician to
obtain any necessary authorizations from the Plan before referring you to a specialist or making
arrangements for hospitalization Services of other providers are covered only when you have been
referred by your primary care physician with the following exceptions female members may receive
gynecological maternity reproductive or other health care particular to women and all members may
receive an annual eye exam and chiropractic care
The Plan's provider directory lists primary care physicians family practitioners pediatricians and
internists with their locations and phone numbers and notes whether or not the doctor is accepting new
patients Directories are updated frequently and are available at the time of enrollment or upon request
by calling the Premera HealthPlus Member Services Department at 800 527 6675 you can also find out
if your doctor participates with this Plan by calling this number If you are interested in receiving care
from a specific provider who is listed in the directory call the provider to verify that he or she still
participates with the Plan and is accepting new patients Important note When you enroll in this Plan
services except for emergency benefits are provided through the Plan's delivery system the
continued availability and or participation of any one doctor hospital or other provider cannot
be guaranteed
What do I do if Call us We will help you select a new one
my primary
care physician
leaves the Plan
What do I do if I Talk to your Plan physician If you need to be hospitalized your primary care physician or specialist
need to go into will make the necessary hospital arrangements and supervise your care
the hospital
What do I do if First call our customer service department at 800 527 6675 If you are new to the FEHB Program we
I'm in the will arrange for you to receive care If you are currently in the FEHB Program and are switching to us
hospital when I your former plan will pay for the hospital stay until
join this Plan You are discharged not merely moved to an alternative care center or
The day your benefits from your former plan run out 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
How do I get Your primary care physician will arrange your referral to a specialist
specialty care If you need to see a specialist frequently because of a chronic complex or serious medical condition
your primary care physician will develop a treatment plan that allows you to see your specialist for a
certain number of visits without additional referrals Your primary care physician will use our criteria
when creating your treatment plan
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Premera HealthPlus 2000
What services You can self refer to Plan providers for the following services
don't require a Routine eye exam to prescribe corrective lenses one each calendar year
referral Chiropractic care up to 20 visits each calendar year
Additionally female members may self refer for women's health care services including gynecological
care reproductive health services and obstetrical care All services must be from Plan providers
How do I If you have a medical emergency call 911 or seek care immediately
receive care
after normal For other health care problems arising after normal clinic hours always call your primary care doctor's
office hours office If you reach an answering service tell them you are a Premera HealthPlus member and briefly describe your problem A primary care physician or other on call practitioner is available 24 hours a
day and will return your call with instructions on how to receive care Your primary care physician may
have other ways for you to obtain after hours care Call his or her office and ask
What do I do if Your primary care physician will decide what treatment you need If they decide to refer you to a
I am seeing a specialist ask if you can see your current specialist If your current specialist does not participate with
specialist when I us you must receive treatment from a specialist who does Generally we will not pay for you to see a
enroll specialist who does not participate with our Plan
What do I do if Call your primary care physician who will arrange for you to see another specialist You may receive
my specialist services from your current specialist until we can make arrangements for you to see someone else
leaves the Plan
But what if I Please contact us if you believe your condition is chronic or disabling You may be able to continue
have a serious seeing your provider for up to 90 days after we notify you that we are terminating our contract with the
illness and my provider unless the termination is for cause If you are in the second or third trimester of pregnancy
provider leaves you may continue to see your OB GYN until the end of your postpartum care
the Plan or this You may also be able to continue seeing your provider if your plan drops out of the FEHB Program and
Plan leaves the you enroll in a new FEHB plan Contact the new plan and explain that you have a serious or chronic
Program 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
How do you Your physician must get our approval before sending you to a hospital referring you to a specialist or
authorize recommending follow up care Before giving approval we consider if the service is medically
