This brochure describes the benefits of the Association Benefit Plan under the Government Employees Health Associa-tion's
contract (CS 1065) with the Office of Personnel Management (OPM), as authorized by the Federal Employees
Health Benefits law. The Plan is underwritten by Mutual of Omaha Insurance Company. This brochure is the official
statement of benefits. No oral statement can modify or otherwise affect the benefits, limitations, and exclusions of this
brochure.

If you are enrolled in this Plan, you are 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. You do not have a right to benefits that
were available before January 1, 2001, unless those benefits are also shown in this brochure.

OPM negotiates benefits and rates with each plan annually. Benefit changes are effective January 1, 2001, and are sum-marized
on page 72. Rates are shown at the end of this brochure.

Plain Language
The President and Vice President are making the Government's communication more responsive, accessible, and under-standable
to the public by requiring agencies to use plain language. In response, a team of health plan representatives
and OPM staff worked cooperatively to make this brochure clearer. Except for necessary technical terms, we use com-mon
words. "You" means the enrollee or family member; "we" means the Association Benefit Plan.

The plain language team reorganized the brochure and the way we describe our benefits. When you compare this Plan
with other FEHB plans, you will find that the brochures have the same format and similar information to make compari-sons
easier.

If you have comments or suggestions about how to improve this brochure, let us know. Visit OPM's "Rate Us" feedback
area at www. opm. gov/ insure or e-mail us at fehbwebcomments@ opm. gov or write to OPM at Insurance Planning and
Evaluation Division, PO Box 436, Washington, DC 20044-0436.

Introduction/ Plain Language 5
5 Page 6 7
2001 Association Benefit Plan 4 Section 1
Section 1. Facts about this fee-for-service plan
This Plan is a fee-for-service (FFS) plan. You can choose your own physicians, hospitals, and other health care provid-ers.

We reimburse you or your provider for your covered services, usually based on a percentage of the amount we allow.
The type and extent of covered services, and the amount we allow, may be different from other plans. Read brochures
carefully.

We also have Preferred Provider Organizations (PPO):
Our fee-for-service plan offers services through a PPO. When you reside in the PPO network area and use our PPO pro-viders,
you will receive covered services at reduced cost. If you reside in Washington, DC, or in one of the states listed
below, contact us at 1-800-634-0069 for information concerning your PPO. You can also go to the Mutual of Omaha
website, www. mutualofomaha. com, for PPO information. Do not call OPM for our provider directory. Also, when you
phone for an appointment, please verify that your physician is still a PPO provider.

PPO benefits apply only when you reside in the PPO network area and use a PPO provider. You must present your
PPO identification (ID) card confirming your PPO participation to be eligible for PPO benefits. Provider networks
may be more extensive in some areas than others. We cannot guarantee the availability of every specialty in all areas. If
no PPO provider is available, or you do not use a PPO provider, the standard non-PPO benefits apply. When you use a
PPO hospital, keep in mind that the professionals who provide services to you in the hospital, such as radiologists, emer-gency
room physicians, anesthesiologists, and pathologists, may not all be preferred providers. If they are not, they will
be paid as non-PPO providers.

The PPO Network Area consists of Washington, D. C. and selected counties and cities in the following states:
Alaska California Delaware
Florida Idaho Maryland
Pennsylvania Virginia Washington
If you reside in the PPO network area and no PPO provider is available, or if you do not use a PPO provider, non-PPO
benefits apply.

How we pay providers
Our participating providers are generally reimbursed according to an agreed-upon fee schedule and are not offered addi-tional
financial incentives based on care provided or not provided to you. Our standard provider agreements do not con-tain
any contractual provisions that include incentives to restrict a providers ability to communicate with and advise
patients of any appropriate treatment options. In addition, the Plan has no compensation, ownership, or other influential
interests that are likely to affect provider advice or treatment decisions.

Patients' Bill of Rights
OPM requires that all FEHB Plans comply with the Patients' Bill of Rights, recommended by the President's Advisory
Commission on Consumer Protection and Quality in the Health Care Industry. You may get information about us, our
networks, providers, and facilities. If you want more information about us, call 1-800-634-0069, or write to Association
Benefit Plan, PO Box 668587, Charlotte, NC 28266-8587. 6
6 Page 7 8
2001 Association Benefit Plan 5 Section 2
Section 2. How we change for 2001
Program-wide changes
° The plain language team reorganized the brochure and the way we describe our benefits. We hope this will make it
easier for you to compare plans.

° This year, the Federal Employees Health Benefits Program is implementing network mental health and substance
abuse parity. This means that your coverage for mental health, substance abuse, medical, surgical, and hospital ser-vices
from providers in our PPO network will be the same with regard to deductibles, coinsurance, copays, and day
and visit limitations when you follow a treatment plan that we approve. Previously, we placed shorter day or visit lim-itations
on mental health and substance abuse services than we did on services to treat physical illness, injury, or dis-ease.

° Many healthcare organizations have turned their attention this year to improving healthcare quality and patient safety.
OPM asked all FEHB plans to join them in this effort. You can find specific information on our patient safety activi-ties
by calling 1-800-634-0069. You can find out more about patient safety on the OPM website, www. opm. gov/
insure. To improve your health care, take these five steps:

° Speak up if you have questions or concerns.
° Keep a list of all the medicines you take.
° make sure you get the results of any tests or procedures.
° Talk with your doctor and health care team about your options if you need hospital care.
° Make sure you understand what will happen if you need surgery.
° We clarified the language to show that anyone who needs a mastectomy may choose to have the procedure performed
on an inpatient basis and remain in the hospital up to 48 hours after the procedure. Previously, the language refer-enced
only women.

° North Dakota is deleted from the list of states designated as medically underserved in 2001. See page 7 for informa-tion
on medically underserved areas.

Changes to this Plan
° You no longer have to meet your $250 calendar year PPO deductible for adult preventative care (routine physicals,
cancer screenings, etc.). When you reside in the PPO network area and use a PPO provider, you will simply pay your
copayment or coinsurance when receiving these services.

° We have added a three-tier formulary prescription drug plan. This means that you will have three levels of copay-ments
depending on which prescription drug you are prescribed or choose to receive. Tier one includes all generic
drugs. Tier two includes all brand name drugs that are on the Plan's formulary. Tier three includes all other brand
name drugs.

° Selected counties and cities in the states of Pennsylvania and Delaware have been added to our optional hospital and
physician Preferred Provider Organization (PPO) network area.

° Your share of the premium will increase by 9. 4% for Self Only or 6. 7% for Self and Family. 7
7 Page 8 9
2001 Association Benefit Plan 6 Section 3
Section 3. How you get care
Identification cards We will send you an identification (ID) card and a Prescription Drug Card when you enroll. You should carry both cards with you at all times. You
must show your ID card whenever you receive services from a medical or
dental provider, or your Prescription Drug Card to fill a prescription at a
participating Plan pharmacy. Until you receive your ID card, use your copy
of the Health Benefits Election Form, SF-2809, or your health benefits
enrollment confirmation (for annuitants).

If you do not receive your cards within 30 days after the effective date of
your enrollment, or if you need replacement cards, call us at 1-800-634-
0069.

Where you get covered care You can get care from any "covered provider" or "covered facility." How much we pay – and you pay – depends on the type of covered provider or
facility you use. If you reside in the PPO network area and use our pre-ferred
providers, you will pay less.

° Covered providers We consider the following to be covered providers when they perform ser-vices within the scope of their license or certification:

°° Physician: Doctors of medicine or psychiatry (M. D.), osteopathy
(D. O.), dental surgery (D. D. S.), medical dentistry (D. M. D.), podiatric
medicine (D. P. M.), and optometry (O. D.) when acting within the scope
of their licenses or certification.

°° Qualified Clinical Psychologist: An individual who has earned either a
Doctoral or Masters Clinical Degree in psychology or an allied disci-pline
and who is licensed or certified in the state where services are per-formed.
This presumes a licensed individual has demonstrated to the
satisfaction of state licensing officials that he/ she, by virtue of academic
and clinical experience, is qualified to provide psychological services in
that state.

°° Nurse Midwife: A person who is certified by the American College of
Nurse Midwives or is licensed or certified as a nurse midwife in states
requiring licensure or certification.

°° Nurse Practitioner/ Clinical Specialist: A person who 1) has an active
R. N. license in the United States, 2) has a baccalaureate or higher degree
in nursing, and 3) is licensed or certified as a nurse practitioner or clini-cal
nurse specialist in states requiring licensure or certification.

°° Clinical Social Worker: A social worker who 1) has a Master's or Doc-toral
degree in social work, 2) has at least two years of clinical social
work practice, and 3) in states requiring licensure, certification or regis-tration,
is licensed, certified, or registered as a social worker where the
services are rendered.

°° Physician Assistant: A person who is licensed, registered, or certified
in the state where services are performed.

°° Licensed Professional Counselor or Master's Level Counselor: A
person who is licensed, registered, or certified in the state where ser-vices
are performed 8
8 Page 9 10
2001 Association Benefit Plan 7 Section 3
°° Nursing School Administered Clinic: A clinic that is
1) licensed or certified in the state where the services are performed,
and

2) provides ambulatory care in an outpatient setting— primarily in
rural or inner city areas where there is a shortage of physicians.
Services billed for by these clinics are considered outpatient
'office' services rather than facility charges

°° Christian Science Practitioner: If you choose to visit a Christian Sci-ence
practitioner instead of a physician, the charges are still considered
allowable expenses. To qualify for benefits, you must make this choice
annually. The benefits will then apply to all subsequent expenses
incurred during the year. You can change your mind only at the time of
your first claim each year. The practitioner you choose must be listed as
such in the Christian Science Journal that is current at the time the ser-vice
is provided. Your choice will not apply to, or prevent payment of, a
physician's maternity charges.

Medically underserved areas. In medically underserved areas, we cover
any licensed medical practitioner for any covered service performed within
the scope of that license in states OPM determines are "medically under-served."
For 2001, the states are: Alabama, Idaho, Kentucky, Louisiana,
Mississippi, Missouri, New Mexico, South Carolina, South Dakota, Utah,
and Wyoming.

° Covered facilities Covered facilities include:
°° Hospital

1) An institution that is accredited as a hospital under the hospital
accreditation program of the Joint Commission on Accreditation
of Healthcare Organizations (JCAHO); or

2) Any other institution that is operated pursuant to law, under the
supervision of a staff of doctors and with 24-hours-a-day nursing
service, and that is primarily engaged in providing:

a) General patient 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 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 (as
defined above) or with a specialized provider of those
facilities.

In no event shall the term hospital include a convalescent nursing home or
institution or part thereof that:

1) is used principally as a convalescent facility, rest facility, nursing
facility or facility for the aged;

2) furnishes primarily domiciliary or custodial care including
training in the routines of daily living; or

3) is operated as a school. 9
9 Page 10 11
2001 Association Benefit Plan 8 Section 3
For inpatient and outpatient treatment of alcohol and drug abuse, the term
hospital also includes a free-standing alcohol and drug abuse treatment
facility approved by the JCAHO.

°° Skilled nursing facility: An institution, or that part of an institution that
provides convalescent skilled nursing care 24 hours a day and is
classified as a skilled nursing facility under Medicare.

°° Birthing Center: A licensed facility that is equipped and operated
solely to provide prenatal care, to perform uncomplicated spontaneous
deliveries and to provide immediate post-partum care.

°° Hospice: A facility that meets all of the following:
1) primarily provides inpatient hospice care to terminally ill persons;
2) is certified by Medicare as such, or is licensed or accredited as
such by the jurisdiction it is in;

3) is supervised by a staff of M. D. s or D. O. s, at least one of whom
must be on call at all times; and

4) provides 24-hour-a-day nursing services under the direction of an
R. N. and has a full-time administrator; and

5) provides an ongoing quality assurance program.

What you must do to
get covered care
It depends on the kind of care you want to receive. You can go to any
physician you want, but we must approve some care in advance.

Transitional care: Specialty care: If you have a chronic or disabling condition and lose access to your specialist because we:

° terminate our contract with your specialist for other than cause; or
° drop out of the Federal Employees Health Benefits (FEHB) Program
and you enroll in another FEHB Plan,

you may be able to continue seeing your specialist for up to 90 days after
you receive notice of the change. Contact us or, if we drop out of the
Program, contact your new plan.

If you are in the second or third trimester of pregnancy and you lose access
to your specialist based on the above circumstances, you can continue to
see your specialist until the end of your postpartum care, even if it is
beyond the 90 days.

Hospital care. We pay for covered services from the effective date of your
enrollment. However, if you are in the hospital when your enrollment in
our Plan begins, call our customer service department immediately at
1-800-634-0069.

If you changed from another FEHB plan to us, your former plan will pay
for the hospital stay until:

° You are discharged, not merely moved to an alternative care center; or

° The day your benefits from your former plan run out; or
° The 92 nd day after you become a member of this Plan, whichever
happens first. 10
10 Page 11 12
2001 Association Benefit Plan 9 Section 3
These provisions apply only to the benefits of the hospitalized person.
How to Get Approval for…
° Your hospital stay ° Precertification is the process by which— prior to your inpatient hospi-tal admission— we evaluate the medical necessity of your proposed stay

and the number of days required to treat your condition. Unless we are
misled by the information given to us, we won't change our decision on
medical necessity.

° In most cases, you physician or hospital will take care of precertifica-tion.
Because you are still responsible for ensuring that we are asked to
precertify your care, you should always ask your physician or hospital
whether they have contacted us.

Warning: We will reduce our benefits for the inpatient hospital stay by $500 if no one contacts us for precertification. If the stay is not medically necessary, we
may not pay any benefits.
How to precertify an
admission: ° You, your representative, your physician, or your hospital must call us at

1-800-634-0069 before admission.

° If you have an emergency admission due to a condition that you
reasonably believe puts your life in danger or could cause serious
damage to bodily function, you, your representative, the physician, or
the hospital must telephone us within two business days following the
day of the emergency admission, even if you have been discharged from
the hospital.

