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Document Outline

Table of Contents
Introduction
Plain Language
Inspector General Advisory
Section 1. Facts about this HMO plan

How we pay providers
Your Rights
Service Area

Section 2. How we change for 2002

Program-wide changes
Changes to this Plan

Section 3. How you get care

Identification cards
Where you get covered care

Plan providers
Plan facilities

What you must do to get covered care

Primary care
Specialty care
Hospital care

Circumstances beyond our control
Services requiring our prior approval

Section 4. Your costs for covered services

Copayments
Deductible
Coinsurance
Your out-of-pocket maximum

Section 5. Benefits -- OVERVIEW

(a). Medical services and supplies provided by physicians
(b). Surgical and anesthesia services provided by physicians
(c). Services provided by a hospital or other facility,
(d). Emergency services/accidents
(e). Mental health and substance abuse benefits
(f). Prescription drug benefits
(g). Special features

Flexible benefits option

(h). Dental benefits
(i). Non-FEHB benefits available to Plan members

Section 6. General exclusions -- things we don't cover
Section 7. Filing a claim for covered services
Section 8. The disputed claims process
Section 9. Coordinating benefits with other coverage

When you have

Other health coverage
The Original Medicare Plan
Medicare managed care plan

TRICARE
Workers Compensation
Medicaid
Other Government agencies
When others are responsible for injuries

Section 10. Definitions of terms we use in this brochure
Section 11. FEHB facts

Coverage Information

No pre-existing condition limitation
Where you can get information about enrolling in the FEHB Program
Types of coverage available for you and your family
When benefits and Premiums start
Your medical and claims records are confidential
When you retire

When you lose benefits

When FEHB coverage ends
Spouse equity coverage
Temporary continuation of coverage (TCC)
Converting to individual coverage
Getting a Certificate of Group Health Plan Coverage

Index
Summary of benefits for Health Alliance Plan - 2002
2002 Rate Information for Health Alliance Plan

Pages 1--52 from Health Alliance Plan

Page 1 2

Health Alliance Plan http:/ www. hapcorp. org 2002
Serving: Detroit and Southeastern Michigan
Enrollment in this Plan is limited. You must live or work in our geographic area to enroll. See page 6 for requirements.

Enrollment codes for this Plan:
521 Self Only 522 Self and Family

This Plan has Excellent accreditation from
NCQA. See the 2002 Guide for more
information on NCQA.

RI 73-015

A Health Maintenance Organization 1
1 Page 2 3

Summary of benefits ..................................................................................................................................................................... 51
Rates .............................................................................................................................................................................. Back cover 3
3 Page 4 5

4 Page 5 6
2002 Health Alliance Plan 5 Introduction/ Plain Language
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 an 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. 5
5 Page 6 7

2002 Health Alliance Plan 6 Section 1
Section 1. Facts about this HMO plan
This Plan is a health maintenance organization (HMO). We require you to see specific physicians, hospitals, and other providers that
contract with us. These Plan providers coordinate your health care services.

HMOs emphasize preventive care such as routine office visits, physical exams, well-baby care, and immunizations, in addition to
treatment for illness and injury. Our providers follow generally accepted medical practice when prescribing any course of treatment.

When you receive services from Plan providers, you will not have to submit claim forms or pay bills. You only pay the copayments,
coinsurance, and deductibles described in this brochure. When you receive emergency services from non-Plan providers, you may
have to submit claim forms.

You should join an HMO because you prefer the plan's benefits, not because a particular provider is available. You cannot change plans because a provider leaves our Plan. We cannot guarantee that any one physician, hospital, or other provider will
be available and/ or remain under contract with us.
How we pay providers
We contract with individual physicians, medical groups, and hospitals to provide the benefits in this brochure. These Plan providers
accept a negotiated payment from us, and you will only be responsible for your copayments.

Your Rights
OPM requires all FEHB Plans to provide certain information to their FEHB members You may get information about us, our
networks, providers and facilities. OPM's FEHB website (www. opm. gov/ insure) lists the specific types of information that we must
make available to you. Some of the required information is listed below.

The Plan is federally-qualified and licensed by the State of Michigan as an HMO.
The Plan has been licensed as an HMO since 1979.
The Plan is a Michigan non-profit corporation.
If you want more information about us, call 313/ 872-8100 or 800/ 422-4641, or write to HAP at 2850 West Grand Boulevard, Detroit,
MI 48202. You may also visit our website at www. hapcorp. org.

Service Area
To enroll in this Plan, you must live in or work in our Service Area. This is where our providers practice. Our service areas include
Genesee, Lapeer, Livingston, Macomb, Monroe, Oakland, St. Clair, Washtenaw and Wayne Counties.

Ordinarily, you must get your care from providers who contract with us. If you receive care outside our service area, we will pay only
for emergency care. We will not pay for any other health care services out of our service area unless the services have prior plan
approval.

If you or a covered family member move outside of our service area, you can enroll in another plan. If your dependents live out of the
area (for example, if your child goes to college in another state), you should consider enrolling in a fee-for-service plan or an HMO
that has agreements with affiliates in other areas. If you or a family member move, you do not have to wait until Open Season to
change plans. Contact your employing or retirement office. 6
6 Page 7 8
2002 Health Alliance Plan 7 Section 2
Section 2. How we change for 2002
Do not rely on these change descriptions; this page is not an official statement of benefits. For that, go to Section 5 Benefits. Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change
benefits.
Program-wide changes
We changed the address for sending disputed claims to OPM. (Section 8)
Changes to this Plan
Your share of the non-Postal premium will increase by 29.4% for Self Only or 64.8% for Self and Family.

We changed speech therapy benefits by removing the requirement that services must be required to restore functional speech. (Section 5 (a))

We no longer limit total blood cholesterol tests to certain age groups. (Section 5( a))
We not cover certain intestinal transplants. (Section 5 (b))

We clarified the Preventive care, adult benefits by removing the entry for blood lead level testing for adults because it is a test more typically done for children. (Section 5( a)) 7
7 Page 8 9

2002 Health Alliance Plan 8 Section 3
Section 3. How you get care
Identification cards We will send you an identification (ID) card when you enroll. You should carry your ID card with you at all times. You must show it whenever you receive services from a Plan
provider, or fill a prescription at a Plan pharmacy. Until you receive your ID card, use
your copy of the Health Benefits Election Form, SF-2809, your health benefits
enrollment confirmation (for annuitants), or your Employee Express confirmation letter.