medical necessary and if it follows generally accepted medical practice
services
How do you The Plan reviews current medical or scientific literature and studies to determine whether medical
decide if a procedures are experimental and or investigational
service is
experimental or
investigational
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Section 4 What to do if we deny your claim or request for service
If we deny services or won't pay your claim 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 Arrange for a health care provider to give you the service 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 You may ask OPM to review the denial after you ask us to reconsider our initial denial or refusal
OPM to review a OPM will determine if we correctly applied the terms of our contract when we denied your claim
denial or request for service
What if I have a Call Premera HealthPlus Member Services at 800 527 6675 and we will expedite your review
serious or lifethreatening
condition
and you haven't
responded to my
request for service
What if you have If we expedite your review due to a serious medical condition and deny your claim we will
denied my request inform OPM so that they can give your claim expedited treatment too Alternatively you can
for care and my call OPM's health benefits Contract Division IV at 202 606 0737 between 8 a m and 5 p m
condition is serious Serious or life threatening conditions are ones that may cause permanent loss of bodily functions
or life threatening or death if they are not treated as soon as possible
Are there other time You must write to OPM and ask them to review our decision within 90 days after we uphold our
limits initial denial or refusal of service 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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What do I send to Your request must be complete or OPM will return it to you You must send the following
OPM 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 the Those who have a legal right to file a disputed claim with OPM are
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 with
the review request
Where should I mail Send your request for review to Office of Personnel Management Office of Insurance
my disputed claim to Programs Contract Division IV P O Box 436 Washington D C 20044
OPM OPM's decision is final There are no other administrative appeals If OPM agrees with our
What if OPM decision your only recourse is to sue
upholds the Plan's
denial If you decide to sue you must file the suit 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 if I Federal law governs your lawsuit benefits and payment of benefits The Federal court will base
file a lawsuit 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 the Chapter 89 of title 5 United States Code allows OPM to use the information it collects from you
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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Section 5 BENEFITS
Medical and Surgical Benefits What is A comprehensive range of preventive diagnostic and treatment services is provided by Plan
covered doctors and other Plan providers This includes all necessary office visits you pay a 10 office visit copay but no additional copay for laboratory tests and X rays Within the service area
house calls will be provided if in the judgment of the Plan doctor such care is necessary and
appropriate you pay a 10 copay for a doctor's house call nothing for home visits by Plan
providers
The following services are included
Preventive care including well baby care and periodic check ups
Mammograms are covered as follows for women age 35 through age 39 one mammogram during these five years for women age 40 through 49 one mammogram every one or two
years for women age 50 through 64 one mammogram every year and for women age 65
and above one mammogram every two years In addition to routine screening
mammograms are covered when prescribed by the doctor as medically necessary to diagnose
or treat your illness
Routine immunizations and boosters
Consultations by specialists
Diagnostic procedures such as laboratory tests and X rays
Complete obstetrical maternity care for all covered females including prenatal delivery and postnatal care by a Plan doctor Office visit copays for maternity care are waived 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
If enrollment in the Plan is terminated during pregnancy benefits will not be provided after
coverage under the Plan has ended Ordinary nursery care of the newborn child during the
covered portion of the mother's hospital confinement for maternity will be covered under
either a Self Only or Self and Family enrollment other care of an infant who requires
definitive treatment will be covered only if the infant is covered under a Self and Family
enrollment
Benefits for professional and other services necessary for follow up care for newborns are
provided for the first 21 days from the date of birth provided the mother is covered by this
contract under a Self Only or Self and Family enrollment Hospitalization for newborn children
for other than routine newborn care will be covered by this contract Other care of an infant who
requires definitive treatment beyond the 21 days will be covered only if the infant is covered