° 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 and phone number of admitting physician;
°° Name of hospital or facility; and
°° Number of planned days of confinement.
°° We will then tell the physician and/ or hospital the number of approved
inpatient days and we will send written confirmation of our decision to
you, your physician, and the hospital.

Maternity care You do not need to precertify a maternity admission for a routine delivery.
However, if your medical condition requires you to stay more than 48
hours after a vaginal delivery or 96 hours after a cesarean section, then
your physician or the hospital must contact us for precertification of
additional days. Further, if your baby stays after you are discharged, then
your physician or the hospital must contact us for precertification of
additional days for your baby. 11
11 Page 12 13
2001 Association Benefit Plan 10 Section 3
If your hospital stay needs to
be extended:
If your hospital stay— including for maternity care— needs to be extended,
your physician or the hospital must ask us to approve the additional days.

What happens when you
do not follow the
precertification rules

° When we precertified the admission but you remained in the hospital
beyond the number of days we approved and did not get the additional
days precertified, then:

°° for the part of the admission that was medically necessary, we will
pay inpatient benefits, but

°° for the part of the admission that was not medically necessary, we
will pay only medical services and supplies otherwise payable on an
outpatient basis and will not pay inpatient benefits.

° If no one contacted us, we will decide whether the hospital stay was
medically necessary.

°° If we determine that the stay was medically necessary, we will pay
the inpatient charges, less the $500 penalty.

°° If we determine that it was not medically necessary for you to be an
inpatient, we will not pay inpatient hospital benefits. We will only
pay for any covered medical supplies and services that are otherwise
payable on an outpatient basis.

° If no one contacted us for specified services such as Hospice Care,
Skilled Nursing Facility Care, Home Health Care, we will disqualify
higher paid benefits.

°° If we denied the precertification request, we will not pay inpatient
hospital benefits. We will only pay for any covered medical supplies
and services that are otherwise payable on an outpatient basis.

Exceptions: You do not need precertification in these cases:
° You are admitted to a hospital outside the United States.

° You have another group health insurance policy that is the primary
payer for the hospital stay.

° Your Medicare Part A is the primary payer for the hospital stay. Note: If
you exhaust your Medicare hospital benefits and do not want to use your
Medicare lifetime reserve days, then we will become the primary payer
and you do need precertification.

° Other services Some other services require precertification, or prior authorization, such as:

° Home health care
° Hospice care
° Organ/ tissue transplants
° Skilled nursing facilities
° Psychiatric and substance abuse treatment 12
12 Page 13 14
2001 Association Benefit Plan 11 Section 3
° Growth hormone therapy
° Durable medical equipment rental in excess of 30 days
° Surgery for morbid obesity 13
13 Page 14 15
2001 Association Benefit Plan 12 Section 4
Section 4. Your costs for covered services
This is what you will pay out-of-pocket for your covered care:
° Copayments A copayment is a fixed amount of money you pay to the provider when you receive services.

Example: When you see your PPO physician you pay a copayment of $10
per visit.

° Deductible A deductible is a fixed amount of covered expenses you must incur for cer-tain covered services and supplies before we start paying benefits for them.

Copayments do not count toward any deductible.
°° The calendar year deductible is $250 per person. Under a family enroll-ment,
the deductible is satisfied for all family members when the com-bined
covered expenses applied to the calendar year deductible for
family members reach $500.

Note: If you change plans during open season, you do not have to start a
new deductible under your old plan between January 1 and the effective
date of your new plan. If you change plans at another time during the year,
you must begin a new deductible under your new plan.

And, if you change your enrollment option in this Plan during the year, we
will credit the amount of covered expenses already applied toward the
deductible of your old option to the deductible of your new option.

° Coinsurance Coinsurance is the percentage of our allowance that you must pay for your care. Coinsurance doesn't begin until you meet your deductible.

Example: You pay 10% of our allowance for an X-ray.
Note: If your provider routinely waives (does not require you to pay) your
copayments, deductibles, or coinsurance, the provider is misstating the fee
and may be violating the law. In this case, when we calculate our share, we
will reduce the provider's fee by the amount waived.

For example, if your physician ordinarily charges $100 for a service but
routinely waives your 10% coinsurance, the actual charge is $90. We will
pay $81 (90% of the actual charge of $90).

° Differences between our
allowance and the bill
Our "Plan allowance" is the amount we use to calculate our payment for covered services. Fee-for-service plans arrive at their allowances in

different ways, so their allowances vary. For more information about how
we determine our Plan allowance, see the definition of Plan allowance in
Section 10.

Often, the provider's bill is more than a fee-for-service plan's allowance.
Whether or not you have to pay the difference between our allowance and
the bill will depend on the provider you use.

° PPO providers agree to limit what they will bill you. Because of that,
when you use a preferred provider, your share of covered charges
consists only of your deductible and coinsurance. Here is an example:
You see a PPO physician who charges $150, but our allowance is $100.
If you have met your deductible, you are only responsible for your
coinsurance. That is, you pay just— 10% of our $100 allowance ($ 10).
Because of the agreement, your PPO physician will not bill you for the
$50 difference between our allowance and his bill. 14
14 Page 15 16
2001 Association Benefit Plan 13 Section 4
° Non-PPO providers, on the other hand, have no agreement to limit
what they will bill you. For instance,

°° When reside in the PPO network area and use a non-PPO
provider, you will pay your deductible and coinsurance— plus any
difference between our allowance and charges on the bill. Here is an
example: You see a non-PPO physician who charges $150 and our
allowance is again $100. Because you've met your deductible, you
are responsible for your coinsurance, so you pay 25% of our $100
allowance ($ 25). Plus, because there is no agreement between the
non-PPO physician and us, he can bill you for the $50 difference
between our allowance and his bill.

°° When you reside outside the PPO network area, you will pay your
deductible and coinsurance – plus any difference between our
allowance and charges on the bill. As in the exampleabove, once you
have met your deductible, you are responsible for your coinsurance.
You will pay 15% of our allowance ($ 15) and the physician can bill
you for the $50 difference between our allowance and his bill.

The following table illustrates the examples of how much you have to pay
out-of-pocket for services from a PPO physician vs. a non-PPO physician
when you reside in the PPO network area. The table uses our example of a
service for which the physician charges $150 and our allowance is $100.
The table shows the amount you pay if you have met your calendar year
deductible.

Your out-of-pocket maximum
for deductibles, coinsurance,
and copayments

If your out-of-pocket coinsurance expenses exceed your catastrophic limit
in a calendar year, we will pay 100% of the Plan allowance for the
remainder of the year. The calendar year limits are:

° PPO providers: $2, 000

° Non-PPO providers: $3, 000
° Out-of-network providers: $2, 000
Out-of-pocket expenses are:
° Your $250/$ 500 calendar year deductible;

EXAMPLE PPO physician Non-PPO physician
Physician's charge $150 $150
Our allowance We set it at: 100 We set it at: 100
We pay 90% of our allowance: 90 75% of our allowance: 75
You owe:
Coinsurance
10% of our allowance: 10 25% of our allowance: 25

+Difference up to charge?
No: 0 Yes: 50

TOTAL YOU PAY $10 $75 15
15 Page 16 17
2001 Association Benefit Plan 14 Section 4
° The percentage you pay for covered services after you have met your
deductible;

° The percentage you pay for surgery, anesthesia and extended medical
care after an accidental injury; and

° Your $100 copayment for hospital admissions..
The following cannot be included in your out-of-pocket expenses:
° Expenses in excess of the Plan allowance or maximum benefit
limitations;

° Non-covered services and supplies;
° Prescription drug copayments;
° PPO copayments;
° Expenses for dental care including the 20% you pay for extended dental
care after an accidental injury; or

° Any amounts you pay if benefits have been reduced because of
noncompliance with our cost containment requirements.

When government facilities
bill us
Facilities of the Department of Veterans Affairs, the Department of
Defense, and the Indian Health Service are entitled to seek reimbursement
from us for certain services and supplies they provide to you or a family
member. They may not seek more than their governing laws allow.

If we overpay you We will make diligent efforts to recover benefit payments we made in error but in good faith. If your claim has been paid in error for any reason, we
shall make a diligent effort to recover an overpayment to you from you or,
if to the provider, from the provider. We may reduce subsequent benefit
payments to the member or to a provider on behalf of the member to offset
overpayments.

When you are age 65 or over and you do not have Medicare

Under the FEHB law, we must limit our payments for those benefits you would be entitled to if you had Medicare. And,
your physician and hospital must follow Medicare rules and cannot bill you for more than they could bill you if you had
Medicare. The following chart has more information about the limits.

If you…
° are age 65 or over, and
° do not have Medicare Part A, Part B, or both; and
° have this Plan as an annuitant or as a former spouse, or as a family member of an annuitant or former
spouse; and

° are not employed in a position that gives FEHB coverage. (Your employing office can tell you if this
applies.) 16
16 Page 17 18
2001 Association Benefit Plan 15 Section 4
When you the have the Original
Medicare Plan
We limit our payment to an amount that supplements the benefits that
Medicare would pay under Part A (Hospital insurance) and Part B (Medi-cal
insurance), regardless of whether Medicare pays. Note: We pay our
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 covered by Medicare Part B and it is primary, your out-of-pocket
costs for services both Medicare Part B and we cover depend on whether
your physician accepts Medicare assignment for the claim.

° If your physician accepts Medicare assignment, then you pay nothing
for covered charges.

° If your physician does not accept Medicare assignment, then you pay
the difference between our payment combined with Medicare's pay-ment
and the charge.

Then, for your inpatient hospital care,
° The law requires us to base our payment on an amount— the "equivalent Medicare amount"— set by
Medicare's rules for what Medicare would pay, not on the actual charge;

° You are responsible for your applicable deductibles, coinsurance, or copayments you owe under this
Plan;

° You are not responsible for any charges greater than the equivalent Medicare amount; we will show that
amount on the explanation of benefits; and

° The law prohibits a hospital from collecting more than the Medicare equivalent amount.
And, for your physician care, the law requires us to base our payment and your coinsurance on…

° an amount— set by Medicare and called the "Medicare approved amount," or
° the actual charge if it is lower than the Medicare approved amount.
If your physician… Then you are responsible for…
Participates with Medicare or accepts
Medicare assignment for the claim and
is a member of our PPO network,

your deductibles, coinsurance, copayments; and
any balance up to the Medicare approved
amount;

Participates with Medicare and is not in
our PPO network,
your deductibles, coinsurance, copayments, and
any balance up to the Medicare approved
amount;

Does not participate with Medicare, your deductibles, coinsurance, copayments, and
any balance up to 115% of the Medicare
approved amount

It is generally to your financial advantage to use a physician who participates with Medicare. Such physicians are only
permitted to collect up to the Medicare approved amount.

Our explanation of benefits (EOB) form will tell you how much the physician or hospital can collect from you. If your
physician or hospital tries to collect more than allowed by law, ask the physician or hospital to reduce the charges. If
you have paid more than allowed, ask for a refund. If you need further assistance, call us. 17
17 Page 18 19
2001 Association Benefit Plan 16 Section 4
Note: The physician who does not accept Medicare assignment may not
bill you for more than 115% of the amount Medicare bases its payment on,
called the "limiting charge." The Medicare Summary Notice (MSN) form
that Medicare will send you will have more information about the limiting
charge. If your physician tries to collect more than allowed by law, ask
them to reduce their charges. If they do not, report them to your Medicare
carrier who sent you the MSN form. Call us if you need further assistance.

When you have a Medicare
Private Contract
A physician may ask you to sign a private contract agreeing that you can be
billed directly for service ordinarily covered by Medicare. Should you sign
an agreement, Medicare will not pay any portion of the charges, and we
will not increase our payment. We will still limit our payment to the
amount we would have paid after Medicare's payment.

Please see Section 9, Coordinating benefits with other coverage, for more
information about how we coordinate benefits with Medicare. 18
18 Page 19 20
2001 Association Benefit Plan 17 Section 5
Section 5. Benefits – OVERVIEW (See page 5 for how our benefits changed this year and page 72 for a benefits summary.)
NOTE: This benefits section is divided into subsections. Please read the important things you should keep in mind at the
beginning of each subsection. Also read the General Exclusions in Section 6; they apply to the benefits in the following
subsections. To obtain claims forms, claims filing advice, or more information about our benefits, contact us at
1-800-634-0069.

(a) Medical services and supplies provided by physicians and other health care professionals .................................. 18-29

(b) Surgical and anesthesia services provided by physicians and other health care professionals............................... 30-34
(c) Services provided by a hospital or other facility, and ambulance services ............................................................. 35-38

(d) Emergency services/ Accidents................................................................................................................................ 39-40
(e) Mental health and substance abuse benefits............................................................................................................ 41-45
(f) Prescription drug benefits........................................................................................................................................ 46-48
(g) Special features ....................................................................................................................................................... 49

(h) Dental benefits......................................................................................................................................................... 50-51
(i) Non-FEHB benefits available to Plan members ..................................................................................................... 52
SUMMARY OF BENEFITS.......................................................................................................................................... 72

° Diagnostic and treatment services
° Lab, X-ray, and other diagnostic tests
° Preventive care, adult
° Preventive care, children
° Maternity care
° Family planning
° Infertility services
° Allergy care
° Treatment therapies
° Rehabilitative therapies
° Hearing services (testing, treatment, and
supplies)

° Vision services (testing, treatment, and
supplies)

° Foot care
° Orthopedic and prosthetic devices
° Durable medical equipment (DME)
° Home health services
° Alternative treatments
° Educational classes and programs

° Surgical procedures
° Reconstructive surgery
° Oral and maxillofacial surgery

° Organ/ tissue transplants
° Anesthesia

° Inpatient hospital
° Outpatient hospital or ambulatory surgical
center

° Skilled nursing care facility benefit

° Hospice care
° Ambulance

° Medical emergency
° Accidental injury
° Ambulance

° Flexible benefits option
° High risk pregnancies
° Services Overseas

° 24-hour nurse line
° Centers of excellence 19
19 Page 20 21
2001 Association Benefit Plan 18 Section 5 (a)
Section 5 (a). Medical services and supplies provided by physicians and other health care professionals
I
M
P
O
R
T
A
N
T

Here are some important things you should keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure and are payable only when we determine they are medically
necessary.