If you do not receive your ID card within 30 days after the effective date of your
enrollment, or if you need replacement cards, call us at 313/ 872-8100 or
800/ 422-4641.

Where you get covered care You get care from "Plan providers" and "Plan facilities." You will only pay copayments, and you will not have to file claims.

Plan providers Plan providers are physicians (internists, family practicioners, general practitioners, pediatricians or specialists) and other health care professionals in our service area that we
contract with to provide covered services to our members. We credential Plan providers
according to national standards, National Committee on Quality Assurance standards and
other applicable regulatory bodies.

We list Plan providers in the provider directory, which we update periodically. The list is
also on our website.

Plan facilities Plan facilities are hospitals and other facilities in our service area that we contract with to provide covered services to our members. We list these in the provider directory, which
we update periodically. The list is also on our website.
It depends on the type of care you need. First, you and each family member must choose
a primary care physician. This decision is important since your primary care physician
provides or arranges for most of your health care.

We offer the flexibility of selecting a PCP based on your needs. You may want to select
a PCP located near your work, while a physician close to school or home is better for
your children. Physician profiles are available through the Member Services
Department's computerized system called "PCPSelect." When you call Member
Services, a PCP Selection Assistant will assist you with finding a PCP based on your
personal preferences. Simply call our toll-free PCPSelect line at: 888/ PIC-A-PCP or
888/ 742-2727. You may also select a PCP using out on-line PCPSelect services. Visit
HAP's website at www. hapcorp. org and choose "PCPSelect On-Line."

Primary care Your primary care physician can be a family practitioner, internist, general practitioner, or pediatrician. Your primary care physician will provide most of your health care, or
give you a referral to see a specialist.
If you want to change primary care physicians or if your primary care physician leaves
the Plan, call us. We will help you select a new one.

Specialty care Your primary care physician will refer you to a specialist for needed care. When you receive a referral from your primary care physician, you must return to the primary care
physician after the consultation, unless your primary care physician authorized a certain
number of visits without additional referrals. The primary care physician must provide or
authorize all follow-up care. Do not go to the specialist for return visits unless your
primary care physician gives you a referral. However, you may see an obstetrician-gynecologist
for an annual office visit and routine ob-gyn care without a referral.

What you must do
to get covered care 8
8 Page 9 10
2002 Health Alliance Plan 9 Section 3
Here are other things you should know about specialty care:
If you need to see a specialist frequently because of a chronic, complex, or serious medical condition, your primary care physician will work with a specialist to develop
a treatment plan that allows you to see your specialist for a certain number of visits
without additional referrals. Your primary care physician will use our criteria when
creating your treatment plan (the physician may have to get an authorization or
approval beforehand).

If you are seeing a specialist when you enroll in our Plan, talk to your primary care physician. Your primary care physician will decide what treatment you need. If he or
she decides to refer you to a specialist, ask if you can see your current specialist. If
your current specialist does not participate with us, you must receive treatment from a
specialist who does. Generally, we will not pay for you to see a specialist who does
not participate with our Plan.

If you are seeing a specialist and your specialist leaves the Plan, call your primary care physician, who will arrange for you to see another specialist. You may receive
services from your current specialist until we can make arrangements for you to see
someone else.

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; or

--reduce our service area 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 Your Plan primary care physician or specialist will make necessary hospital arrangements and supervise your care. This includes admission to a skilled nursing or other type of
facility.
If you are in the hospital when your enrollment in our Plan begins, call our customer
service department immediately at 313/ 872-8100 or 800/ 422-4641. If you are new to the
FEHB Program, we will arrange for you to receive care.

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.
These provisions apply only to the benefits of the hospitalized person. 9
9 Page 10 11
2002 Health Alliance Plan 10 Section 3
Circumstances beyond our control Under certain extraordinary circumstances, such as natural disasters, we may have to delay your services or we may be unable to provide them. In that case, we will make all
reasonable efforts to provide you with the necessary care.
Your primary care physician has authority to refer you for most services. For certain
services, however, your physician must obtain approval from us. Before giving approval,
we consider if the service is covered, medically necessary, and follows generally
accepted medical practice.

We call this review and approval process precertification. Your physician must obtain
precertification for the following services such as:

Select Outpatient procedures
Diagnostic tests
Home Care services
Durable medical equipment
Inpatient care Mental Health and Substance Abuse (MH/ SA)

Failure to obtain precertification may result in financial liability on behalf of the member
or the provider.

Physicians may contact us by phone, fax or electronically to submit new requests or to
seek a renewal or extension of an existing referral.

Services requiring our
prior approval 10
10 Page 11 12
2002 Health Alliance Plan 11 Section 4
Section 4. Your costs for covered services
You must share the cost of some services. You are responsible for:
Copayments A copayment is a fixed amount of money you pay to the provider when you receive services.

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

Deductible We do not have a deductible.
Coinsurance We do not have coinsurance.

Your catastrophic protection We do not have an out-of-pocket maximum.
out-of-pocket maximum for deductibles, coinsurance, and

copayments 11
11 Page 12 13

2002 Health Alliance Plan 12 Section 5
Section 5. Benefits --OVERVIEW
(See page 7 for how our benefits changed this year and page 51 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 313/ 872-8100 or 800/ 422-4641 or at our
website at www. hapcorp. org .

(a) Medical services and supplies provided by physicians and other health care professionals..................................................... 13-21
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
Physical and occupational therapies

Speech therapy
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
Chiropractic
Alternative treatments
Educational classes and programs

(b) Surgical and anesthesia services provided by physicians and other health care professionals............................................... 22-25

Surgical procedures
Reconstructive surgery
Oral and maxillofacial surgery
Organ/ tissue transplants
Anesthesia

(c) Services provided by a hospital or other facility, and ambulance services ........................................................................... 26-27
Inpatient hospital
Outpatient hospital or ambulatory surgical center
Extended care benefits/ skilled nursing care facility benefits
Hospice care
Ambulance

(d) Emergency services/ accidents ........................................................................................................................................... 28-29
Medical emergency Ambulance

(e) Mental health and substance abuse benefits ....................................................................................................................... 30-31
(f) Prescription drug benefits.................................................................................................................................................. 32-33
(g) Special features ..................................................................................................................................................................... 34
Flexible benefits option

(h) Dental benefits....................................................................................................................................................................... 35
(i) Non-FEHB benefits available to Plan members ..................................................................................................................... 36
Summary of benefits ..................................................................................................................................................................... 51 12
12 Page 13 14
2002 Health Alliance Plan 13 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 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.