under a Self and Family enrollment
Voluntary sterilization and family planning services
Diagnosis and treatment of diseases of the eye
Allergy testing and treatment including testing and treatment materials such as allergy serum
Office consultations and services from participating naturopathic physicians acupuncturists massage therapists and dieticians
The insertion of internal prosthetic devices such as pacemakers and artificial joints
CARE MUST BE RECEIVED FROM OR ARRANGED BY PLAN DOCTORS
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Cornea heart kidney and liver transplants lung heart lung allogenic donor bone marrow transplants autologous bone marrow transplants autologous stem cell and peripheral stem cell
support for the following conditions acute lymphocytic or non lymphocytic leukemia
advanced Hodgkin's lymphoma advanced non Hodgkin's lymphoma advanced neuroblastoma
breast cancer multiple myeloma epithelial ovarian cancer and testicular mediastinal
retroperitoneal and ovarian germ cell tumors Transplants are covered when approved by the
Medical Director Related medical and hospital expenses of the donor are covered when the
recipient is covered by this Plan
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
Dialysis
Chemotherapy radiation therapy and inhalation therapy
Home health services from participating providers including intravenous fluids and medications when prescribed by your Plan doctor who will periodically review the program
for continuing appropriateness and need
All necessary medical or surgical care in a hospital or extended care facility from Plan doctors and
other Plan providers
Limited Oral and maxillofacial surgery is provided for nondental surgical and hospitalization
benefits procedures for congenital defects such as cleft lip and cleft palate and for medical or surgical procedures occurring within or adjacent to the oral cavity or sinuses including but not limited to
treatment of fractures and excision of tumors and cysts All other procedures involving the teeth
or intra oral areas surrounding the teeth are not covered including any dental care involved in the
treatment of temporomandibular joint TMJ pain dysfunction syndrome
Reconstructive surgery will be provided to correct a condition resulting from a functional
defect or from an injury or surgery that has produced a major effect on the member's appearance
and if the condition can reasonably be expected to be corrected by such surgery
A patient and her attending physician may decide whether to have breast reconstruction surgery
following a mastectomy and whether surgery on the other breast is needed to produce a
symmetrical appearance
Short term rehabilitative therapy physical speech occupational cardiac and massage is
provided on an inpatient or outpatient basis for up to two consecutive months per condition if
significant improvement can be expected within two months you pay 10 per outpatient session
Speech therapy is limited to treatment of certain speech impairments of organic origin
Occupational therapy is limited to services that assist the member to achieve and maintain
self care and improved functioning in other activities of daily living
Diagnosis and treatment of infertility is covered you pay 50 of charges The following
types of artificial insemination are covered intracervical insemination ICI and intrauterine
insemination IUI you pay 50 of charges cost of donor sperm is not covered Fertility drugs
are not covered Other assisted reproductive technology ART procedures such as in vitro
fertilization and embryo transfer are not covered
Surgical treatment of morbid obesity is covered You pay 50 of charges
Chiropractic services are covered for up to 20 visits per calendar year You may self refer to a
participating plan provider for this service You pay a 10 copay per visit
CARE MUST BE RECEIVED FROM OR ARRANGED BY PLAN DOCTORS
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Neurodevelopmental Therapy for children age six and under including speech physical and
occupational therapy required due to a neurodevelopmental disability are covered for up to 60
outpatient visits and 30 inpatient days per calendar year Services must be to improve function
where development is not occurring at a normal rate You pay a 10 copay per outpatient visit
Durable medical equipment orthopedic devices prosthetic devices braces and orthotics are
covered for up to 1000 per Member per calendar year You pay all charges thereafter Breast
prosthesis and surgical bras as well as their replacements are covered with no dollar limitation All
items must be prescribed by your primary care provider and purchased through a Plan participating
supplier Call Premera HealthPlus Member Services at 800 527 6675 for a list of Plan participating
suppliers
Routine hearing examinations are covered for children age 17 and under Adults age 18 and older
may receive a routine hearing exam once every 24 consecutive months You pay a 10 copay
Implantable contraceptive drugs such as Norplant are limited to one device every five years
Coverage includes implantation and removal within a five year period You pay a 100 copay
Smoking cessation programs are covered for up to 250 per Member per calendar year A referral