° The calendar year deductible is: $250 per person ($ 500 per family). The calendar year
deductible applies to almost all benefits in this Section. We added "( No deductible)" to
show when the calendar year deductible does not apply.

° Be sure to read Section 4, Your costs for covered services, for valuable information
about how cost sharing works, with special sections for members who are age 65 or
over. Also read Section 9 about coordinating benefits with other coverage, including
with Medicare.

I
M
P
O
R
T
A
N
T

Benefit Description You p a y After the calendar year deductible…
NOTE: The calendar year deductible applies to almost all benefits in this Section. We say "No deductible" when it
does not apply.

Diagnostic and treatment services
Professional services of physicians
° In physician's office
PPO: $10 copayment (No deductible)
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount.

Professional services of physicians

° In a hospital or urgent care center
° In a skilled nursing facility
° Second surgical opinion
° At home

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount. 20
20 Page 21 22
2001 Association Benefit Plan 19 Section 5 (a)
Lab, X-ray and other diagnostic tests You p a y
Tests, such as:
° Blood tests
° Urinalysis
° Non-routine pap tests
° Pathology
° X-rays
° Non-routine Mammograms
° CAT Scans/ MRI
° Ultrasound
° Electrocardiogram and EEG
° Sonograms

PPO: Services in physician's office—$ 10
copayment (No deductible)

PPO: Services outside physician's office—
10% of the Plan allowance

Note: If your PPO provider uses a non-PPO
lab or radiologist, we will pay non-PPO bene-fits
for any lab and X-ray charges.

Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount.

Not covered:
Preventative medical care and services (including periodic checkups
and immunizations such as polio, flu, mumps, and smallpox shots),
except as provided under Preventative care, adult and children, page
20

All charges

Preventive care, adult
One annual routine physical examination per person to include a his-tory
and physical, chest X-ray, urinalysis, blood tests, and EKG (elec-trocardiogram).

One annual cervical cancer screening (pap smear) for women age 18
and older.

One annual Prostate Specific Antigen test (PSA— prostate cancer
screening) for men age 40 and older.

One annual fecal occult blood test (colorectal cancer screening) for
members age 40 and older.

A sigmoidoscopy once every five years starting at age 50.
Routine mammogram (breast cancer screening) for women age 35 and
older as follows:

° From age 35-39, one baseline mammogram during this five-year
period

° From 40-45, one mammogram screening every other calendar year
° Starting at age 46, one mammogram every calendar year
NOTE: Your physician's bill must clearly state "Routine Physical
Exam". If a medical diagnosis is provided on the bill, those services
will be paid under the medical benefit.

PPO: Services in physician's office—$ 10
copayment (No deductible)

PPO: Services outside physician's office—
10% of the Plan allowance (No deductible)

Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-Network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount. (No deductible) 21
21 Page 22 23
2001 Association Benefit Plan 20 Section 5 (a)
Preventative care, adult -Continued You P a y
Routine Immunizations, limited to:
° Tetanus-diphtheria (Td) booster – once every 10 years, ages 19 and
over (except as provided for under Childhood immunizations)

° Pneumococcal vaccine, annually, age 65 and over
° Influenza vaccine, annually

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount

Preventive care, children
° Childhood immunizations recommended by the American
Academy of Pediatrics (to age 22)
PPO: Nothing (No deductible)

Non-PPO: Only the difference between the
Plan allowance and the billed amount (No
deductible)

Out-of-network: Only the difference between
the Plan allowance and the billed amount (No
deductible)

° For well-child care charges for routine examinations and care (to
age 2)
PPO: 10% of the Plan allowance.

Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount.

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount

Maternity care
Complete maternity (obstetrical) care such as:
° Prenatal care
° Amniocentesis
° Inpatient delivery
° Initial, routine examination of your newborn infant covered under
your family enrollment

° Circumcision of your newborn infant
° Postnatal care
Note: Here are some things to keep in mind
° You do not have to precertify your normal delivery; see page 9 for
other circumstances, such as extended stays for you or your baby.

° You may remain in the hospital up to 48 hours after a regular
delivery and 96 hours after a cesarean delivery. We will cover an
extended stay, if medically necessary, but you must precertify.

PPO: 10% of the Plan allowance (No
deductible)

Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount (No deductible)

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount (No deductible) 22
22 Page 23 24
2001 Association Benefit Plan 21 Section 5 (a)
Maternity care-Continued You P a y
° We cover routine nursery care of the newborn child during the
covered portion of the mother's maternity stay. We will cover other
care of an infant who requires non-routine treatment if we cover
the infant under a Self and Family enrollment.

° We pay hospitalization and surgeon services (delivery) the same as
for illness and injury. See Hospital benefits (Section 5( c)) and
Surgery benefits (Section 5( b)).

° Bassinet or nursery charges on which you and your baby are
confined are considered your maternity expenses, not your baby's.

° Sonograms and other related tests that are not included in your
routine prenatal or postnatal care are covered in Lab, X-ray, and
other diagnostic tests, page 19.

If your child stays in the hospital after your
discharge and is covered under a Self and
Family enrollment, you must pay a separate
hospital copayment:

PPO: Nothing
Non-PPO: $100 per admission and 25% of the
covered charges

Out-of-network: $100 per admission
Outpatient maternity (obstetrical care) for covered hospital and
physician services at the time of delivery, including the initial, routine
examination of your newborn infant covered under your family
enrollment, when:

° Delivery is on an outpatient basis;
° Delivery is at a licensed birthing center; or
° Inpatient delivery results in a hospital confinement of one day
(overnight) or less and no more than one day's room and board
charge applies

PPO: Nothing
Non-PPO: Only the difference between the
Plan allowance and the billed amount

Out-of-network: Only the difference between
the Plan allowance and the billed amount

Note: If you or your newborn child is transferred from a birthing
center to a hospital due to medical complications, the birth center
expenses will be paid as inpatient care.

If you and your child leave the hospital against medical advice, this
outpatient benefit is not payable.

Not covered:

Routine sonograms to determine fetal age, size or sex; or 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 or rape or incest

All charges 23
23 Page 24 25
2001 Association Benefit Plan 22 Section 5 (a)
Family planning You Pay
° Voluntary sterilization
° Surgically implanted contraceptives
° Intrauterine devices (IUDs)

PPO: 10% of the Plan allowance (No
deductible)

Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount (No deductible)

Out-of-network: 15% of the Plan allowance
and any difference between our allowance and
the billed amount (No deductible)

° Injection of contraceptive drugs

Note: We cover contraceptive drugs in Section 5( f), Prescrip-tion
drug benefits.

PPO: $10 copay (no deductible)
Non-PPO: 25% of the Plan allowance and the
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and the difference between our allowance and
the billed amount

Not covered: reversal of voluntary surgical sterilization,
genetic counseling,
All charges.

Infertility services
Diagnosis and treatment of infertility up to $5, 000 per person per life-
time, except as excluded below.
PPO: Charges in excess of the maximum
$5, 000 benefit

Non-PPO: Charges in excess of the maximum
$5, 000 benefit and the difference between the
Plan allowance and the billed amount

Out-of-network: Charges in excess of the max-imum
$5, 000 benefit and the difference
between the Plan allowance and the billed
amount 24
24 Page 25 26
2001 Association Benefit Plan 23 Section 5 (a)
Infertility services-Continued You P a y
Not covered:
° Fertility drugs
° Assisted reproductive technology (ART) procedures, such as:
°° artificial insemination
°° in vitro fertilization
°° embryo transfer and GIFT
°° intravaginal insemination (IVI)
°° intracervical insemination (ICI)
°° intrauterine insemination (IUI)
° Services and supplies related to ART procedures.

All charges

Allergy care
Allergy testing, injections and treatment

Note: We cover allergy serum in Section 5( f), Prescription drug
benefits

PPO: $10 copayment (No deductible)
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Not covered: Provocative food testing, end point titration techniques,
hair analysis, and sublingual allergy desensitization
All charges 25
25 Page 26 27
2001 Association Benefit Plan 24 Section 5 (a)
Treatment therapies You P a y
° Chemotherapy and radiation therapy

Note: High dose chemotherapy in association with autologous bone
marrow transplants is limited to those transplants listed in Section 5( b),
Organ/ tissue transplants.

Note: We cover chemotherapy drugs in Section 5( f).
° Dialysis – Hemodialysis and peritoneal dialysis

° Intravenous (IV)/ Infusion Therapy – Home IV and antibiotic
therapy

° Respiratory and inhalation therapies
° Growth hormone therapy (GHT)
Note: – We only cover GHT when we preauthorize the treatment. Call
1-800-634-0069 for preauthorization. We will ask you to submit infor-mation
that establishes that the GHT is medically necessary. Ask us to
authorize GHT before you begin treatment; otherwise, we will only
cover GHT services from the date you submit the information. If you
do not ask or if we determine GHT is not medically necessary, we will
not cover the GHT or related services and supplies. See Services
requiring our prior approval in Section 3.

PPO: $10 copayment (No deductible)
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Rehabilitative therapies
Physical therapy, occupational therapy, and speech therapy –
° Visits for the services of each of the following:

°° qualified physical therapists;
°° speech therapists; and
°° occupational therapists
Note: We only cover therapy to restore bodily function or
speech when there has been a total or partial loss of bodily
function or functional speech due to illness or injury and when a
physician:

1) orders the care;
2) identifies the specific professional skills you require and the
medical necessilty for skilled services; and

3) indicates the length of time you need the services.

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount 26
26 Page 27 28
2001 Association Benefit Plan 25 Section 5 (a)
Rehabilitative therapies-Continued You P a y
Not covered:
° long-term rehabilitative therapy

° exercise programs
° speech therapy for congenital disorders or loss/ impairment due to
mental, psychoneurotic and personality disorders

All charges

Hearing services (testing, treatment, and supplies)
First hearing aid and testing only when necessitated by accidental
injury or intra-aural surgery.

Note: Expenses must be incurred within one year of the date of the
accident or surgery.

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Not covered:
° hearing aids, testing and examinations for them, except for
accidental injury or intra-aural surgery.

All charges.

Vision services (testing, treatment, and supplies)
° One pair of eyeglasses or contact lenses to correct an impairment
directly caused by accidental ocular injury or intraocular surgery
(such as for cataracts)

Note: Services must be received within one year of the date of accident
or surgery.

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Not covered:
° Eyeglasses or contact lenses and examinations for them, except for
accidental injury and intraocular surgery

° Eye exercises and orthoptics
° Radial keratotomy and other refractive surgery
° Eye refractions

All charges. 27
27 Page 28 29
2001 Association Benefit Plan 26 Section 5 (a)
Foot care You pay
No routine benefits All charges

Orthopedic and prosthetic devices
° Orthopedic braces, canes, casts, cervical collars, cervical traction
kits, crutches splints and trusses

° Artificial limbs and eyes to replace natural limbs and eyes; stump
hose

° Two externally worn breast prostheses and two surgical bras per
calendar year, including necessary replacements following a mas-tectomy

° Internal prosthetic devices, such as artificial joints, pacemakers,
cochlear implants, and surgically implanted breast implant follow-ing
mastectomy. Note: See Section 5( b), Surgery procedures, for
coverage of the surgery to insert the device.

° Two wigs per lifetime, up to a maximum of $150 each, when
required due to hair loss in connection with chemotherapy or radia-tion
treatment

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Not covered:
° Orthopedic and corrective shoes and other supportive devices for
the feet

° Arch supports
° Foot orthotics
° Heel pads and heel cups
° Lumbosacral supports
° Corsets, trusses, elastic stockings, support hose, and other
supportive devices

All charges 28
28 Page 29 30
2001 Association Benefit Plan 27 Section 5 (a)
Durable medical equipment (DME) You P a y
Durable medical equipment (DME) is equipment and supplies that:
1) Are prescribed by your attending physician (i. e., the physician
who is treating your illness or injury);

2) Are medically necessary;
3) Are primarily and customarily used only for a medical pur-pose;

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 ill-ness
or injury.

We cover purchase or rental up to the purchase price, at our option,
including repair and adjustment, of durable medical equipment, such as
oxygen and dialysis equipment. Under this benefit, we also cover:

° Hospital beds;

° Respirators;
° Wheelchairs;
° Crutches; and
° Wal kers.
Note: Call us at 1-800-634-0069 for preauthorization if purchase or
rental of equipment is in excess of 30 days.

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

° Not covered: Sun or heat lamps, whirlpool baths, heating pads, air
purifiers, humidifiers, air conditioners, and exercise devices
All charges 29
29 Page 30 31
2001 Association Benefit Plan 28 Section 5 (a)
Home health services You pay
If precertified, 90 days per calendar year up to a maximum plan pay-ment
of $80 per day when:

° A registered nurse (R. N.) or licensed practical nurse (L. P. N.) pro-vides
the services;

° A licensed therapist provides physical, occupational or speech ther-apy;

° Services are provided on a part-time basis (less than an 8-hours
shift);

° The attending physician orders the care;
° The physician identifies the specific professional skills required by
the patient and the medical necessity for skilled services; and

° The physician indicates the length of time the services are needed.

PPO: Charges in excess of $80 per day maxi-mum
benefit (No deductible)

Non-PPO: Charges in excess of $80 per day
maximum benefit and any difference between
the Plan allowance and the billed amount (No
deductible)

Out-of-network: Charges in excess of $80 per
day maximum benefit and any difference
between the Plan allowance and the billed
amount (No deductible)

If not precertified, 40 days per calendar year up to a maximum plan
payment of $40, subject to the above provisions
PPO: Charges in excess of $40 per day maxi-mum
benefit (No deductible).