Plan physicians must provide or arrange your care.
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.

I M
P O
R T
A N
T

Benefit Description You pay
Diagnostic and treatment services
Professional services of physicians
In physician's office

$10 per office visit

Professional services of physicians
In an urgent care center
During a hospital stay
In a skilled nursing facility
Office medical consultations
Second surgical opinion

$10 per office visit

At home Nothing
Diagnostic and treatment services --continued on next page 13
13 Page 14 15
2002 Health Alliance Plan 14 Section 5( a)
Lab, X-ray and other diagnostic tests
Tests, such as:
Blood tests
Urinalysis
Non-routine pap tests
Pathology
X-rays
Non-routine Mammograms
Cat Scans/ MRI
Ultrasound
Electrocardiogram and EEG

Nothing if you receive these services
during your office visit; otherwise, $10 per
office visit

Preventive care, adult
Routine screenings, such as:
Total Blood Cholesterol – once every three years
Colorectal Cancer Screening, including

--Fecal occult blood test
--Sigmoidoscopy, screening – every five years starting at age 50

Nothing if you receive these services
during your office visit; otherwise, $10 per
office visit

Prostate Specific Antigen (PSA test) – one annually for men age 40 and older Nothing if you receive these services
during your office visit; otherwise, $10 per
office visit

Routine pap test
Note: The office visit is covered if pap test is received on the same day;
see Diagnosis and Treatment, above.

Nothing if you receive these services
during your office visit; otherwise, $10 per
office visit

Preventive Care -Adult --continued on next page 14
14 Page 15 16
2002 Health Alliance Plan 15 Section 5( a)
Preventive care, adult (continued) You pay
Routine mammogram –covered for women age 35 and older, as
follows:

From age 35 through 39, one during this five year period
From age 40 through 64, one every calendar year
At age 65 and older, one every two consecutive calendar years

Anytime as prescribed medically necessary by an affiliated Plan provider

Nothing if you receive these services
during your office visit; otherwise $10 per
office visit

Routine immunizations, limited to:
Tetanus-diphtheria (Td) booster – once every 10 years, ages19 and over (except as provided for under Childhood immunizations)

Influenza/ Pneumococcal vaccines, annually, age 65 and over
Any immunizations prescribed as medically necessary by an affiliated Plan provider

Nothing if you receive these services
during your office visit; otherwise, $10 per
office visit

Preventive care, children
Childhood immunizations recommended by the American Academy of Pediatrics Nothing if you receive these services during your office visit; otherwise, $10 per
office visit

Well-child care charges for routine examinations, immunizations and care

Examinations, such as:
--Eye exams to determine the need for vision correction. --Ear exams to determine the need for hearing correction

--Examinations done on the day of immunizations ( under age 22)

$10 per office visit 15
15 Page 16 17

2002 Health Alliance Plan 16 Section 5( a)
Maternity care You pay
Complete maternity (obstetrical) care, such as:
Prenatal care
Delivery
Postnatal care
Note: Here are some things to keep in mind:
You may remain in the hospital up to 48 hours after a regular delivery and 96 hours after a cesarean delivery. We will extend

your inpatient stay if medically necessary.
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 only 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 5c) and

Surgery benefits (Section 5b).

$10 per office visit

Not covered: Routine sonograms to determine fetal age, size or sex All charges.
Family planning
A broad range of voluntary family planning services, limited to:
Voluntary sterilization
Surgically implanted contraceptives (such as Norplant)
Injectable contraceptive drugs (such as Depo provera)
Intrauterine devices (IUDs)
Diaphragms
Infertility injectable drugs limited to 3 cycles per lifetime
NOTE: We cover oral contraceptives under the prescription drug
benefit.

$10 per office visit

Not covered: reversal of voluntary surgical sterilization, genetic
counseling, voluntary abortions
All charges. 16
16 Page 17 18
2002 Health Alliance Plan 17 Section 5( a)
Infertility services You pay
Diagnosis and treatment of infertility, such as:
Artificial insemination (limited to one attempt per lifetime):
--intravaginal insemination (IVI) --intracervical insemination (ICI)

--intrauterine insemination (IUI)
Injectable fertility drugs
Note: We cover injectable fertility drugs under medical benefits and oral
fertility drugs under the prescription drug benefit.

$10 per office visit

Not covered:
Assisted reproductive technology (ART) procedures, such as:
--in vitro fertilization --embryo transfer, gamete GIFT and zygote ZIFT

--Zygote transfer
Services and supplies related to excluded ART procedures

Cost of donor sperm
Cost of donor egg

All charges.

Allergy care
Testing and treatment
Allergy injection
$10 per office visit

Allergy serum (Must be provided in the physician's office) Nothing
Not covered: provocative food testing and sublingual allergy
desensitization
All charges. 17
17 Page 18 19
2002 Health Alliance Plan 18 Section 5( a)
Treatment therapies You pay
Chemotherapy and radiation therapy
Note: High dose chemotherapy in association with autologous bone
marrow transplants are limited to those transplants listed under
Organ/ Tissue Transplants on page 24.

Respiratory and inhalation therapy
Dialysis – Hemodialysis and peritoneal dialysis
Intravenous (IV)/ Infusion Therapy – Home IV and antibiotic therapy

Growth hormone therapy (GHT)
Note: Growth hormone is covered under the prescription drug benefit.
Note: – We will only cover GHT when we preauthorize the treatment.
Your physician will obtain this authorization for you.

Nothing if you receive these services
during your office visit; otherwise, $10
per office visit

Physical and occupational therapies
60 visits per condition for the services of each of the following:
--physical therapists and --occupational therapists.