is not required from your primary care doctor however you must use one of our participating stopsmoking
programs Call Premera Member Services at 800 527 6675 for a list of participating
programs
Community Wellness Programs offered by Plan providers are covered for up to 250 per member
per calendar year You do not need a referral from your primary care doctor Call Premera
HealthPlus Member Services at 800 527 6675 for a list of programs and providers
Up to 10 visits to a Plan biofeedback specialist are covered when referred by your primary care
doctor You pay a 10 copay per visit
What is not Physical examinations that are not necessary for medical reasons such as those required for
covered obtaining or continuing employment or insurance attending school or camp or travel Reversal of voluntary surgically induced sterility
Surgery primarily for cosmetic purposes
Homemaker services
Hearing aids
Transplants not listed as covered
Penile implants
Long term rehabilitative therapy
CARE MUST BE RECEIVED FROM OR ARRANGED BY PLAN DOCTORS
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Hospital Extended Care
What is covered
Hospital care The Plan provides a comprehensive range of benefits with no dollar or day limit when you are hospitalized under the care of a Plan doctor You pay a 100 copay per admission up to a 300
maximum under a Self Only enrollment or a 500 maximum under a Self and Family enrollment
per calendar year All necessary services are covered including
Semiprivate room accommodations when a Plan doctor determines it is medically necessary the doctor may prescribe private accommodations or private duty nursing care
Specialized care units such as intensive care or cardiac care units
Extended Care The Plan provides a comprehensive range of benefits for up to 120 days per calendar year when full time skilled nursing care is necessary and confinement in a skilled nursing facility is
medically appropriate as determined by a Plan doctor and approved by the Plan You pay a 100
copay per admission up to a 300 maximum under a Self Only enrollment or a 500 maximum
under a Self and Family enrollment per calendar year All necessary services are covered
including
Bed board and general nursing care
Drugs biologicals supplies and equipment ordinarily provided or arranged by the skilled nursing facility when prescribed by a Plan doctor
Hospice care Supportive and palliative care for a terminally ill member is covered in the home or a hospice facility Services include inpatient hospice care for up to 10 days outpatient care and family
counseling Respite care services are covered for up to 120 hours every three months These
services are provided under the direction of a Plan doctor who certifies that the patient is in the
terminal stage of illness with a life expectancy of approximately six months or less
Ambulance Benefits are provided for ambulance transportation ordered or authorized by a Plan doctor You
service pay a 25 copay per trip
Limited benefits
Inpatient dental Hospitalization for certain dental procedures is covered when a Plan doctor determines there is a
procedures need for hospitalization for reasons totally unrelated to the dental procedure the Plan will cover the hospitalization but not the cost of the professional dental services Conditions for which
hospitalization would be covered include hemophilia and heart disease the need for anesthesia by
itself is not such a condition
Hospitalization for medical treatment of substance abuse is limited to emergency care diagnosis
Acute inpatient treatment of medical conditions and medical management of withdrawal symptoms acute
detoxification detoxification if the Plan doctor determines that outpatient management is not medically appropriate You pay a 100 copay per admission up to a 300 maximum under a Self Only
enrollment or a 500 maximum under a Self and Family enrollment per calendar year See page 16
for nonmedical substance abuse benefits
What is not Personal comfort items such as telephone and television
covered Custodial care rest cures domiciliary or convalescent care
CARE MUST BE RECEIVED OR ARRANGED BY PLAN DOCTORS
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Emergency Benefits
What is a medical A medical emergency is the sudden and unexpected onset of a condition or an injury that you
emergency believe endangers your life or could result in serious injury or disability and requires immediate medical or surgical care Some problems are emergencies because if not treated promptly they
might become more serious examples include deep cuts and broken bones Others are
emergencies because they are potentially life threatening such as heart attacks strokes
poisonings gunshot wounds or sudden
inability to breathe There are many other acute conditions that the Plan may determine are
medical emergencies what they all have in common is the need for quick action
Emergencies within If you are in an emergency situation please call your primary care doctor In extreme
the service area emergencies if you are unable to contact your doctor contact the local emergency system e g the 911 telephone system or go to the nearest hospital emergency room Be sure to tell the
emergency room personnel that you are a Plan member so they can notify the Plan You or a