Non-PPO: Charges in excess of $40 per day
maximum benefit and any difference between
the Plan allowance and the billed amount (No
deductible)

Out-of-network: Charges in excess of $40 per
day maximum benefit and any difference
between the Plan allowance and the billed
amount (No deductible)

Not covered:
° Nursing care requested by, or for the convenience of, the patient or
the patient's family;

° nursing care primarily for hygiene, feeding, exercising, moving the
patient, homemaking, companionship or giving oral medication.

All charges. 30
30 Page 31 32
2001 Association Benefit Plan 29 Section 5 (a)
Alternative treatments You P a y
Acupuncture when used as an anesthetic agent for covered surgery. PPO: 10% of the Plan allowance (No
deductible)

Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount (No deductible)

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Not covered:
° Chiropractic services

° Chelation therapy except for acute arsenic, gold, mercury, or lead
poisoning

° Naturopathic services
(Note: Benefits of certain alternative treatment providers may be
covered in medically underserved areas; see pages 7)

All charges

Educational classes and programs
Coverage is limited to:
° Smoking Cessation – Up to $100 for one smoking cessation
program per person per lifetime, including all related expenses
such as prescription drugs.

PPO: Charges in excess of $100 maximum
benefit

Non-PPO: Charges in excess of $100 maxi-mum
benefit and any difference between the
Plan allowance and the billed amount

Out-of-network: Charges in excess of $100
maximum benefit and any difference between
the Plan allowance and the billed amount 31
31 Page 32 33
2001 Association Benefit Plan 30 Section 5 (b)
Section 5 (b). Surgical and anesthesia services provided by physicians and other health care professionals
I
M
P
O
R
T
A
N
T

Here are some important things you should keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and exclu-sions
in this brochure and are payable only when we determine they are medically nec-essary.

° Unlike Section (a) in this section the calendar year deductible does not apply for these
benefits.

° Be sure to read Section 4, Your costs for covered services for valuable information
about how cost sharing works, with special sections for members who are age 65 or
over. Also read Section 9 about coordinating benefits with other coverage, including
with Medicare.

° The amounts listed below are for the charges billed by a physician or other health care
professional for your surgical care. Look in Section 5( c) for charges associated with the
facility (i. e., hospital, surgical center, etc.).

° YOU MUST GET PRECERTIFICATION OF SOME SURGICAL PROCE-DURES.
Please refer to the precertification information shown in Section 3 to be
sure which services require precertification.

I
M
P
O
R
T
A
N
T

Benefit Description You p a y
NOTE: The calendar year deductible does not apply to these benefits.

Surgical procedures
° Operative procedures

° Treatment of fractures, including casting
° Normal pre-and post-operative care by the surgeon
° Endoscopy procedure
° Biopsy procedure
° Removal of tumors and cysts
° Correction of congenital anomalies (see Reconstructive surgery)
° Surgical treatment of morbid obesity— a condition in which an
individual (1) is the greater of 100 pounds or 100% over his or her
normal weight (in accordance with the Plan's underwriting
standards) with complicating conditions; and (2) has been so for at
least five years with documented unsuccessful attempts to reduce
under a doctor-monitored diet and exercise program

° Insertion of internal prosthetic devices. See Section 5( a), Orthopedic
and prosthetic devices, for device coverage information.

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and
any difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount 32
32 Page 33 34
2001 Association Benefit Plan 31 Section 5 (b)
Surgical procedures— Continued You P a y
° Voluntary sterilization, Norplant (a surgically implanted
contraceptive), and intrauterine devices (IUDs)

° Treatment of burns
° Surgical treatment of bunions or spurs
° Assistant surgeons -we cover up to 20% of our allowance for the
surgeon's charge

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and
any difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount (No deductible)

When multiple or bilateral surgical procedures performed during the
same operative session add time or complexity to patient care, our
benefits are:

° For the primary procedure:

°° PPO: 90% of the Plan allowance or
°° Non-PPO: 75% of the Plan allowance or
°° Out-of-network: 85% of the Plan allowance
° For the secondary procedure( s):
°° PPO: 90% of one-half of the Plan allowance or
°° Non-PPO: 75% of one-half of the Plan allowance
°° Out-of-network: 85% of one-half of the Plan allowance
Note: Multiple or bilateral surgical procedures performed through the
same incision are "incidental" to the primary surgery. That is, the
procedure would not add time or complexity to patient care. We do not
pay extra for incidental procedures.

PPO: 10% of the Plan allowance for the
primary procedure and 10% of one-half of the
Plan allowance for the secondary
procedure( s)

Non-PPO: 25% of the Plan allowance for the
primary procedure and 25% of one-half of the
Plan allowance for the secondary
procedure( s); and any difference between our
payment and the billed amount

Out-of-network: 15% of the Plan allowance
for the primary procedure and 15% of
one-half of the Plan allowance for the
secondary procedure( s); and any difference
between our payment and the billed amount.

Not covered:
° Reversal of voluntary sterilization

° Services of a standby surgeon, except during angioplasty or other
high risk procedures when we determine standbys are medically
necessary

° Routine treatment of conditions of the foot
° Radial keratotomy, or similar surgery to correct myopia (except for
cornea graft); see Section 5( a), Vision services

° Removal of corns or calluses, or the trimming of toenails

All charges. 33
33 Page 34 35
2001 Association Benefit Plan 32 Section 5 (b)
Reconstructive surgery You P a y
° Surgery to correct a functional defect

° Surgery to correct a condition caused by injury or illness if:
°° the condition produced a major effect on the member's
appearance and

°° the condition can reasonably be expected to be corrected by such
surgery

° Surgery to correct a condition that existed at or from birth and is a
significant deviation from the common form or norm. Examples of
congenital anomalies are: protruding ear deformaties; cleft lip; cleft
palate; birth marks; and webbed fingers and toes.

° All stages of breast reconstruction surgery following a mastectomy,
such as:

°° surgery to produce a symmetrical appearance on the other breast;
°° treatment of any physical complications, such as lymphedemas;
°° breast prostheses; and surgical bras and replacements (see
Prosthetic devices for coverage)

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and
any difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Note: We pay for internal breast prostheses as hospital benefits.
Note: If you need a mastectomy, you may choose to have the procedure
performed on an inpatient basis and remain in the hospital up to 48
hours after the procedure.

Not covered:
° Cosmetic surgery – any surgical procedure (or any portion of a
procedure) performed primarily to improve physical appearance
through change in bodily form, except repair of accidental injury

° Surgeries related to sex transformation or sexual dysfunction

All charges 34
34 Page 35 36
2001 Association Benefit Plan 33 Section 5 (b)
Oral and maxillofacial surgery You P a y
Oral surgical procedures, limited to:
° Reduction of fractures of the jaws or facial bones
° Surgical correction of cleft lip, cleft palate or severe functional
malocclusion

° Removal of stones from salivary ducts
° Excision of leukoplakia or malignancies
° Excision of cysts and incision of abscesses when done as
independent procedures

° Surgical correction of temporomandibular joint (TMJ) dysfunction
° Surgical removal of impacted teeth, including anesthesia charges
° Other surgical procedures that do not involve the teeth or their
supporting structures

20% of the Plan allowance and any difference
between the Plan allowance and the billed
amount

Not covered:
° Oral implants and transplants
° Procedures that involve the teeth or their supporting structures
(such as the periodontal membrane, gingiva, and alveolar bone)

All charges

Organ/ tissue transplants
Limited to:
° Cornea
° Heart
° Lung
° Kidney
° Kidney/ Pancreas
° Liver
° Pancreas
° Allogeneic bone marrow transplants
° Autologous bone marrow transplants – only for patients with acute
lymphocytic or nonlymphocytic leukemia, advanced Hodgkin's
lymphoma, advanced nonHodgkin's lymphoma, advanced
neuroblastoma, breast cancer, multiple myeloma, epithelial ovarian
cancer, and testicular, mediastinal, retroperitoneal and ovarian germ
cell tumors

Note: We cover related medical and hospital expenses of the donor
when we cover the recipient.

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and
any difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Not covered:
° Donor screening tests and donor search expenses, except those per-formed
for the actual donor

° Transplants not listed as covered
° Implants of artificial organs

All charges 35
35 Page 36 37
2001 Association Benefit Plan 34 Section 5 (b)
Anesthesia You P a y
Professional services provided in –
° Hospital (inpatient)
PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and
any difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Professional services provided in –
° Hospital outpatient department

° Skilled nursing facility
° Ambulatory surgical center
° Office

PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and
any difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount 36
36 Page 37 38
2001 Association Benefit Plan 35 Section 5( c)
Section 5( c). Services provided by a hospital or other facility, and ambulance services
I
M
P
O
R
T
A
N
T

Here are some important things you should keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure and are payable only when we determine they are medically
necessary.

° Unlike Sections (a) and (b), in this section the calendar year deductible applies to only a
few benefits. In that case, we added "( calendar year deductible applies)".

° Be sure to read Section 4, Your costs for covered services for valuable information about
how cost sharing works, with special sections for members who are age 65 or over. Also
read Section 9 about coordinating benefits with other coverage, including with Medicare.

° The amounts listed below are for the charges billed by the facility (i. e. hospital or
surgical center) or ambulance service for your surgery or care. Any costs associated with
the professional charge (i. e. physicians, etc.) are in Section 5( a) or (b).

° YOU MUST GET PRECERTIFICATION OF HOSPITAL STAYS; FAILURE TO
DO SO WILL RESULT IN A MINIMUM $500 PENALTY. Please refer to the
precertification information shown in Section 3 to be sure which services require
precertification.

I
M
P
O
R
T
A
N
T

Benefit Description You p a y
NOTE: The calendar year deductible applies ONLY when we say below: "calendar year deductible applies".

Inpatient hospital
Room and board, such as
° semiprivate or intensive care accommodations;
° general nursing care; and
° meals and special diets.
NOTE: We only cover a private room when you must be isolated to
prevent contagion. Otherwise, we will pay the hospital's average charge
for semiprivate accommodations. If the hospital only has private rooms,
we base our payment on the average semiprivate rate of the most com-parable
hospital in the area.

Other hospital services and supplies, such as:
° Operating, recovery, maternity, and other treatment rooms
° Prescribed drugs and medicines
° Diagnostic laboratory tests and X-rays
° Blood or blood plasma, if not donated or replaced
° Dressings, splints, casts, and sterile tray services
° Medical supplies and equipment, including oxygen
° Anesthetics, including nurse anesthetist services

PPO: Nothing
Non-PPO: $100 per admission and 25% of
the covered charges

Out-of-Network: $100 per admission 37
37 Page 38 39
2001 Association Benefit Plan 36 Section 5( c)
Inpatient hospital-Continued You P a y
° Take-home drugs are covered under Section 5( f), Prescription drug
benefits

° Take-home medical supplies, appliances, medical equipment, and
any covered items billed by a hospital (Calendar year deductible
applies to these items.)

NOTE: We base payment on whether the facility or a health care
professional bills for the services or supplies. For example, when the
hospital bills for its nurse anesthetists' services, we pay Hospital
benefits and when the anesthesiologist bills, we pay Anesthesia
benefits.

PPO: Nothing
Non-PPO: $100 per admission and 25% of
the covered charges

Out-of-Network: $100 per admission

Hospitalization for dental procedures
° We cover hospital services related to dental procedures (even though
the dental procedure itself may not be covered) only when a
nondental physical impairment exists that makes hospitalization
necessary to safeguard your health.

PPO: Nothing
Non-PPO: Nothing
Out-of-network: Nothing

Not covered:
° A hospital admission that is not medically necessary, i. e., the medi-cal
services did not require the acute hospital inpatient (overnight)
setting but could have been provided in a doctor's office, the outpa-tient
department of a hospital, or some other setting without
adversely affecting your condition or quality of medical care ren-dered.

° Inpatient hospital services and supplies for surgery that we do not
cover

° Custodial care (see definition) even when provided by a hospital.
° Non-covered facilities, such as nursing homes, rest homes, places
for the aged, convalescent homes or any place that is not a hospital,
skilled nursing facility, or hospice

° Personal comfort items, such as radio, television, telephone, beauty
and barber services

° Private nursing care

All charges. 38
38 Page 39 40
2001 Association Benefit Plan 37 Section 5( c)
Outpatient hospital or ambulatory surgical center You P a y
° Operating, recovery, and other treatment rooms
° Prescribed drugs and medicines
° Diagnostic laboratory tests, X-rays, and pathology services
° Administration of blood, blood plasma, and other biologicals
° Blood and blood plasma, if not donated or replaced
° Pre-surgical testing
° Dressings, casts, and sterile tray services
° Medical supplies, including oxygen
° Anesthetics and anesthesia service
Note: We cover directly related services and supplies rendered at the
time of the surgery at 100% of the Plan allowance.

We cover hospital services related to dental procedures (even though
the dental procedure itself may not be covered) only when a nondental
physical impairment exists that makes hospitalization necessary to safe-guard
your health.

PPO: 10% of Plan allowance
Non-PPO: 25% of the Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Skilled nursing care facility benefits
If precertified, we cover semiprivate room, board, services and sup-plies
in a Skilled Nursing Facility (SNF) for up to 60 days when:

1) confinement is medically necessary and
2) when the confinement is under the supervision of a physician

PPO: Charges in excess of 60-day maximum
Non-PPO: Charges in excess of 60-day maxi-mum
and the difference between the Plan
allowance and the billed amount

Out-of-network: Charges in excess of 60-day
maximum and the difference between the
Plan allowance and the billed amount

If not precertified, we cover semiprivate room, board, services and
supplies for up to 30 days subject to the above conditions

Note: SNF benefits will be restored for each new period of confine-ment.
There is a new period of confinement when at least 60 days have
elapsed since you were last confined in an SNF.