Note: We only cover therapy to restore bodily function when there has
been a total or partial loss of bodily function due to illness or injury.

Cardiac rehabilitation following a heart transplant, bypass surgery or a
myocardial infarction, is provided for up to 12 sessions

$10 per office visit
$10 per outpatient visit

Not covered:
long-term rehabilitative therapy
exercise programs

Speech therapy
60 visits per condition for the services of speech therapists. $10 per office visit $10 per outpatient visit 18
18 Page 19 20
2002 Health Alliance Plan 19 Section 5( a)
Hearing services (testing, treatment, and supplies) You pay
Hearing testing for all members $10 per office visit

Not covered:
hearing aid fittings
hearing aids, testing and examinations for them

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)
Charges over the Plan guidelines

Eye exam to determine the need for vision correction
Annual eye refractions
$10 per office visit

Not covered:
Eyeglasses or contact lenses
Eye exercises and orthoptics
Radial keratotomy and other refractive surgeries

All charges.

Foot care
Routine foot care when you are under active treatment for a metabolic
or peripheral vascular disease, such as diabetes.

See orthopedic and prosthetic devices for information on podiatric shoe
inserts.

$10 per office visit

Not covered:
Cutting, trimming or removal of corns, calluses, or the free edge of toenails, and similar routine treatment of conditions of the foot,

except as stated above
Treatment of weak, strained or flat feet or bunions or spurs; and of any instability, imbalance or subluxation of the foot (unless the

treatment is by open cutting surgery)

All charges. 19
19 Page 20 21
2002 Health Alliance Plan 20 Section 5( a)
Orthopedic and prosthetic devices
Artificial limbs and eyes; stump hose
Externally worn breast prostheses and surgical bras, including necessary replacements, following a mastectomy

Corrective orthopedic appliances for non-dental treatment of temporomandibular joint (TMJ) pain dysfunction syndrome.

Nothing

Not covered:
orthopedic and corrective shoes
arch supports
foot orthotics
heel pads and heel cups
lumbosacral supports
corsets, trusses, elastic stockings, support hose, and other supportive devices

All charges.

Durable medical equipment (DME)
Rental or purchase, at our option, including repair and adjustment, of
durable medical equipment prescribed by your Plan physician, such as
oxygen and dialysis equipment. Under this benefit, we also cover:

hospital beds;
wheelchairs; standard or motorized when criteria are met;
crutches;
walkers;
blood glucose monitors; and
insulin pumps.

Nothing

Not covered:
Foot orthotics

Physician Equipment
Medical equipment needed only for comfort and convenience
Replacement or repair of any medical equipment or prosthetic or orthopedic device due to misuse

Eyeglasses or contact lenses including the fitting of contact lenses except as necessary for the first pair of corrective lenses following
cataract surgery

All charges. 20
20 Page 21 22
2002 Health Alliance Plan 21 Section 5( a)
Home health services You pay
Home health care ordered by a Plan physician and provided by a registered nurse (R. N.), licensed practical nurse (L. P. N.), licensed

vocational nurse (L. V. N.), or home health aide.
Services include oxygen therapy, intravenous therapy and medications.

Nothing

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

Home care primarily for personal assistance does not include a medical component and is not diagnostic, therapeutic, or
rehabilitative.

All charges.

Chiropractic
No Benefit All charges.

Alternative trCould not acquire words on page 22 eatments
Not covered:
Chiropractic services
Naturopathic services Hypnotherapy

Biofeedback
Acupuncture

All charges.

Educational classes and programs
Coverage is limited to:

Smoking Cessation
Diabetes self-management

$10 per office visit 21
21 Page 22 23

22 Page 23 24
2002 Health Alliance Plan 23 Section 5( b)
Reconstructive surgery
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 deformities; cleft lip; cleft
palate; birth marks; webbed fingers; and webbed toes.

Nothing

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)
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.

See above.

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

All charges.

Oral and maxillofacial surgery
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; and

Temporomandibular joint (TMJ) treatment
Other surgical procedures that do not involve the teeth or their supporting structures.

Nothing

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. 23
23 Page 24 25
2002 Health Alliance Plan 24 Section 5( b)
Organ/ tissue transplants You pay
Limited to:
Cornea
Heart
Heart/ lung
Kidney
Kidney/ Pancreas
Liver
Lung: Single –Double
Pancreas
Intestinal
Allogeneic (donor) bone marrow transplants
Autologous bone marrow transplants (autologous stem cell and peripheral stem cell support) for the following conditions: acute

lymphocytic or non-lymphocytic leukemia; advanced Hodgkin's
lymphoma; advanced non-Hodgkin's lymphoma; advanced
neuroblastoma; breast cancer; multiple myeloma; epithelial ovarian
cancer; and testicular, mediastinal, retroperitoneal and ovarian germ
cell tumors
Intestinal transplants (small intestine) and the small intestine with the liver or small intestine with multiple organs such as the liver,

stomach, and pancreas
National Transplant Program (NTP)

Organ/ tissue transplants and other related services are covered when
prior authorized by the Plan's medical director when criteria are met.

Limited Benefits -Treatment for breast cancer, multiple myeloma, and
epithelial ovarian cancer may be provided in an NCI-or NIH-approved
clinical trial at a Plan-designated center of excellence and if approved
by the Plan's medical director in accordance with the Plan's protocols.

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

Nothing

Not covered:
Donor screening tests and donor search expenses, except those performed for the actual donor

Implants of artificial organs
Transplants not listed as covered

All charges. 24
24 Page 25 26
2002 Health Alliance Plan 25 Section 5( b)
Anesthesia You pay
Professional services provided in –
Hospital (inpatient)
Nothing

Professional services provided in –
Hospital outpatient department
Skilled nursing facility
Ambulatory surgical center Office

Nothing 25
25 Page 26 27
2002 Health Alliance Plan 26 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 to remember 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.

Plan physicians must provide or arrange your care and you must be hospitalized in a Plan facility.
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.
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 covered in Sections 5( a) or (b).
YOU MUST GET PRECERTIFICATION OF HOSPITAL STAYS. Please refer to Section 3 to be sure which services require precertification.

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Benefit Description You pay
Inpatient hospital
Room and board, such as
ward, semiprivate, or intensive care accommodations;
general nursing care; and
meals and special diets.