family member must notify the Plan within 48 hours unless it was not reasonably possible to do so
It is your responsibility to ensure that the Plan has been timely notified
If you need to be hospitalized in a non Plan facility the Plan must be notified within 48 hours or
on the first working day following your admission unless it was not reasonably possible to notify
the Plan within that time If you are hospitalized in non Plan facilities and your primary care
doctor believes care can be better provided in a Plan hospital you will be transferred when
medically feasible with any ambulance charges covered in full
Benefits are available for care from non Plan providers in a medical emergency only if delay in
reaching a Plan provider would result in death disability or significant jeopardy to your condition
To be covered by this Plan any follow up care recommended by non Plan providers must be
approved by the Plan or provided by Plan providers
Plan pays Reasonable charges for emergency services to the extent the services would have been covered if received from Plan providers
You pay 50 per hospital emergency room visit or a 10 copay per urgent care center visit for emergency services that are covered benefits of this Plan If the emergency results in admission to a hospital
from an emergency room the copay is waived
Emergencies outside Benefits are available for any medically necessary health service that is immediately required
the service area because of injury or unforeseen illness
If you need to be hospitalized the Plan must be notified within 48 hours or on the first working
day following your admission unless it was not reasonably possible to notify the Plan within that
time If your primary care doctor and the Plan believe care can be better provided in a Plan
hospital you will be transferred when medically feasible with any ambulance charges covered in
full
To be covered by this Plan any follow up care recommended by non Plan providers must be
approved by the Plan or provided by Plan providers
CARE MUST BE RECEIVED OR ARRANGED BY PLAN DOCTORS
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Premera HealthPlus 2000
Plan pays Reasonable charges for emergency services to the extent the services would have been covered if received from Plan providers
You pay 50 per hospital emergency room visit or a 10 copay per urgent care center visit for emergency services that are covered benefits of this Plan If the emergency results in admission to a hospital
from an emergency room the copay is waived
What is covered Emergency care at a doctor's office or an urgent care center Emergency care as an outpatient or inpatient at a hospital including doctors services
Ambulance service approved by the Plan
What is not covered Elective care or nonemergency care Emergency care provided outside the service area if the need for care could have been
foreseen before leaving the service area
Filing claims for nonPlan With your authorization the Plan will pay benefits directly to the providers of your emergency
providers care upon receipt of their claims Physician claims should be submitted on the HCFA 1500 claim form If you are required to pay for the services submit itemized bills and your receipts to the Plan
along with an explanation of the services and the identification information from your ID card
Payment will be sent to you or the provider if you did not pay the bill unless the claim is denied
If it is denied you will receive notice of the decision including the reasons for the denial and the
provisions of the contract on which denial was based If you disagree with the Plan's decision you
may request reconsideration in accordance with the disputed claims procedure described on page
8
Mental Conditions Substance Abuse Benefits
Mental
conditions What is covered To the extent shown below the Plan provides the following services necessary for the diagnosis
and treatment of acute psychiatric conditions including the treatment of mental illness or
disorders
Diagnostic evaluation
Psychological testing
Psychiatric treatment including individual and group therapy
Hospitalization including inpatient professional services
Outpatient Up to 20 outpatient visits to Plan doctors or other psychiatric personnel each calendar year you
care pay a 25 copay for each covered visit all charges thereafter
Inpatient care Up to 30 days of hospitalization each calendar year you pay a 50 copay per day for the first 30 days all charges thereafter
What is not Care for psychiatric conditions that in the professional judgment of Plan doctors are not
covered subject to significant improvement through relatively short term treatment Psychiatric evaluation or therapy on court order or as a condition of parole or probation
unless determined by a Plan doctor to be necessary and appropriate
Psychological testing that is not medically necessary to determine the appropriate treatment of a short term psychiatric condition
CARE MUST BE RECEIVED OR ARRANGED BY PLAN DOCTORS
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Substance abuse What is covered This Plan provides medical and hospital services such as acute detoxification services for the
medical non psychiatric aspects of substance abuse including alcoholism and drug addiction the
same as for any other illness or condition and to the extent shown below the services necessary