PPO: 20% and charges in excess of the
30-day maximum

Non-PPO: 20% of the Plan allowance
and any difference between our allow-ance
and the billed amount for 30 days,
then all additional charges

Out-of-network: 20% of the Plan
allowance and any difference between
our allowance and the billed amount
for 30 days, then all additional charges

Not covered: Custodial care All charges. 39
39 Page 40 41
2001 Association Benefit Plan 38 Section 5( c)
Hospice care You Pay
Hospice is a coordinated inpatient and outpatient program of
maintenance and supportive care for the terminally ill provided by a
medically supervised team under the direction of a
Plan-approved independent hospice administration.

If precertified, we pay $7500 for inpatient or outpatient hospice care

PPO: Charges in excess of $7500
maximum

Non-PPO: Charges in excess of $7500
maximum and the difference between the
Plan allowance and the billed amount

Out-of-network: Charges in excess of $7500
maximum and the difference between the
Plan allowance and the billed amount

If not precertified, we pay $4500 for inpatient or outpatient hospice
care
PPO: Charges in excess of $4500 maximum

Non-PPO: Charges in excess of $4500
maximum and the difference between the
Plan allowance and the billed amount

Note: One hospice program is covered per lifetime. This benefit does
not apply to services covered under any other provisions of the Plan.
Out-of-network: Charges in excess of $4500
maximum and the difference between the
Plan allowance and the billed amount

Ambulance
We pay the first $50 for:
° Local professional ambulance service when medically appropriate

° Transportation by professional ambulance, railroad or commercial
airline on a regularly scheduled flight to the nearest hospital
equipped to furnish special and unique treatment

PPO: 10% of Plan allowance after $50 benefit
(calendar year deductible applies)

Non-PPO: 25% of Plan allowance and any
difference between our allowance and the
billed amount after $50 benefit (calendar year
deductible applies)

Out-of-network: 15% of Plan allowance and
any difference between our allowance and the
billed amount after $50 benefit (calendar year
deductible applies). 40
40 Page 41 42
2001 Association Benefit Plan 39 Section 5 (d)
Section 5 (d). Emergency services/ accidents
I
M
P
O
R
T
A
N
T

Here are some important things to keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure.

° The calendar year deductible is: $250 per person ($ 500 per family). The calendar year
deductible applies to almost all benefits in this Section. We added "( No deductible)" to
show when the calendar year deductible does not apply.

° Be sure to read Section 4, Your costs for covered services for valuable information
about how cost sharing works, with special sections for members who are age 65 or
over. Also read Section 9 about coordinating benefits with other coverage, including
with Medicare.

I
M
P
O
R
T
A
N
T

What is an accidental injury? An accidental injury is a bodily injury that requires immediate medical attention and is sustained solely through violent,
external, and accidental means, such as broken bones, animal bites, insect bites and stings, and poisonings. Accidental
dental injury is under Section 5( h), Dental benefits.

Benefit Description You p a y After the calendar year deductible…
NOTE: The calendar year deductible applies to almost all benefits in this Section. We say "No deductible" when it does
not apply.

Accidental injury
If you receive care for your accidental injury within 96 hours, we cover:
° Non-surgical physician services and supplies

° Related outpatient hospital services
Note: We pay Hospital benefits if you are admitted.

PPO: Nothing (No deductible)
Non-PPO: Only the difference between our
allowance and the billed amount (No
deductible)

Out-of-network: Only the difference between
our allowance and the billed amount (No
deductible) 41
41 Page 42 43
2001 Association Benefit Plan 40 Section 5 (d)
Accidental injury-Continued You Pay
If you receive follow-up care for your accidental injury within 30 days
and were initially seen by a physician within 96 hours of the accident ,
we cover:

° Non-surgical physician services PPO: Nothing (No deductible)
Non-PPO: Only the difference between our
allowance and the billed amount (No
deductible)

Out-of-network: Only the difference between
our allowance and the billed amount (No
deductible)

Associated X-rays, laboratory expenses, or durable medical equipment
Note: We pay Hospital benefits if you are admitted.
PPO: 10% of the Plan allowance
Non-PPO: 25% of the Plan allowance and
any difference between our allowance and the
billed amount.

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount

Medical emergency
Outpatient medical or surgical services and supplies PPO: 10% of Plan allowance
Non-PPO: 25% of Plan allowance and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and any difference between our allowance
and the billed amount.

Ambulance
We pay $50 for:
° Local professional ambulance service when medically appropriate

° Transportation by professional ambulance, railroad or commercial
airline on a regularly scheduled flight to the nearest hospital
equipped to furnish special and unique treatment

PPO: 10% of Plan allowance after the $50
benefit (calendar year deductible applies)

Non-PPO: 25% of Plan allowance and any
difference between our allowance and the
billed amount after the $50 benefit (calendar
year deductible applies)

Out-of-network: 15% of Plan allowance and
any difference between our allowance and the
billed amount after the $50 benefit (calendar
year deductible applies) 42
42 Page 43 44
2001 Association Benefit Plan 41 Section 5 (e)
Section 5 (e). Mental health and substance abuse benefits
I
M
P
O
R
T
A
N
T

Parity
° Beginning in 2001, all FEHB plans' mental health and substance abuse benefits will
achieve "parity" with other benefits. This means that we will provide mental health
and substance abuse benefits differently than in the past.

° If you reside in the PPO Network Area, you may now choose to get Non-PPO
(same as before) or PPO care (new in 2001). If you reside outside the network area,
out-of-network care is new in 2001. You must get our approval for services and fol-low
a treatment plan we approve. If you do, cost-sharing and limitations for PPO or
Out-of-Network mental health and substance abuse benefits will be no greater than
for similar benefits for other illnesses and conditions.

° Here are some important things to keep in mind about these benefits:
° All benefits are subject to the definitions, limitations, and exclusions in this brochure.
° The calendar year deductible is $250 per person ($ 500 per family) and applies to
almost all benefits in this Section. We added "( No deductible)" to show when the cal-endar
year deductible does not apply.

° Be sure to read Section 4, Your costs for covered services, for valuable information
about how cost sharing works. Also read Section 9 about coordinating benefits with
other coverage, including with Medicare.

° YOU MUST GET PREAUTHORIZATION OF THESE SERVICES. See the
instructions after the benefits descriptions below.

° PPO mental health and substance abuse benefits are below, then Non-PPO and
Out-of-Network benefits begin on page 44.

I
M
P
O
R
T
A
N
T

Benefit Description You P a y After the calendar year deductible
NOTE: The calendar year deductible applies to almost all benefits in this Section. We say "No deductible" when it
does not apply

PPO Network benefits
All diagnostic and treatment services contained in a treatment plan that
we approve. The treatment plan may include services, drugs, and sup-plies
described elsewhere in this brochure.

Note: PPO benefits are payable only when we determine the care is clin-ically
appropriate to treat your condition and only when you receive the
care as part of a treatment plan we approve.

Your cost sharing responsibilities are no
greater than for other illness or conditions. 43
43 Page 44 45
2001 Association Benefit Plan 42 Section 5 (e)
PPO Network benefits-Continued You P a y
° Professional services provided by a psychiatrist PPO: 10% of the Plan allowance (no deduct-ible)

° Other professional services (i. e., psychologists, clinical social work-ers,
licensed counselors), inpatient professional services, and outpa-tient
hospital services

° Diagnostic tests

PPO: 10% of the Plan allowance

° Medication management PPO: $10 copayment (no deductible)
° Inpatient hospital charges

° Services in approved alternative care settings such as partial hospi-talization
or facility-based intensive outpatient treatment

PPO: Nothing

Not covered:
° Services we have not approved.

° All charges for chemical aversion therapy, conditioned reflex
treatments, narcotherapy or any similar aversion treatments and all
related charges (including room and board)

° Any provider not specifically listed as covered
° Counseling or therapy for marital, educational or behavioral
problems, or related to mental retardation or learning disabilities

° Community-based programs such as self-help groups or 12 step
program

° Treatments for learning disabilities and mental retardation
° Services by pastoral, marital, or drug/ alcohol counselors
Note: OPM will base its review of disputes about treatment plans on the
treatment plan's clinical appropriateness. OPM will generally not order
us to pay or provide one clinically appropriate treatment plan in favor of
another.

All charges 44
44 Page 45 46
2001 Association Benefit Plan 43 Section 5 (e)
PPO Network benefits-Continued
Preauthorization To be eligible to receive these enhanced mental health and substance abuse benefits you must follow your treatment plan and all of our net-work
authorization processes. These include:
°Preauthorization and concurrent review are required for all levels of care
whether in-or out-of-network.

°The medical necessity of your inpatient services must be precertified for
you to receive full Plan benefits. Otherwise, the benefits payable will
be reduced by $500. Emergency admissions must be reported within
two business days following the day of admission even if you have
been discharged.

°Outpatient mental health and substance abuse benefits will be reduced
by 50% if services are not preauthorized within two business days of
the initial visit.

You, your representative, your doctor, or your hospital must call Mutual
of Omaha's Care Review Unit prior to admission. The toll-free number is
1-800-634-0069.

You must provide the following information: enrollee's name and Plan
identification number; patient's name, birth date and phone number; rea-son
for hospitalization, proposed treatment; name of hospital or facility;
name and number of admitting physician; and number of planned days of
confinement.

Special transitional benefit If a mental health or substance abuse professional provider is treating you under our plan as of January 1, 2001, you will be eligible for continued

coverage with your provider for up to 90 days under the following condi-tion:

° If your mental health or substance abuse professional provider with
whom you are currently in treatment leaves the plan at our request for
other than cause.

° If changes to this plan's benefit structure for 2001 cause your out-of-pocket
costs for your out-of-network provider to be greater than they
were in contract year 2000.

If this condition applies to you, we will allow you reasonable time to
transfer your care to a network mental health or substance abuse profes-sional
provider. During the transitional period, you may continue to see
your treating provider and will not pay any more out-of-pocket than you
did in the year 2000 for services. This transitional period will begin with
our notice to you of the change in coverage. The transitional period will
last for up to 90 days from the date you receive notice of the change. You
may receive this notice prior to January 1, 2001, and the 90 day period
begins with receipt of the notice.

Network limitation If you do not obtain and follow an approved treatment plan, we will pro-vide only non-PPO benefits. 45
45 Page 46 47
2001 Association Benefit Plan 44 Section 5 (e)
Non-PPO and Out-of-Network benefits You P a y
Mental Health Professional services by psychiatrists, psychologists, clinical social
workers or licensed counselors, and inpatient professional services
Non-PPO: 50% of the Plan allowance until
50 visit maximum benefit is met and any
difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and the difference between our allowance
and the billed amount

° Diagnostic tests

° Medical management
Non-PPO: 25% of the Plan allowance and
the difference between our allowance and the
billed amount

Out-of-Network: 15% of the Plan allow-ance
and the difference between our Plan and
the billed amount

° Outpatient hospital charges Non-PPO: 50% of the Plan allowance and
the difference between our allowance and the
billed amount

Out-of-network: 15% of the Plan allowance
and the difference between our Plan and the
billed amount

° Inpatient hospital charges Non-PPO: $100 per admission and 25% of
the covered charges

Out-of-network: $100 per admission

Substance Abuse

° Inpatient care includes room and board and ancillary charges for con-finements
in a treatment facility for rehabilitative treatment of alco-holism
or substance

Non-PPO: $100 per admission and 25% of
the covered charges up to $10, 500 per
28-day program

Out-of-Network: $100 per admission

° Outpatient benefits (including aftercare) Non-PPO: 25% of the Plan allowance and
the difference between our allowance and the
billed amount up to the maximum $4,000
benefit

Out-of-Network: 15% of the Plan allow-ance
and the difference between our allow-ance
and the billed amount 46
46 Page 47 48
2001 Association Benefit Plan 45 Section 5 (e)
Non-PPO and Out-of-Network benefits-Continued You P a y
Not covered:
° Services we have not approved.

° All charges for chemical aversion therapy, conditioned reflex treat-ments,
narcotherapy or any similar aversion treatments and all
related charges (including room and board)

° Any provider not specifically listed as covered
° Counseling or therapy for marital, educational or behavioral prob-lems,
or related to mental retardation or learning disabilities

° Community-based programs such as self-help groups or 12 step pro-gram

° Treatments for learning disabilities and mental retardation
° Services by pastoral, marital, or drug/ alcohol counselors

All charges.

Lifetime maximum Non-PPO inpatient or outpatient care for the treatment of alcoholism and drug abuse is limited to three treatment programs per lifetime. With-drawal
from a treatment program prior to completion constitutes use of
one program.

Precertification The medical necessity of your admission to a hospital or other covered facility must be precertified for you to receive these 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 Section 3 for details.

See these sections of the brochure for more valuable information about these benefits:
° Section 3, How you get care, for information about catastrophic protection for these benefits

° Section 7, Filing a claim for covered services, for information about submitting non-PPO and Out-of-network
claims 47
47 Page 48 49
2001 Association Benefit Plan 46 Section 5 (f)
Section 5 (f). Prescription drug benefits
I
M
P
O
R
T
A
N
T

Here are some important things to keep in mind about these benefits:
° We cover prescribed drugs and medications, as described below.

° All benefits are subject to the definitions, limitations and exclusions in this brochure
and are payable only when we determine they are medically necessary.

° The calendar year deductible does not apply to almost all benefits in this Section. We
added "calendar year deductible applies" when the calendar year deductible applies.

° Be sure to read Section 4, Your costs for covered services for valuable information
about how cost sharing works, with special sections for members who are age 65 or
over. Also read Section 9 about coordinating benefits with other coverage, including
with Medicare.

I
M
P
O
R
T
A
N
T
° Who can write your prescription. A licensed physician or dentist must write the prescription.