NOTE: If you want a private room when it is not medically necessary,
you pay the additional charge above the semiprivate room rate.

Nothing

Other hospital services and supplies, such as:
Operating, recovery, maternity, and other treatment rooms Prescribed drugs and medicines

Diagnostic laboratory tests and X-rays
Administration of blood and blood products
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
Take-home items
Medical supplies, appliances, medical equipment, and any covered items billed by a hospital for use at home (Note: calendar year

deductible applies.)

Nothing

Not covered:
Custodial care
Non-covered facilities, such as nursing homes, schools
Personal comfort items, such as telephone, television, barber services, guest meals and beds

Private nursing care

All charges. 26
26 Page 27 28
2002 Health Alliance Plan 27 Section 5( c)
Outpatient hospital or ambulatory surgical center You Pay
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 hospital services and supplies related to dental
procedures when necessitated by a non-dental physical impairment. We
do not cover the dental procedures.

Nothing

Extended care benefits/ skilled nursing care facility benefits
Extended care benefit:

The Plan provides a comprehensive range of benefits when full-time
skilled nursing care is necessary and confinement in a skilled nursing
facility is medically appropriate as determined by a Plan doctor. The
Plan pays for up to 730 days each continuous period of confinement or
for successive periods separated by less than 60 days. This 730 day
period will be reduced by two days for every inpatient hospital day prior
to admission to a skilled nursing facility. A new period of 730 days
will begin after at least 60 days have elapsed from the last date of
discharge. You pay nothing. All necessary services are covered,
including:

Bed, board and general nursing care
Drugs, biologicals, supplies and equipment ordinarily provided or arranged by the skilled nursing facility when prescribed by a Plan

doctor.

Nothing

Not covered: custodial care All charges.
Hospice care
Supportive and palliative care for a terminally ill member is covered in
the home or hospice facility. Services include inpatient and outpatient
care, and family counseling; those services which are provided under
the direction of a Plan doctor who certified that the patient is in the
terminal stages of illness, with a life expectancy of approximately six
months or less. This benefit is limited to 210 days per member per
lifetime.

Nothing

Not covered: Independent nursing, homemaker services All charges.
Ambulance
Local professional ambulance service when medically appropriate Nothing 27
27 Page 28 29
2002 Health Alliance Plan 28 Section 5( d)
Section 5 (d). Emergency services/ accidents
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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.

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.

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What is a medical emergency?
A medical emergency is the sudden and unexpected onset of a condition or an injury that you believe endangers your life or
could result in serious injury or disability, and requires immediate medical or surgical care. Some problems are emergencies
because, if not treated promptly, they might become more serious; examples include deep cuts and broken bones. Others are
emergencies because they are potentially life-threatening, such as heart attacks, strokes, poisonings, gunshot wounds, or
sudden inability to breathe. There are many other acute conditions that we may determine are medical emergencies – what
they all have in common is the need for quick action.

What to do in case of emergency:

Emergencies within our service area: If you are in an emergency situation, please call your Plan physician. In extreme emergencies, if you are unable to contact a doctor, contact the local emergency system (e. g., the 911 telephone
system) or go to the nearest hospital emergency room. Be sure to tell the emergency room personnel that you are a Plan
member so they can notify the Plan. You or a family member should notify the Plan within 48 hours unless it is not
reasonably possible to do so. It is your responsibility to ensure that the Plan has been timely notified.

If you need to be hospitalized, the Plan must be notified within 48 hours or on the first working day following your
admission, unless it is not reasonably possible to notify the Plan within that time. If you are hospitalized in non-Plan
facilities and Plan doctors believe care can be better provided in a Plan hospital, you will be transferred when medically
feasible with any ambulance charges covered in full.

Benefits are available for any care from non-Plan providers in a medical emergency only if delay in reaching a Plan provider
would result in death, disability, or significant jeopardy to your condition.

To be covered by this Plan, any follow-up care recommended by non-Plan providers must be approved by the Plan and
provided by the Plan providers.

Emergencies outside our service area: Benefits are available for any medically necessary health service that is immediately required because of injury or unforeseen illness.
If you need to be hospitalized, the Plan must be notified within 48 hours or on the first working day following your
admission, unless it is not reasonably possible to notify the Plan within that time. If a Plan doctor believes care can be better
provided in a Plan hospital, you will be transferred when medically feasible with any ambulance charges covered in full.

To be covered by this Plan, any follow-up care recommended by non-Plan providers must be approved by the Plan and
provided by Plan providers. 28
28 Page 29 30

2002 Health Alliance Plan 29 Section 5( d)
Benefit Description You pay
Emergency within our service area
Emergency care at a doctor's office

Emergency care at an urgent care center
Emergency care as an outpatient or inpatient at a hospital, including doctors' services

$10 per office visit
Nothing
Nothing

Not covered: Elective care or non-emergency care All charges.
Emergency outside our service area
Emergency care at a doctor's office
Emergency care at an urgent care center
Emergency care as an outpatient or inpatient at a hospital, including doctors' services

$10 per office visit
Nothing
Nothing

Not covered:
Elective care or non-emergency care
Emergency care provided outside the service area if the need for care could have been foreseen before leaving the service area

Medical and hospital costs resulting from a normal full-term delivery of a baby outside the service area

All charges.

Ambulance
Professional ambulance service when medically appropriate.
See 5 (c) for non-emergency service. 29
29 Page 30 31
2002 Health Alliance Plan 30 Section 5( e)
Section 5 (e). Mental health and substance abuse benefits
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T

When you get our approval for services and follow a treatment plan we approve, cost-sharing and limitations
for Plan 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.
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 description below.

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Benefit Description You pay
Mental health and substance abuse benefits
All diagnostic and treatment services recommended by a Plan provider
and contained in a treatment plan that we approve. The treatment plan
may include services, drugs, and supplies described elsewhere in this
brochure.

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

Your cost sharing responsibilities are no
greater than for other illness or conditions.