for diagnosis and treatment
All substance abuse services must be coordinated by the Plan Chemical Dependency Coordinator
The coordinator will assess your condition and arrange your care You may reach the Chemical
Dependency Coordinator by calling 800 333 1687 24 hours a day
Inpatient and outpatient substance abuse benefits have a combined limit 5000 per member every
24 consecutive months There is a lifetime benefit maximum of 10,000 per member
Outpatient Unlimited outpatient visits to Plan providers for treatment you pay nothing for each covered visit
care during the benefit period all charges thereafter
Inpatient care Unlimited days in a substance abuse rehabilitation intermediate care program in an alcohol or drug rehabilitation center approved by the Plan Chemical Dependency Coordinator you pay a
100 copay up to a 300 maximum under a Self Only enrollment or a 500 maximum under a
Self and Family enrollment per admission during the benefit period all charges thereafter
What is not Treatment that is not authorized by the Chemical Dependency Coordinator
covered
Prescription Drug Benefits
What is covered Prescription drugs prescribed by a Plan or referral doctor and obtained at a Plan retail pharmacy will be dispensed for up to a 34 day supply You pay a 5 copay for generic drugs or a 10 copay
for name brand drugs per prescription unit or refill When generic substitution is permissible i e
a generic drug is available and the prescribing doctor does not require the use of a name brand
drug but you request the name brand you pay the price difference between the generic and name
brand drug as well as the 10 copay per prescription unit or refill
Members may receive up to a 100 day supply of covered drugs through the Plan's participating
mail order pharmacy You pay a 5 copay for generic drugs or a 10 copay for name brand drugs
per prescription unit or refill Simply submit your prescription and order form along with the
required copayment to the participating mail order pharmacy Contact Premera HealthPlus
Member Services at 800 527 6675 for a supply of mail order forms
Drugs are prescribed by Plan doctors and dispensed in accordance with the Plan's drug formulary
Nonformulary drugs will be covered when prescribed by a Plan doctor
Covered medications and accessories include
Drugs for which a prescription is required by Federal law
Oral contraceptive drugs contraceptive diaphragms
Insulin
Disposable needles and syringes needed to inject covered prescribed medication
Diabetic supplies including insulin syringes needles glucose test tablets and test tape Benedict's solution or equivalent and acetone test tablets Insulin syringes and needles are
covered under a single copay if dispensed at the same time Diabetic testing supplies require
a separate copay for each type of supply dispensed
CARE MUST BE RECEIVED OR ARRANGED BY PLAN DOCTORS
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Premera HealthPlus 2000
Intravenous fluids and medication for home use implantable drugs such as Norplant and some
injectable drugs such as Depo Provera are covered under Medical and Surgical Benefits
Limited benefits Drugs to treat sexual dysfunction are limited Contact the Plan for dose limits You pay a 10 copay for up to the dosage limit and all charges above that
Smoking cessation drugs and medication including nicotine patches that require a prescription are covered up to a maximum Plan payment of 250 per member per calendar
year You pay the appropriate copay per prescription
What is not Drugs available without a prescription or for which there is a nonprescription equivalent available
covered Drugs obtained at a non Plan pharmacy except for out of area emergencies Vitamins and nutritional substances that can be purchased without a prescription except for
prenatal vitamins that require a prescription
Medical supplies such as dressings and antiseptics
Drugs for cosmetic purposes
Drugs to enhance athletic performance
Drugs to encourage weight reduction
Fertility drugs
Other Benefits
Dental care What is covered Accidental injury benefit
Restorative services and supplies necessary to promptly repair but not replace sound natural
teeth The need for these services must result from an accidental injury All repair must be started
within 12 months of the date of the accidental injury You pay nothing
What is not Other dental services not shown as covered
covered
Vision care
What is covered In addition to the medical and surgical benefits provided for the diagnosis and treatment of diseases of the eye annual eye refractions to provide a written lens prescription may be obtained
from Plan providers You pay a 10 copay per visit You may self refer to a participating Plan
provider for this service Please call Premera HealthPlus Member Services at 800 527 6675 if
you would like a list of Plan participating providers
What is not Corrective lenses or frames
covered Eye exercises
CARE MUST BE RECEIVED OR ARRANGED BY PLAN DOCTORS
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Premera HealthPlus 2000
Section 6 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 your Plan doctor determines it is medically necessary to prevent diagnose or treat your illness or condition
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