° Where you can obtain them. You may fill the prescription at a network pharmacy or by mail. To locate a network
pharmacy in your area, call 1-800-752-0598 or you may also visit Mutual of Omaha's website at www. mutualofo-maha.
com. We will send you information on the mail order drug program. To use the program: 1) complete the ini-tial
mail order form; 2) enclose your prescription and copayment; 3) mail your order to Express Scripts, Inc., PO
Box 27226, Albuquerque, NM 87125-9908; 4) allow two to three weeks for delivery. You will receive forms for
refills and future prescription orders each time you receive drugs or supplies under this program. If you have ques-tions
about the mail order program, call 1-800-417-8173.

° We use a formulary. A formulary is a list of selected FDA-approved commonly prescribed medications from
which your physician or dentist may choose to prescribe. The formulary is designed to inform you and your physi-cian
about quality medications that, when prescribed in place of other nonformulary medications, can help contain
the increasing cost of prescription drug coverage without sacrificing quality. To find out if your medication is on the
formulary call Express Scripts, Inc., at 1-800-752-0598 or visit Mutual of Omaha's website at www. mutualofomaha. com. If you
are prescribed a drug not on the formulary, you will pay a higher copayment.

° These are the dispensing limitations. When you obtain prescription drugs from a pharmacy using your Prescrip-tion
Drug Card, you may obtain up to a 30-day supply of covered drugs. If purchasing more than a 30-day supply on
the same day, any expense exceeding that supply limit will not be covered through the pharmacy arrangement. You
may purchase your covered prescription drugs and supplies by presenting your prescription drug card and your pre-scription
to a participating provider. Prescription refills will be covered when no more than 25% of the 30-day sup-ply
remains based on your physician's prescription.

If your physician or dentist prescribes a medication that will be taken over an extended period of time, you should
request two prescriptions— one for immediate use with a participating retail pharmacy and the other for up to a 90-day
supply from the Mail Order Program. Express Scripts, Inc., will fill your prescription. All drugs and supplies covered
by the Plan are available under this program except drugs to aid in smoking cessation and fertility drugs. If you have
questions about a particular drug or a prescription, and to request your first order forms, call 1-800-417-8173. If a
generic equivalent to the prescribed drug is available, Express Scripts will dispense the generic equivalent instead of
the brand name unless you or your physician specifies that the brand name is required. 48
48 Page 49 50
2001 Association Benefit Plan 47 Section 5 (f)
Benefit Description You P a y After the calendar year deductible…
NOTE: The calendar year deductible does not apply to almost all benefits in this Section. We say "calendar year
deductible applies" when it does apply.

Covered medications and supplies
Each new enrollee will receive a prescription drug card (two cards if
enrolled in a Family plan), a mail order form/ patient profile and a pread-dressed
reply envelope. If you need additional cards, call 1-800-634-0069.

You may purchase the following medications and supplies prescribed by
a physician from either a pharmacy or by mail:

° Drugs, vitamins and minerals that by Federal law of the United States
require a doctor's prescription for their purchase

° Insulin
° FDA-approved drugs and devices requiring a doctor's prescription
for the purpose of birth control

° Needles and syringes for the administration of covered medications
° Diabetic, colostomy, and ostomy supplies
Here are some things to keep in mind about our prescription drug pro-gram:

° A generic equivalent will be dispensed if it is available, unless your
physician specifically requires a name brand. If you receive a name
brand drug when a Federally-approved generic drug is available, and
your physician has not specified "dispense as written" for the name
brand drug, you have to pay the difference in cost between the name
brand drug and the generic.

° When purchasing drugs at a pharmacy, you must use your Prescrip-tion
Drug Card. Please call us to request additional prescription drug
cards for family members.

° We have an open formulary. If your physician believes a name brand
product is necessary or there is no generic available, your physician
may prescribe a name brand drug from a formulary list. To order a
prescription drug brochure, call Customer Service at 1-800-752-0598.

° Network Retail:
$10 generic
$20 formulary brand name
$30 nonformulary brand name

° Network Retail Medicare:
$5 generic
$15 formulary brand name
$25 nonformulary brand name

° Network Mail Order:
$15 generic
$30 formulary brand name
$45 nonformulary brand name

° Network Mail Order Medicare:
$8 generic
$23 formulary brand name
$38 nonformulary brand name

Note: If there is no generic equivalent avail-able,
you will still have to pay the brand
name copay.

If you are overseas and do not order prescription drugs through the Mail
Order Prescription Drug Program:

If you are provided drugs directly by a physician or
covered facility (not a pharmacy):

20% (calendar year deductible applies)
20% (calendar year deductible applies) 49
49 Page 50 51
2001 Association Benefit Plan 48 Section 5 (f)
Covered medications and supplies-Continued You P a y
Not covered:
° Drugs and supplies for cosmetic purposes

° Nutritional supplements and vitamins (including prenatal) that do
not require a prescription

° Medication that does not require a prescription under Federal law
even if your physician prescribes it or a prescription is required
under your State law

° Medical supplies such as dressings and antiseptics
° Medication for which there is a non-prescription equivalent avail-able

° Prescriptions received from non-participating pharmacies unless
overseas or through a covered physician or facility. Call 1-800-752-0598
to locate a participating pharmacy.

° Drugs to aid in smoking cessation are covered only under "Educa-tional
classes and programs"

° Fertility drugs are covered only under "Infertility services"

All Charges 50
50 Page 51 52
2001 Association Benefit Plan 49 Section 5 (g)
Section 5 (g). Special features
Special features Description
Flexible benefits option Under the flexible benefits option, we determine the most effective way to provide services.

° We may identify medically appropriate alternatives to traditional care
and coordinate other benefits as a less costly alternative benefit.

° Alternative benefits are subject to our ongoing review.
° By approving an alternative benefit, we cannot guarantee you will get
it in the future.

° The decision to offer an alternative benefit is solely ours, and we may
withdraw it at any time and resume regular contract benefits.

° Our decision to offer or withdraw alternative benefits is not subject to
OPM review under the disputed claims process.

24 hour nurse line For any of your health concerns, 24 hours a day, 7 days a week, you may call the Optum NurseLine at toll free 1-877-861-3861 and talk with a

registered nurse who will discuss treatment options and answer your
health questions.

High risk pregnancies You have access to Mutual of Omaha's Health Maternity Program, which provides educational material and support to pregnant women. Contact

Customer Service at 1-800-634-0069 for more information
Centers of excellence Mutual of Omaha has special arrangements with 15 facilities to provide services for tissue and organ transplants— its Medical Specialty Network.

The network was designed to give you an opportunity to access providers
that demonstrate high quality medical care for transplant patients. For a
list of facilities included in the Medical Specialty Network, call
Customer Service, consult your PPO provider directory, or visit Mutual
of Omaha's website at www. mutualofomaha. com.

Services overseas Our overseas customers receive the same out-of-network benefits and prompt customer service as their stateside counterparts. There is no

additional claims processing time for foreign claims. 51
51 Page 52 53
2001 Association Benefit Plan 50 Section 5 (h)
Section 5 (h). Dental benefits
I
M
P
O
R
T
A
N
T

Here are some important things to keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure and are payable only when we determine they are
medically necessary.

° Be sure to read Section 4, Your costs for covered services for valuable
information about how cost sharing works, with special sections for members
who are age 65 or over. Also read Section 9 about coordinating benefits with
other coverage, including with Medicare.

° Note: Even when the dental procedure itself may not be covered, we cover
hospitalization for dental procedures when a non-dental physical impairment
exists which makes hospitalization necessary to safeguard the health of the
patient.

I
M
P
O
R
T
A
N
T

Accidental injury benefit You P a y
We cover outpatient restorative services necessary to promptly
repair (but not replace) sound natural teeth. The need for these
services must result from an accidental injury from an external
force such as a blow or fall that requires immediate attention
(not from biting or chewing). Services must be rendered within
96 hours of the injury

We cover follow-up treatment (including initial replacement
of sound natural teeth and dental X-rays) for 24 months from the
date of the accident as recommended by the attending physician.
If treatment or repair to your child's teeth must be delayed because
of age, we may extend coverage to a period of not more than 36
months from the date of the accident. Your request for delay must
be received by us within one year of the accident. You must remain
covered by the Plan until treatment is completed.

Any difference between the Plan
allowance and the billed amount

20% of the Plan allowance and the
difference between our allowance
and the billed amount (calendar year
deductible applies)

Dental benefits
Service We pay (scheduled allowance) You pay
Routine oral examinations
including X-rays, cleaning,
diagnosis, and preparation of a
treatment plan

Dental fillings:

$39 twice per year All charges in excess of the
scheduled amounts listed to the
left

° One surface $12
° Two surfaces $19
° Three or more surfaces $24 52
52 Page 53 54
2001 Association Benefit Plan 51 Section 5 (h)
Dental benefits— Continued
Not covered:
° Charges for tooth extractions, dental implants, preparation for orthodontic treatment or dentures, or other dental
work or surgery that involves any tooth structure, alveolar process, abscess, periodontal disease or disease of the
gingival tissue

° Dental appliances, study models, splints, and other devices or dental services associated with the treatment of tem-poromandibular
joint (TMJ) dysfunction

° Crowns and root canals
Other dental services not listed as covered 53
53 Page 54 55
2001 Association Benefit Plan 52 Section 5 (i)
Section 5 (i). Non-FEHB benefits available to Plan members
The benefits on this page are not part of the FEHB contract or premium, and you cannot file an FEHA disputed claim
about them. Fees you pay for these services do not count toward FEHB deductibles or out-of-pocket maximums.

Supplemental Dental
Consumer Dental Care offers a reduced fee dental program to individuals located in Maryland and Washington, DC,
through Consumer Dental Corp.; and to individuals located in Virginia through Consumer Dental Care of Virginia, Inc.

Through the Consumer Dental Care Select you can enjoy reduced savings on all areas of dentistry to include:

Additional features include:
Retired persons are eligible
Over 1, 500 Participating General Dentists and Specialists
Extremely attractive rates!

Vision Care Outlook Vision Services offers you and your dependents the opportunity to purchase eye wear at special discount
prices. Enrollment in Outlook Vision Services provides the following benefits:
° Substantial savings on eye wear purchases with over 8, 000 optical providers located nationwide (not
available in CA).

° Discounts on eye exams at select locations where approved (not available in CA or WA)
° Optical providers consist of but are not limited to: Sears, J. C. Penney Optical, Vision Works, D. O. C.
Optics, Shopko Optical, LensCrafters, Pearle, and many others

° Save up to 50% of retail prices on eye wear: lenses, frames, contact lenses, prescription and
nonprescription sunglasses and accessories.

° Save up to 50% off on contact lenses when ordering though Outlook's unique mail order contact lens
replacement program.

° Unlimited selection on eye wear with no limit on quantities
° NO waiting periods, NO pre-existing conditions, NO paperwork
° Benefits cover the entire household at extremely attractive rates!

Long Term Care When you or a family member require help with normal daily activities due to aging or a disabling accident or illness,
you may need long term care assistance. Long term care situations can quickly deplete a family's lifetime of savings.
Long Term Care guards against this circumstance. Long Term Care insurance underwritten by Mutual of Omaha
Insurance Company is available to you, your spouse, parents and parents-in-law under the age of 80.

For additional information or enrollment in any of these programs, please call 1-800-280-6370.

NON-FEHB Benefits are not part of the FEHB contract

° Diagnostic/ Preventative, Restorative ° Dentures
° Crowns and Bridges ° Endodontics
° Periodontics ° Oral Surgery
° Orthodontics

No deductibles No claim forms
No pre-existing conditions
(except orthodontics in progress)
No maximum level of benefits 54
54 Page 55 56
2001 Association Benefit Plan 53 Section 6
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 we determine it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or
condition.

We do not cover the following:
° Services, drugs, or supplies you receive while you are not enrolled in this Plan;
° Services, drugs, or supplies that are not medically necessary;
° Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice;
° Experimental or investigational procedures, treatments, drugs or devices;
° Services, drugs, or 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, or supplies related to sex transformations, sexual dysfunction or sexual inadequacy;
° Services, drugs, or supplies you receive from a provider or facility barred from the FEHB Program;
° Expenses 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 a result of an act of war within the United States, its territories, or
possessions or (2) during combat;

° Services furnished by immediate relatives or household members. Immediate relatives include spouse, parent, child,
brother or sister by blood, marriage, or adoption;

° Services furnished or billed by a noncovered facility, except that medically necessary prescription drugs are covered;
or

° Procedures, services, drugs and supplies not specifically listed as covered. 55
55 Page 56 57
2001 Association Benefit Plan 54 Section 7
Section 7. Filing a claim for covered services
How to claim benefits To obtain claim forms or other claims filing advice or answers about our benefits, contact us at 1-800-634-0069.
In most cases, providers and facilities file claims for you. Your physician
must file on the form HCFA-1500, Health Insurance Claim Form. Your
facility will file on the UB-92 form. For claims questions and assistance,
call us at 1-800-634-0069.

When you must file a claim— such as for overseas claims or when another
group health plan is primary— submit it on the HCFA-1500 or a claim form
that includes the information shown below. Itemized bills and receipts
should be sent to Association Benefit Plan, PO Box 668587, Charlotte, NC
28266-8587.

° Name of patient and relationship to enrollee;
° Plan identification number of the enrollee;
° Name and address of person or firm providing the service or supply;
° Dates that services or supplies were furnished;
° Diagnosis;
° Type of each service or supply; and
° The charge for each service or supply.
You should use the Plan's standard claim form to file dental claims. Attach
the dentist's itemized bill. The bill must include the name of the patient,
dates of service, itemized charges and the dentist's tax ID number.

Note: Canceled checks, cash register receipts, or balance due statements
are not acceptable substitutes for itemized bills.

In addition:
° You must send a copy of the explanation of benefits (EOB) from any
primary payer (such as the Medicare Summary Notice (MSN)) with
your claim.

° Bills for home nursing care 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; private
duty nursing; and physical, occupational, and speech therapy require a
written statement from the physician specifying the medical necessity
for the service or supply and the length of time needed. 56
56 Page 57 58
2001 Association Benefit Plan 55 Section 7
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. We will not provide duplicate or year-end statements.