Professional services, including individual or group therapy by
providers such as psychiatrists, psychologists, or clinical social
workers

Medication management

$10 per visit

Mental health and substance abuse benefits -continued on next page 30
30 Page 31 32
2002 Health Alliance Plan 31 Section 5( e)
Mental health and substance abuse benefits (continued) You pay
Diagnostic tests $10 per office visit

Services provided by a hospital or other facility
Services in approved alternative care settings such as partial
hospitalization, half-way house, residential treatment, full-day
hospitalization, facility based intensive outpatient treatment

Nothing

Not covered: Services we have not approved.
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.

Preauthorization To be eligible to receive these benefits you must follow your treatment plan and all the following authorization processes:
You may directly access services by contacting Coordinated Behavioral Health Management at 800/ 444-5755

Limitation We may limit your benefits if you do not follow your treatment plan. 31
31 Page 32 33

2002 Health Alliance Plan 32 Section 5( f)
Section 5 (f). Prescription drug benefits
I M
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T

Here are some important things to keep in mind about these benefits:
We cover prescribed drugs and medications, as described in the chart beginning on the next page.
All benefits are subject to the definitions, limitations and exclusions in this brochure and are payable only when we determine they are medically necessary.

I M
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There are important features you should be aware of. These include:
Who can write your prescription. A licensed physician must write the prescription.
Where you can obtain them. You must fill the prescription at a Plan pharmacy; you may fill the prescription by mail for a maintenance medication.

We use a formulary. A Plan formulary is a list of Plan-approved prescription drugs. We cover non-formulary drugs prescribed by a Plan doctor.
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. This list of name
brand drugs is a preferred list of drugs that we selected to meet patient needs at a lower cost.

These are the dispensing limitations. Prescription drugs prescribed by a Plan or referral doctor and obtained at a Plan pharmacy will be dispensed for up to a 30-day supply; you pay a $2 copay per prescription unit or

refill. Generic maintenance drugs are covered up to a 100-unit dose or a 30-day supply, whichever is a
greater, for the $2 copay per prescription unit or refill. The cost of prescriptions filled at non-Plan pharmacies
are reimbursable to the enrollee only for out-of-service emergencies, minus the $2 copay per prescription or
refill.

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.

Why use generic drugs? Generic drugs contain the same active ingredients and are equivalent in strength and dosage to the original brand name product. Generic drugs cost you and your plan less money than a
name-brand drug.
When you have to file a claim. See Section 7 for information of filing a claim for the prescription drug benefits. 32
32 Page 33 34

2002 Health Alliance Plan 33 Section 5( f)
Benefit Description You pay
Covered medications and supplies
We cover the following medications and supplies prescribed by a Plan
physician and obtained from a Plan pharmacy or through our mail order
program:

Contraceptive drugs, including injectable contraceptive drugs, and devices that require a prescription (such as a diaphragm)

Drugs and medicines that by Federal law of the United States require a physician's prescription for their purchase, except those
listed as Not covered.
Insulin
Compounded dermatological preparations Implanted time-release medications, such as Norplant. For

Norplant, you pay a $10 office visit copay per prescription. For
other internally implanted time-release medications, you pay a $10
office visit copay. There is no charge when the device is implanted
during a covered hospitalization.
Disposable needles and syringes needed to inject covered prescribed medication

Intravenous fluids and medication for home use are covered under Medical and Surgical Benefits
Injectable medications
Limited as to number of month's supply:
Smoking cessation drugs and medications including nicotine patches (up to a three-month supply per year)

Drugs for sexual dysfunction (Viagra) limited to 4 tablets every 28 days
Oral infertility drugs
Growth Hormone

$2 per prescription for a 30-day supply of
generic and brand-name drugs (if the
physician has indicated Dispense As
Written on the prescription) at Plan
pharmacies

$4 per prescription for a 90-day supply
through the mail order program. (See
section 5 ( i ) for information about our
mail order program

Not covered:
Drugs and supplies for cosmetic purposes
Drugs to enhance athletic performance
Drugs obtained at a non-Plan pharmacy; except for out-of-area emergencies

Vitamins, nutrients and food supplements even if a physician prescribes or administers them
Nonprescription medicines
Medical supplies such as dressings and antiseptics
Drugs available without a prescription or for which there is a nonprescription equivalent available

All charges. 33
33 Page 34 35
2002 Health Alliance Plan 34 Section 5( g)
Section 5 (g). Special features
Feature 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. 34
34 Page 35 36
2002 Health Alliance Plan 35 Section 5( h)
Section 5 (h). Dental benefits
I M
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T

We cover hospitalization for dental procedures only when a non-dental physical impairment exists which makes hospitalization necessary to safeguard the health of the patient; we do not cover the dental procedure unless it is
described below.
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.

I M
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T
Accidental injury benefit You pay

We cover restorative services and supplies necessary to promptly repair
(but not replacement of) sound natural teeth. The need for these
services must result from an accidental injury.

Nothing

Dental benefits
We have no other dental benefits. 35
35 Page 36 37
2002 Health Alliance Plan 36 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 FEHB disputed
claim about them. Fees you pay for these services do not count toward FEHB deductibles or out-of-pocket maximums.

A Mail-Order Prescription Drug Program is also available for a $4 copayment up to a 90-day supply. Please contact the Plan for information about the Mail Order Program.
Medicare prepaid plan enrollment – This Plan offers Medicare recipients the opportunity to enroll in the Plan through Medicare. As indicated on page 43, annuitants and former spouses with FEHB coverage and Medicare Part B
may elect to drop their FEHB coverage and enroll in a Medicare prepaid plan where one is available in their area.
They may then later reenroll in the FEHB Program. Most Federal annuitants have Medicare Part A. Those without
Medicare Part A may join this Medicare prepaid plan but will probably have to pay for hospital coverage in addition
to the Part B premium. Before you join the Plan, ask whether the Plan covers hospital benefits and, if so, what you
will have to pay. Contact your retirement system for information on dropping your FEHB enrollment and changing to
a Medicare prepaid plan. Contact us at 313/ 872-8100 or 800/ 422-4641for information on the Medicare prepaid Plan
and the cost of that enrollment.

If you are Medicare eligible and are interested in enrolling in a Medicare HMO sponsored by this Plan without
dropping your enrollment in this Plan's FEHB Plan, call 313/ 872-8100 or 800-422-4641for information on the benefits
available under the Medicare HMO. 36
36 Page 37 38
2002 Health Alliance Plan 37 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 your Plan doctor determines it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or condition.