Care by non Plan providers except for authorized referrals or emergencies see Emergency Benefits or eligible self referred services
Experimental or investigational procedures treatments drugs or devices
Procedures 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
Procedures services drugs and supplies related to sex transformations
Services or supplies you receive from a provider or facility barred from the FEHB Program and
Expenses you incurred while you were not enrolled in this Plan
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Premera HealthPlus 2000
Section 7 Limitations Rules that affect your benefits
Medicare Tell us if you or a family member is enrolled in Medicare Part A or B Medicare 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 request it from SSA at 1 800 638 6833
Other group When anyone has coverage with us and with another group health plan it is called double coverage
insurance You must tell us if you or a family member has double coverage You must also send us documents
coverage about other insurance if we ask for them
When you have double coverage one plan is the primary payer it pays benefits first The other plan is
secondary it pays benefits next We decide which insurance is primary according to the National
Association of Insurance Commissioners Guidelines
If we pay second we will determine what the reasonable charge for the benefit should be After the
first plan pays we will pay either what is left of the reasonable charge or our regular benefit whichever
is less We will not pay more than the reasonable charge If we are the secondary payer we may be
entitled to receive payment from your primary plan
We will always provide you with the benefits described in this brochure Remember even if you do
not file a claim with your other plan you must still tell us that you have double coverage
Circumstances Under certain extraordinary circumstances we may have to delay your services or be unable to provide
beyond our them In that case we will make all reasonable efforts to provide you with necessary care
control
When others When you receive money to compensate you for medical or hospital care for injuries or illness that
are responsible another person caused you must reimburse us for whatever services we paid for We will cover the
for injuries cost of treatment that exceeds the amount you received in the settlement If you do not seek damages you must agree to let us try This is called subrogation If you need more information contact us for
our subrogation procedures
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Premera HealthPlus 2000
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 We do not cover services that
compensation 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 We do not cover services and supplies that a local State or Federal Government agency directly or
Government indirectly pays for
Agencies
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Premera HealthPlus 2000
Section 8 FEHB FACTS
You have a right to OPM requires that all FEHB plans comply with the Patients Bill of Rights which gives you the
information about right to information about your health plan its networks providers and facilities You can also
your HMO 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 www opm gov lists the specific types of information that we must make
available to you
If you want specific information about us call 800 527 6675 or write to us at Premera
HealthPlus PO Box 2113 Seattle WA 98111 2113 You may also contact us by fax at 425
670 5922 or visit our website at www premera 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
enrolling in the make 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 The benefits in this brochure are effective on January 1 If you are new to this plan your
benefits and coverage and premiums begin on the first day of your first pay period that starts on or after
premiums effective January 1 Annuitants premiums begin January 1
What happens when When you retire you can usually stay in the FEHB Program Generally you must have been
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
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Premera HealthPlus 2000
What types of Self Only coverage is for you alone Self and Family coverage is for you your spouse and your
coverage are unmarried dependent children under age 22 including any foster or step children your employing
available for my or retirement office authorizes coverage for Under certain circumstances you may also get
family and me coverage for a disabled child 22 years of age or older who is incapable of self support
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 another FEHB plan
Are my medical and We will keep your medical and claims information confidential Only the following will have
claims records access to it
confidential OPM this plan and 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 benefit payments 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 or
OPM when reviewing a disputed claims or defending litigation about a claim
Information for new members
Identification We will send you an Identification ID card Use your copy of the Health Benefits Election