Deadline for filing your claim Send us all of the documents for your claim as soon as possible. You must submit the claim within two years of the date you received the service,
unless timely filing was prevented by administrative operations of Govern-ment
or legal incapacity and provided the claim was submitted as soon as
reasonably possible.

Overseas claims For covered services you receive in hospitals outside the United States and Puerto Rico and performed by physicians outside the United States, you
must send a completed claim form and the itemized bills.
° Overseas (foreign) claims for prescription drugs and supplies that are
not ordered through the Mail Order Prescription Drug Program must
include receipts that include the prescription number, name of drug or
supply, prescribing physician's name, date, and charge.

° Claims for overseas (foreign) services should include an English trans-lation.

° Charges should be converted to U. S. dollars using the exchange rate
applicable at the time the expense was incurred.

When we need more information Please reply promptly when we ask for additional information. We may delay processing or deny your claim if you do not respond. 57
57 Page 58 59
2001 Association Benefit Plan 56 Section 8
Section 8. The disputed claims process
Follow this Federal Employees Health Benefits Program disputed claims process if you disagree with our decision on
your claim or request for services, drugs, or supplies – including a request for preauthorization/ prior approval:

Step Description
1 Ask us in writing to reconsider our initial decision. You must: (a) Write to us within 6 months from the date of our decision; and

(b) Send your request to us at: Association Benefit Plan, PO Box 668587, Charlotte, NC 28266-8587;
and

(c) Include a statement about why you believe our initial decision was wrong, based on specific
benefit provisions in this brochure; and

(d) Include copies of documents that support your claim, such as physicians' letters, operative
reports, bills, medical records, and explanation of benefits (EOB) forms.

2 We have 30 days from the date we receive your request to: (a) Pay the claim (or arrange for the health care provider to give you the care); or

(b) Write to you and, if applicable, maintain our denial— go to step 4; or
(c) Ask you or your provider for more information. If we ask your provider, we will send you a
copy of our request— go to step 3.

3 You or your provider must send the information so that we receive it within 60 days of our request. We will then decide within 30 more days.
If we do not receive the information within 60 days, we will decide within 30 days of the date the informa-tion
was due. We will base our decision on the information we already have.

We will write to you with our decision.

4 If you do not agree with our decision, you may ask OPM to review it. You must write to OPM within:

° 90 days after the date of our letter upholding our initial decision; or
° 120 days after you first wrote to us— if we did not answer that request in some way within 30 days; or
° 120 days after we asked for additional information.
Write to OPM at: Office of Personnel Management, Office of Insurance Programs, Contracts Division II,
PO Box 436, Washington, DC 20044-0436. 58
58 Page 59 60
2001 Association Benefit Plan 57 Section 8
NOTE: If you have a serious or life threatening condition (one that may cause permanent loss of bodily functions or
death if not treated as soon as possible), and

a) We haven't responded yet to your initial request for care or preauthorization/ prior approval, then call us at 1-800-634-0069
and we will expedite our review; or

b) We denied your initial request for care or preauthorization/ prior approval, then:

If we expedite our review and maintain our denial, we will inform OPM so that they can give your claim expedited treatment too, or

You can call OPM's Health Benefits Contracts Division II at 202/ 606-3818 between 8 a. m. and 5 p. m. eastern time.

The Disputed Claims process (Continued)
Send OPM the following information:
° A statement about why you believe our decision was wrong, based on specific benefit provisions in this
brochure;

° Copies of documents that support your claim, such as physicians' letters, operative reports, bills, medical
records, and explanation of benefits (EOB) forms;

° Copies of all letters you sent to us about the claim;
° Copies of all letters we sent to you about the claim; and
° Your daytime phone number and the best time to call.
Note: If you want OPM to review different claims, you must clearly identify which documents apply to
which claim.

Note: You are the only person who has a right to file a disputed claim with OPM. Parties acting as your rep-resentative,
such as medical providers, must provide a copy of your specific written consent with the review
request.

Note: The above deadlines may be extended if you show that you were unable to meet the deadline because
of reasons beyond your control.

5 OPM will review your disputed claim request and will use the information it collects from you and us to decide whether our decision is correct. OPM will send you a final decision within 60 days. There are no
other administrative appeals.

6 If you do not agree with OPM's decision, your only recourse is to sue. 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, drugs, or supplies. This is the only deadline that may not be extended.
OPM may disclose the information it collects during the review process to support their disputed claim deci-sion.
This information will become part of the court record.

You may not sue until you have completed the disputed claims process. Further, Federal law governs your
lawsuit, benefits, and payment of benefits. The Federal court will base its review on the record that was
before OPM when OPM decided to uphold or overturn our decision. You may recover only the amount of
benefits in dispute. 59
59 Page 60 61
2001 Association Benefit Plan 58 Section 9
Section 9. Coordinating benefits with other coverage
When you have other health
coverage
You must tell us if you or a family member is covered under another group
health plan or has automobile insurance that pays health care expenses
without regard to fault. This is called "double coverage."

When you have double coverage, one plan normally pays its benefits in full
as the primary payer and the other plan pays a reduced benefit as the sec-ondary
payer. We, like other insurers, determine which coverage is primary
according to the National Association of Insurance Commissioners' guide-lines.

When we are the primary payer, we will pay the benefits described in this
brochure.

When we are the secondary payer, we will determine our allowance. After
the primary plan pays, we will pay what is left of our allowance, up to our
regular benefit. We will not pay more than our allowance.

° What is Medicare Medicare is a Health Insurance Program for:
° People 65 years of age and older.
° Some people with disabilities, under 65 years of age.
° People with End-Stage Renal Disease (permanent kidney failure requir-ing
dialysis or a transplant.

Medicare has two parts:
° Part A (Hospital Insurance). Most people do not have to pay for Part A.
° Part B (Medical Insurance). Most people pay monthly for Part B.
If you are eligible for Medicare, you may have choices in how you get your
health care. Medicare+ Choice is the term used to describe the various
health plan choices available to Medicare beneficiaries. The information in
the next few pages shows how we coordinate benefits with Medicare,
depending on the type of Medicare+ Choice plan you have.

° The Original Medicare Plan The Original Medicare Plan is available everywhere in the United States. It is the way most people get their Medicare Part A and Part B benefits. You

may go to any physician, specialist, or hospital that accepts Medicare.
Medicare pays its share and you pay your share. Some things are not cov-ered
under Original Medicare, like prescription drugs.

When you are enrolled in this Plan and Original Medicare, you still need to
follow the rules in this brochure for us to cover your care.

Claims process— You probably will never have to file a claim form when
you have both our Plan and Medicare.

° When we are the primary payer, we process the claim first. 60
60 Page 61 62
2001 Association Benefit Plan 59 Section 9
° When Original Medicare is the primary payer, Medicare processes your
claim first. In most cases, your claims will be coordinated automatically
and we will pay the balance of covered charges. You will not need to do
anything. To find out if you need to do something about filing your
claims, call us at 1-800-634-0069.

° We waive some costs when you have Medicare— When Medicare is
the primary payer, we will waive some out-of-pocket costs, as follows:

° If you are enrolled in Medicare Part B, we will waive copayments and
coinsurance for medical services and supplies provided by physicians
and other health care professionals. We will also waive deductibles and
coinsurance for extended dental treatment for accidental dental injuries.

° If you are enrolled in Medicare Part A, we will waive hospital copay-ments
and coinsurance. 61
61 Page 62 63
2001 Association Benefit Plan 60 Section 9
The following chart illustrates whether Original Medicare or this Plan should be the primary payer for you according to
your employment status and other factors determined by Medicare. It is critical that you tell us if you or a covered family
member has Medicare coverage so we can administer these requirements correctly.

Primary Payer Chart
A. When either you— or your covered spouse— are age 65 or over and … Then the primary payer is…
Original Medicare This Plan
1) Are an active employee with the Federal government (including
when you or a family member are eligible for Medicare solely
because of a disability),

2) Are an annuitant,
3) Are a reemployed annuitant with the Federal government when…

a) The position is excluded from FEHB,
or……………………………

b) The position is not excluded from
FEHB……………………………………………………………

Ask your employing office which of these applies to you.
1) Are a Federal judge who retired under title 28, U. S. C., or a Tax Court
judge who retired under Section 7447 of title 26, U. S. C. (or if your
covered spouse is this type of judge),

2) Are enrolled in Part B only, regardless of your employment status,

(for Part B services) (for other
services)

3) Are a former Federal employee receiving Workers' Compensation
and the Office of Workers' Compensation Programs has determined
that you are unable to return to duty, (except for claims related to Workers'

Compensation.)
B. When you— or a covered family member— have Medicare based on
end stage renal disease (ESRD) and…

1) Are within the first 30 months of eligibility to receive Part A benefits
solely because of ESRD,

2) Have completed the 30-month ESRD coordination period and are
still eligible for Medicare due to ESRD,

3) Become eligible for Medicare due to ESRD after Medicare became
primary for you under another provision,

C. When you or a covered family member have FEHB and…
1) Are eligible for Medicare based on disability, and

a) Are an annuitant, or………………………………………………
b) Are an active employee………………………………………….. 62
62 Page 63 64
2001 Association Benefit Plan 61 Section 9
° Medicare managed care
plan
If you are eligible for Medicare, you may choose to enroll in and get your
Medicare benefits from a Medicare managed care plan. These are health
care choices (like HMOs) in some areas of the country. In most Medicare
managed care plans, you can only go to doctors, specialists, or hospitals
that are part of the plan. Medicare managed care plans cover all Medicare
Part A and B benefits. Some cover extras, like Prescription drugs. To learn
more about enrolling in a Medicare managed care plan, contact Medicare at
1-800-MEDICARE (1-800-633-4227) or at www. medicare. gov. If you
enroll in a Medicare managed care plan, the following options are available
to you:

This Plan and another Plan's Medicare managed care plan: You
may enroll in another plan's Medicare managed care plan and also remain
enrolled in our FEHB plan. We will still provide benefits when your
Medicare managed care plan is primary, even out of the managed care
plan's network and/ or service area, but we will not waive any of our
copayments, coinsurance, or deductibles.

Suspended FEHB coverage and a Medicare managed care plan: If you
are an annuitant or former spouse, you can suspend your FEHB coverage to
enroll in a Medicare managed care plan, eliminating your FEHB premium.
(OPM does not contribute to your Medicare managed care plan premium.)
For information on suspending your FEHB enrollment, 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 unless you
involuntarily lose coverage or move out of the Medicare managed care
plan's service area.

° Private Contract A physician may ask you to sign a private contract agreeing that you can be billed directly for service ordinarily covered by Original Medicare. Should

you sign an agreement, Medicare will not pay any portion of the charges,
and we will not increase our payment. We will still limit our payment to the
amount we would have paid after Original Medicare's payment.

° Enrollment in Medicare
Part B
Note: We cannot require you to enroll in Medicare. If you choose not to
enroll in Medicare Part B, you can still be covered under the FEHB
Program.

TRICARE TRICARE is the health care program for eligible dependents of military persons and retirees of the military. TRICARE includes the CHAMPUS
program. If both TRICARE and this Plan cover you, we pay first. 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 determines they must provide; or 63
63 Page 64 65
2001 Association Benefit Plan 62 Section 9
° OWCP or a similar agency pays for through a third party injury settle-ment
or other similar proceeding that is based on a claim you filed under
OWCP or similar laws.

Once OWCP or similar agency pays its maximum benefits for your treat-ment,
we will cover your benefits.

Medicaid When you have this Plan and Medicaid, we pay first.
When other Government
agencies are responsible for
your care

We do not cover services and supplies when a local, State, or Federal
Government agency directly or indirectly pays for them.

When others are responsible
for injuries
When you receive money to compensate you for medical or hospital care
for injuries or illness caused by another person, you must reimburse us for
any expenses we paid. However, we will cover the 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 sub-rogation.
If you need more information, contact us for our subrogation pro-cedures. 64
64 Page 65 66
2001 Association Benefit Plan 63 Section 10
Section 10. Definitions of terms we use in this brochure
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 Your authorization for the Plan to issue payment of benefits directly to the provider. We reserve 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.

Coinsurance Coinsurance is the percentage of our allowance that you must pay for your care. You may also be responsible for additional amounts. See page 12.

Confinement An admission (or series of admissions separated by less than 60 days) to a hospital as an inpatient for any one illness or injury. There is a new
confinement when an admission is:
1) for a cause entirely unrelated to the cause for the previous
admission;

2) for an enrolled employee who returns to work for at least one day
before the next admission; or

3) for a dependent or annuitant when confinements are separated by
at least 60 days.

Congenital anomalies A condition existing at or from birth that is a significant deviation from the common form or anomaly norm. For purposes of this Plan, congenital
includes protruding ear deformities, cleft lips, cleft palates, webbed fingers
or toes, and other conditions that we may determine to be congenital anom-alies.
In no event will the term congenital anomaly include conditions relat-ing
to teeth or intra-oral structures supporting the teeth.

Copayment A copayment is a fixed amount of money you pay when you receive cov-ered services. See page 12.

Cosmetic surgery Any operative procedure or any portion of a procedure performed prima-rily to improve physical appearance and/ or treat a mental condition through
a change in bodily form.

Covered services Services we provide benefits for, as described in this brochure.
Custodial care Treatment or services, regardless of who recommends them or where they are provided, that could be provided safely and reasonably by a person who
is not medically skilled, or are designed mainly to help the patient with
daily living activities. These activities include but are not limited to: 65
65 Page 66 67
2001 Association Benefit Plan 64 Section 10
1) personal care such as help in: walking; getting in or 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 a companion or sitter;
5) supervising medication that can usually be self administered; or
6) treatment services such as recording temperature, pulse, and
respirations, or administration and monitoring of feeding systems.

Deductible A deductible is a fixed amount of covered expenses you must incur for cer-tain covered services and supplies before we start paying benefits for those
services. See page 12.