We do not cover the following:
Care by non-Plan providers except for authorized referrals or emergencies (see Emergency Benefits);
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;

Services, drugs, or supplies related to sex transformations;
Services, drugs, or supplies you receive from a provider or facility barred from the FEHB Program; or
Expenses you incurred while you were not enrolled in this Plan. 37
37 Page 38 39
2002 Health Alliance Plan 38 Section 7
Section 7. Filing a claim for covered services
When you see Plan physicians, receive services at Plan hospitals and facilities, or obtain your prescription drugs at Plan pharmacies,
you will not have to file claims. Just present your identification card and pay your copayment.

You will only need to file a claim when you receive emergency services from non-Plan providers. Sometimes these providers bill us
directly. Check with the provider. If you need to file the claim, here is the process:

Medical, hospital, drug benefits In most cases, providers and facilities file claims for you. Physicians must file on the form HCFA-1500, Health Insurance Claim Form. Facilities will file on the UB-92 form.
For claims questions and assistance, call us at 313/ 872-8100 or 800/ 422-4641.
When you must file a claim --such as for out-of-area care --submit it on the HCFA-1500
or a claim form that includes the information shown below. Bills and receipts should be
itemized and show:

Covered member's name and ID number;
Name and address of the physician or facility that provided the service or supply;
Dates you received the services or supplies;
Diagnosis;
Type of each service or supply;
The charge for each service or supply;
A copy of the explanation of benefits, payments, or denial from any primary payer --such as the Medicare Summary Notice (MSN); and

Receipts, if you paid for your services.
Submit your claims to: HAP
2850 W. Grand Boulevard
Detroit, Michigan 48202

Deadline for filing your claim Send us all of the documents for your claim as soon as possible. You must submit the claim by December 31 of the year after the year you received the service, unless timely

filing was prevented by administrative operations of Government or legal incapacity,
provided the claim was submitted as soon as reasonably possible.

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. 38
38 Page 39 40
2002 Health Alliance Plan 39 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:

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: 2850 W. Grand Boulevard, Detroit, Michigan 48202; 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, if applicable, arrange for the health care provider to give you the care); or
(b) Write to you and 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 information 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 3, 1900 E Street, NW,
Washington, DC 20415-3630. 39
39 Page 40 41
2002 Health Alliance Plan 40 Section 8
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 representative, such
as medical providers, must include 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 or from the year in which you were denied precertification or prior approval. 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 decision. 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.

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 313/ 872-8100 or
800/ 422-4641 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 3 at 202/ 606-0737 between 8 a. m. and 5 p. m. eastern time. 40
40 Page 41 42
2002 Health Alliance Plan 41 Section 9
Section 9. Coordinating benefits with other coverage
When you have other health coverage You must tell us if you are covered or a family member is covered under another group health plan or have 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 secondary payer. We, like
other insurers, determine which coverage is primary according to the National
Association of Insurance Commissioners' guidelines.

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. If we are the secondary payer, we may be entitled to
receive payment from your primary plan.

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 requiring dialysis or a transplant).

Medicare has two parts:
Part A (Hospital Insurance). Most people do not have to pay for Part A. If you or your spouse worked for at least 10 years in Medicare-covered employment, you

should be able to qualify for premium-free Part A insurance. (Someone who was a
Federal employee on January 1, 1983, or since automatically qualifies). Otherwise,
if you are age 65 or older, you may be able to buy it. Contact 1-800-MEDICARE for
more information.

Part B (Medical Insurance). Most people pay monthly for Part B. Generally, Part B premiums are withheld from your monthly Social Security check or your retirement

check.

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 managed care plan
you have.

The Original Medicare Plan (Original Medicare) is available everywhere in the United
States. It is the way everyone used to get Medicare benefits and is the way most people
get their Medicare Part A and Part B benefits now. You may go to any doctor, specialist,
or hospital that accepts Medicare. The Original Medicare Plan pays its share and you
pay your share. Some things are not covered under Original Medicare, like prescription
drugs.

When you are enrolled in Original Medicare along with this Plan, you still need to follow
the rules in this brochure for us to cover your care. Your care must continue to be
authorized by your Plan PCP. We will not waive any of our copayments.
(Primary payer chart begins on next page.)

The Original Medicare Plan (Part A or Part B 41
41 Page 42 43
2002 Health Alliance Plan 42 Section 9
The following chart illustrates whether the Original Medical Plan 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
Then the primary payer is… A. When either you --or your covered spouse --are age 65 or over and …

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.)

4) 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),

5) Are enrolled in Part B only, regardless of your employment status, (for Part B services) (for other services)
6) 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, or
c) Are a former spouse of an annuitant, or
d) Are a former spouse of an active employee … 42
42 Page 43 44

2002 Health Alliance Plan 43 Section 9
Claims process when you have the Original Medicare Plan --You probably will never have to file a claim form when you have both our Plan and the Original Medicare Plan.
When we are the primary payer, we process the claim first.
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 313/ 872-8100 or 800/ 422-
4641, or you may write to the Plan at 2850 W. Grand Boulevard, Detroit, MI 48202.
You may also contact the Plan on our website at www. hapcorp. org.

We do not waive any costs when you have Medicare.

Medicare managed care plan If you are eligible for Medicare, you may choose to enroll in and get your Medicare benefits from another type of Medicare + Choice plan --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 provide all the benefits that Original
Medicare covers. 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 our Medicare managed care plan: You may enroll in our Medicare managed care plan and also remain enrolled in our FEHB plan. In this case, we do not
waive any of our copayments, coinsurance, or deductibles for your FEHB coverage.
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, but we
will not waive any of our copayment, coinsurance, or deductibles. If you enroll in a
Medicare managed care plan, tell us. We will need to know whether you are in the
Original Medicare Plan or in a Medicare managed care plan so we can correctly
coordinate benefits with Medicare.

Suspended FEHB coverage to enroll in 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.

If you do not have one or both Parts of Medicare, you can still be covered under the FEHB Program. We will not require you to enroll in Medicare Part B and, if you can't
get premium-free Part A, we will not ask you to enroll in it.

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.