cards 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 Your old plan's deductible continues until our coverage begins
deductible under
my old plan
Pre existing We will not refuse to cover the treatment of a condition that you or a family member had before
conditions you enrolled in this Plan solely because you had the condition before you enrolled
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Premera HealthPlus 2000
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
Plan ends Your enrollment ends unless you cancel your enrollment or 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 If you are divorced from a Federal employee or annuitant you may not continue to get benefits
spouse coverage under your former 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 ex spouse'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
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 32 nd 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
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Premera HealthPlus 2000
How do I enroll in Former spouses You or your former spouse must notify your employing or retirement office
TCC within 60 days of one of these qualifying events
continued 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
them 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 health insurance or other health care coverage You must arrange for the other coverage within
Coverage 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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Premera HealthPlus 2000
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 800 527 6675 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 D C 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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Summary of Benefits for Premera HealthPlus 2000
Do not rely on this chart alone All benefits are provided in full unless otherwise indicated subject to the 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 SERVICES COVERED UNDER THIS PLAN WITH THE EXCEPTION OF
EMERGENCY CARE OR AS SPECIFICALLY STATED IN THIS BROCHURE ARE COVERED ONLY WHEN
PROVIDED OR ARRANGED BY PLAN DOCTORS
Benefits Plan pays provides Page Comprehensive range of medical and surgical services without dollar or day
Inpatient Care Hospital limit Includes in hospital doctor care room and board general nursing care private room and private nursing care if medically necessary diagnostic tests
drugs and medical supplies use of operating room intensive care and complete
maternity care You pay a 100 copay per admission up to a 300 maximum
under a Self Only enrollment or a 500 maximum under a Self and Family
enrollment per calendar year 13
Extended All necessary services for up to 120 days per calendar year You pay a 100
Care copay per admission 13
Mental Diagnosis and treatment of acute psychiatric conditions for up to 30 days of
conditions inpatient care per year You pay a 50 copay per day 15
Substance Unlimited days for up to 5000 per 24 consecutive months for services in a
abuse substance abuse treatment program You pay a 100 copay per admission 16
Outpatient care Comprehensive range of services such as diagnosis and treatment of illness or injury including specialist's care preventive care including well baby care
periodic check ups and routine immunizations laboratory tests and X rays
complete maternity care You pay a 10 copay per office visit or house call by a
doctor office visit copays are waived for maternity care 10
Home health All necessary visits by Plan providers You pay nothing 11
care
Mental Up to 20 outpatient visits per year You pay a 25 copay per visit 15
conditions
Substance Unlimited visits for up to 5000 per 24 consecutive months You pay
abuse nothing 16
Emergency care Reasonable charges for services and supplies required because of a medical emergency You pay a 50 copay to the hospital for each emergency room visit
and any charges for services that are not covered by this Plan 14
Prescription Drugs prescribed by a Plan doctor and obtained at a Plan pharmacy You pay a
drugs 5 copay for generic drugs or a 10 copay for name brand drugs per prescription unit or refill Mail order drugs are available for up to a 100 day
supply you pay a 5 copay for generic drugs or a 10 copay for name brand
drugs 16
Dental care Accidental injury benefit you pay nothing 17
Vision care One refraction annually You pay a 10 copay per visit 17
Out of pocket Your out of pocket expenses for benefits under this Plan are limited to the stated
maximum copayments required for a few benefits 13
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2000 Rate Information for
Premera HealthPlus 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 career 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 postal employee but not a member
of a special postal employment class refer to the category definition in The Guide to federal employees Health benefits Plans for
United States Postal Service Employees RI 70 2 to determine which rate 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 Postal Postal
Premium Premium A 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
Self Only 8F1 74.75 24.92 161.96 53.99 88.46 11.21 88.46 11.21
Self and 8F2 175.97 64.89 381.27 140.59 207.74 33.12 201.02 39.84
Family
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