Effective date The date the benefits described in this brochure are effective:
1) January 1 for continuing enrollments and for all annuitant enroll-ments;

2) the first day of the first full pay period of the new year for enroll-ees
who change plans or options or elect FEHB coverage during
Open Season for the first time; or

3) for new enrollees during the calendar year, but not during Open
Season, the effective date of enrollment as determined by your
employing office or retirement system.

Experimental or
investigational services
A drug, device, or biological product is experimental or investigational if it
cannot lawfully be marketed without approval of the U. S. Food and Drug
Administration (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 deter-mine
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 is
that further studies or clinical trials are necessary to determine its maxi-mum
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 proto-cols
used by the treating facility or the protocol( s) of another facility study-ing
substantially the same drug, device, 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, or medical treatment
or procedure.

Group health coverage Health care coverage that you are eligible for because of employment, membership in, or connection with, a particular organization or group that
provides payment for hospital, medical or other health care service or sup-plies,
or that pays a specific amount for each day or period hospitalization. 66
66 Page 67 68
2001 Association Benefit Plan 65 Section 10
Home health care agency A public agency or private organization under Medicare that is licensed as a home health care agency by the State and is certified as such.
Home health care plan A plan of continued care and treatment when you are under the care of a physician, and when certified by the physician that, without the home
health care, confinement in a hospital or skilled nursing facility would be
required.

Hospice care program A coordinated program of home and inpatient pain control and supportive care for the terminally-ill patient and the patient's family. Care is provided
by a medically supervised team under the direction of an independent
hospice administration that we approve.

Intensive outpatient Program
(IOP)
IOPs offer time-limited services that are coordinated, structured, and
intensively therapeutic. Such programs are designed to treat a variety of
individuals with moderate to marked impairment in at least one area of
daily life resulting from psychiatric or addictive disorders. At a minimum,
IOPs offer three to four hours of active treatment per day at least two to
three days per week.

Medical necessity Services, drugs, supplies, or equipment provided by a hospital or covered provider of health care services that we determine:

1) are appropriate to diagnose or treat your 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 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/
substance abuse
Conditions and diseases listed in the most recent edition of the Interna-tional
Classification of 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.

Plan allowance Our Plan allowance is the amount we use to determine our payment and your coinsurance for covered services. Fee-for-service plans determine
their allowances in different ways. We determine our allowance as follows: 67
67 Page 68 69
2001 Association Benefit Plan 66 Section 10
Twice a year the Health Insurance Association of America (HIAA) com-piles
actual claims received in each Zip Code area throughout the United
States. HIAA guides are applied at the 90 th percentile to surgery, physician
services, therapy, X-ray and lab expenses.

PPO providers accept the plan allowance as payment in full.
For more information, see Section 4, Differences between our allowance
and the bill.

Partial hospitalization A time-limited, ambulatory, active treatment program that offers therapeu-tically intensive, coordinated, and structured clinical services with a stable
therapeutic environment. At a minimum, 20 hours of scheduled program-ming
extended over a minimum of five days per week will be provided by
a partial hospitalization program that is either licensed or JCAHO accred-ited.

Routine physical examination A complete evaluation, including a comprehensive history and physical examination, without symptoms or illness.
Sound natural tooth A tooth that is whole or properly restored and is without impairment, peri-odontal, or other conditions and is not in need of the treatment provided for
any other reason other than an accidental injury.

Us/ We Us and we refer to the Association Benefit Plan
You You refers to the enrollee and each covered family member. 68
68 Page 69 70
2001 Association Benefit Plan 67 Section 11
Section 11. FEHB facts
No pre-existing condition
limitation
We will not refuse to cover the treatment of a condition that you had before
you enrolled in this Plan solely because you had the condition before you
enrolled.

Where you can get information
about enrolling in the
FEHB Program

See www. opm. gov/ insure. Also, your employing or retirement officecan
answer your questions, and give you a Guide to Federal Employees Health
Benefits Plans, brochures for other plans, and other materials you need to
make an informed decision about:

° 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
° When the next open season for enrollment begins.
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.

Types of coverage available
for you and your family
Self Only coverage is for you alone. Self and Family coverage is for you,
your spouse, and your unmarried dependent children under age 22,
including any foster children or stepchildren your employing or retirement
office authorizes coverage for. Under certain circumstances, you may also
continue coverage for a disabled child 22 years of age or older who is
incapable of self-support. In order to determine qualification, a medical
certificate must state your child is incapable of self support. The medical
certificate must be submitted to your employing office at least 60 days
prior to your child reaching age 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 that event. The Self
and Family enrollment begins on the first day of the pay period in which
the child is born or becomes an eligible family member. When you change
to Self and Family because you marry, the change is effective on the first
day of the pay period that begins after your employing office receives your
enrollment form; benefits will not be available to your spouse until you
marry.

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, or when your child under age
22 marries or turns 22. 69
69 Page 70 71
2001 Association Benefit Plan 68 Section 11
If you or one of your family members is enrolled in one FEHB plan, that
person may not be enrolled in or covered as a family member by another
FEHB plan.

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

Your medical and claims
records are confidential
We will keep your medical and claims information confidential. Only the
following will have access to it:

° 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 claim or defending litigation about a
claim.

When you retire When you retire, you can usually stay in the FEHB Program. Generally, you must have been 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 (TCC).

When you lose benefits
° When FEHB coverage ends You will receive an additional 31 days of coverage, for no additional premium, when:

°° Your enrollment ends, unless you cancel your enrollment, or
°° You are a family member no longer eligible for coverage.
You may be eligible for spouse equity coverage or Temporary Continuation
of Coverage.

° Spouse equity coverage If you are divorced from a Federal employee or annuitant, you may not continue to get benefits 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 RI 70-5, the Guide to
Federal Employees Health Benefits Plans for Temporary Continuation of
Coverage and Former Spouse Enrollees, or other information about your
coverage choices.

° 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 Temporary Continua-tion

of Coverage (TCC). For example, you can receive TCC if you are not
able to continue your FEHB enrollment after you retire. 70
70 Page 71 72
2001 Association Benefit Plan 69 Section 11
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 or from www. opm. gov/ insure.

° Converting to
individual coverage
You may convert to a non-FEHB individual policy if:

°° Your coverage under TCC or the spouse equity law ends. If you can-celed
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 of your
right to convert. 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.

Getting a Certificate of
Group Health Plan Coverage
If you leave the FEHB Program, your employing or retirement office will
give you a Certificate of Group Health Plan Coverage that indicates how
long you have been enrolled with us. You can use this certificate when
getting health insurance or other health care coverage. Your new plan must
reduce or eliminate waiting periods, limitations, or exclusions for health
related conditions based on the information in the certificate, as long as you
enroll within 63 days of losing coverage under this Plan.

If you have been enrolled with us for less than 12 months, but were previ-ously
enrolled in other FEHB plans, you may also request a certificate from
those plans.

Inspector General Advisory Stop health care fraud! Fraud increases the cost of health care for every-one. 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 1-800-634-0069
and explain the situation. 71
71 Page 72 73
2001 Association Benefit Plan 70 Section 11
° If we do not reslove the issue, call THE HEALTH CARE FRAUD
HOTLINE— 202/ 418-3300 or write to: The United States Office of
Personnel Management, Office of the Inspector General Fraud Hotline,
1900 E Street, NW, Room 6400, Washington, DC 20415.

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 the person tries to obtain services for someone who
is not eligible family member, or is no longer enrolled in the Plan and
tries to obtain benefits. Your agency may also take administrative action
against you. 72
72 Page 73 74
2001 Association Benefit Plan 71 Index
Index
Do not rely on this page; it is for your convenience and does not explain your benefit coverage.
Accidental injury 39
Allergy tests 23
Alternative treatment 29
Ambulance 38, 40
Anesthesia 34
Autologous bone marrow transplant
33
Biopsies 30
Birthing centers 8
Blood and blood plasma 35
Breast cancer screening 19
Carryover 8
Casts 26
Catastrophic protection 13
Changes for 2001 5
Chemotherapy 24
Childbirth 20
Cholesterol tests 19
Circumcision 20
Claims 54
Coinsurance 12
Colorectal cancer screening 19
Congenital anomalies 30
Contraceptive devices and drugs 47
Coordination of benefits 58
Covered charges 6
Covered providers 6
Crutches 27
Deductible 12
Definitions 63
Dental care 50
Diagnostic services 19
Disputed claims review 56
Donor expenses (transplants) 33
Dressings 37
Durable medical equipment 27
Educational classes and programs 29
Effective date of enrollment 64
Emergency 39
Experimental or investigational 64
Eyeglasses 25
Family planning 22
Fecal occult blood test 19
Flexible benefits option 49
Foot care 26
Freestanding ambulatory facilities
37
General Exclusions 53

Hearing services 25
Home health services 28
Hospice care 38
Home nursing care 28
Hospital 7
Immunizations 20
Independent laboratories 19
Infertility 22
Inhospital physician care 19
Inpatient Hospital Benefits 35
Insulin 46
Laboratory and pathological services
19
Machine diagnostic tests 19
Magnetic Resonance Imagings
(MRIs) 19
Mail Order Prescription Drugs 47
Mammograms 19
Maternity Benefits 20
Medicaid 62
Medically necessary 65
Medically underserved areas 7
Medicare 58
Members 66
Mental Conditions/ Substance Abuse
Benefits 44
Neurological testing 19
Newborn care 20
Non-FEHB Benefits 52
Nurse 6
Licensed Practical Nurse 6
Nurse Anesthetist 6
Nurse Midwife 6
Nurse Practitioner 6
Psychiatric Nurse 6
Registered Nurse 6
Nursery charges 21
Nursing School Administered Clinic
7
Obstetrical care 20
Occupational therapy 24
Ocular injury 25
Office visits 18
Oral and maxillofacial surgery 33
Orthopedic devices 26
Ostomy and catheter supplies 46
Out-of-pocket expenses 13
Outpatient facility care 37

Overseas claims 55
Oxygen 27
Pap test 19
Physical examination 19
Physical therapy 24
Physician 6
Pre-admission testing 18
Precertification 9
Preferred Provider Organization
(PPO) 4
Prescription drugs 46
Preventive care, adult 19
Preventive care, children 19
Prior approval 9
Prostate cancer screening 19
Prosthetic devices 26
Psychologist 6
Psychotherapy 44
Radiation therapy 24
Rehabilitative therapies 24
Renal dialysis 24
Room and board 35
Second surgical opinion 18
Skilled nursing facility care 37
Smoking cessation 29
Social Worker 6
Speech therapy 24
Splints 27
Sterilization procedures 22
Subrogation 62
Substance abuse 44
Surgery 30
° Anesthesia 34
° Assistant surgeon 31
° Multiple procedures 31
° Oral 33
° Outpatient 30
° Reconstructive 32
Syringes 46
Temporary continuation of coverage
68
Transplants 33
Treatment therapies 24
Vision services 25
Well child care 20
Wheelchairs 27
Wor kers' compensation 61
X-rays 19 73
73 Page 74 75
2001 Association Benefit Plan 72 Index 74
74 Page 75 76
2001 Association Benefit Plan 72 Summary of benefits 2001
Summary of benefits for the Association Benefit Plan -2001.
° Do not rely on this chart alone. All benefits are subject to the definitions, limitations, and exclusions in this bro-chure.
On this page we summarize specific expenses we cover; for more detail, look inside.

° If you want to enroll or change your enrollment in this Plan, be sure to put the correct enrollment code from the cover
on your enrollment form.

° Below, an asterisk (*) means the item is subject to the $250 calendar year deductible. And, after we pay, you gener-ally
pay any difference between our allowance and the billed amount.

Benefits You Pay Page
Medical services provided by physicians:
° Diagnostic and treatment services provided in the
office…………………………………

PPO: $10 copayment
Non-PPO: 25% of our allowance
Out-of-Network: 15% of our allowance

17

Services provided by a hospital:
° Inpatient………………………………..
PPO: Nothing
Non-PPO: $100 admission; 25% of
charges

Out-of-Network: $100 admission

35

° Outpatient……………………………... PPO: 10%* of our allowance
Non-PPO: 25%* of our allowance
Out-of-Network: 15%* of our allowance

37

Emergency benefits: Within 96 hours: 100% of our allowance
for outpatient care
39

° Accidental injury……………………………… After 96 hours: regular benefits 40
° Medical emergency…………………………… Regular benefits 40
Mental health and substance abuse treatment…… PPO: Regular cost sharing
Non-PPO: Benefits are limited
Out-of-Network: Regular cost sharing

41
44
44

Prescription drugs………………………………… Retail copay: $10 generic, $20 formulary,
$30 brand name

Mail order: $15 generic, $30 formulary,
$45 brand name

Medicare copays
Overseas retail: 20%*

46

Dental care……………………………………… Routine exams and fillings; fee schedule 50
Special features…………………………………… Hospice care
Home health services
Preventative care
Ambulance
Skilled nursing facilities

38
28
19
38
38

Protection against Catastrophic costs……………
(your out-of-pocket maximum)
PPO: Nothing after $2, 000/ Self Only or
Family enrollment per year
Non-PPO: Nothing after $3, 000/ Self
Only or Family enrollment per year
Out-of-network: Nothing after $2, 000/
Self Only or Family enrollment per year
Some costs do not count toward this
protection

13 75
75 Page 76 77
2001 Association Benefit Plan 73 Rates 2001
2001 Rate Information for Association Benefit Plan
FEHB benefits of this Plan are described in the Association Benefit Plan brochure
Premium Premium
Biweekly Monthly
Type of
Enrollment
Code Gov't
Share
Your
Share
Gov't
Share
Your
Share

Self 421 $86.59 $40.95 $187. 61 $88. 73
Self and Family 422 $195.82 $97.96 $424. 28 $212. 24 76
76 Page 77 78
NOTES 77
77 Page 78
NOTES 78

Page Navigation Panel