If you do not enroll in Medicare Part A or Part B 43
43 Page 44 45
2002 Health Alliance Plan 44 Section 9
Workers' Compensation We do not cover services that:
you need because of a workplace-related illness or injury that the Office of Workers' Compensation Programs (OWCP) or a similar Federal or State agency determines they

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

Once OWCP or similar agency pays its maximum benefits for your treatment, we will
cover your care. You must use our providers.

Medicaid When you have this Plan and Medicaid, we pay first.
When other Government agencies We do not cover services and supplies when a local, State,
are responsible for your care or Federal Government agency directly or indirectly pays for them.

When others are responsible When you receive money to compensate you for medical or hospital care for
for injuries 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 subrogation. If
you need more information, contact us for our subrogation procedures. 44
44 Page 45 46

2002 Health Alliance Plan 45 Section 10
Section 10. Definitions of terms we use in this brochure
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.

Copayment A copayment is a fixed amount of money you pay when you receive covered services. See page 11.

Covered services Care we provide benefits for, as described in this brochure.
Custodial care Domiciliary care, or basic care including physician services and other ancillary services in a residential, institutional, or other setting or durable medical equipment provided in
such settings which is primarily for the purpose of meeting a member's personal needs
and which could be provided by persons without professional skills or training.
Examples of custodial care include, but are not limited to, assistance with the activities of
daily living such as bathing, dressing, eating, walking, getting in and out of bed, and
taking medication.

For the purposes of this Contract HAP bases its determination of whether or not a drug,
treatment, device, procedure, service or benefit is experimental or investigational in
nature if it meets any of the following criteria:

It cannot be lawfully marketed without the approval of the FDA and such approval has not been granted at the time of its use or its proposed use; or is the subject of
current investigational new drugs or device applications with the FDA.
It is being provided pursuant to Phase I or Phase II clinical trial or as the experimental or research arm of Phase III clinical trial; or is the subject of written
protocol which describes its objective, determinations of safety, efficacy, efficacy in
comparison to conventional alternatives of toxicity.

It is being delivered or should be delivered subject to the approval and supervision of an Institutional Review Board as required and defined by federal regulations,
particularly those to the FDA or the Department of Health and Human Service.
The predominant opinion among experts as expressed in the published authoritative literature is that the usage should be substantially confined to research settings; or it
is not investigational in itself pursuant to any of the foregoing criteria, and would not
be medically necessary, but for the provision of a drug, device treatment, or
procedure which is "investigational or experimental."

Medical services which are generally regarded by the medical community to be unusual, infrequently provided and not necessary for the protection of health.

Us/ We Us, we and Plan refer to Health Alliance Plan (HAP)
You You refers to the enrollee and each covered family member.

Experimental or
investigational services 45
45 Page 46 47

2002 Health Alliance Plan 46 Section 11
Section 11. FEHB facts
No pre-existing condition We will not refuse to cover the treatment of a condition that you had
limitation before you enrolled in this Plan solely because you had the condition before you enrolled.

Where you can get information See www. opm. gov/ insure. Also, your employing or retirement office can answer
about enrolling in the your questions, and give you a Guide to Federal Employees Health Benefits Plans, FEHB Program 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 Self Only coverage is for you alone. Self and Family coverage is for you, your spouse,
for you and your family 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.

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.

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. 46
46 Page 47 48
2002 Health Alliance Plan 47 Section 11
When benefits and Premiums start The benefits in the brochure are effective on January 1. If you joined this Plan during
Open Season, your coverage begins on the first day of your first pay period that starts on
or after January1. Annuitants' coverage and premiums begin on January 1. If you joined
at any other time during the year, your employing office will tell you the effective date of
coverage.

Your medical and claims We will keep your medical and claims information confidential. Only the following
records are confidential 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 If you are divorced from a Federal employee or annuitant, you may not continue to coverage 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.

Temporary continuation of coverage (TCC) If you leave Federal service, or if you lose coverage because you no longer qualify as a
family member, you may be eligible for Temporary Continuation of Coverage (TCC).
For example, you can receive TCC if you are not able to continue your FEHB enrollment
after you retire, if you lose your job, if you are a covered dependent child and you turn
22, or marry etc.

You may not elect TCC if you are fired from your Federal job due to gross misconduct. 47
47 Page 48 49

2002 Health Alliance Plan 48 Section 11
Enrolling in TCC. 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. It explains what you have to do to enroll.

Converting to You may convert to a non-FEHB individual policy if: individual coverage
Your coverage under TCC or the spouse equity law ends (If you canceled your coverage or did not pay your premium, you cannot convert);

You decided not to receive coverage under TCC or the spouse equity law; or
You are not eligible for coverage under TCC or the spouse equity law.
If you leave Federal service, your employing office will notify you 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 The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a Federal
Group Health Plan Coverage law that offers limited Federal protections for health coverage availability and continuity to people who lose employer group coverage. If you leave the FEHB Program, we 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 previously enrolled in other
FEHB plans, you may also request a certificate from those plans.

For more information, get OPM pamphlet RI 79-27, Temporary Continuation of
Coverage (TCC) under the FEHB Program. See also the FEHB web site
(www. opm. gov/ insure/ health); refer to the "TCC and HIPAA" frequently asked question.
These highlight HIPAA rules, such as the requirement that Federal employees must
exhaust any TCC eligibility as one condition for guaranteed access to individual health
coverage under HIPAA, and have information about Federal and State agencies you can
contact for more information. 48
48 Page 49 50

2002 Health Alliance Plan 49 Long Term Care Insurance
Long Term Care Insurance Is Coming Later in 2002!
The Office of Personnel Management (OPM) will sponsor a high-quality long term care insurance program effective in October
2002. As part of its educational effort, OPM asks you to consider these questions:

It's insurance to help pay for long term care services you may need if you can't take care of yourself because of an extended illness or injury, or an age-related disease
such as Alzheimer's.
LTC insurance can provide broad, flexible benefits for nursing home care, care in an assisted living facility, care in your home, adult day care, hospice care, and more.

LTC insurance can supplement care provided by family members, reducing the
burden you place on them.

Welcome to the club!
76% of Americans believe they will never need long term care, but the facts are that about half them will. And it's not just the old folks. About 40% of people needing

long term care are under age 65. They may need chronic care due to a serious
accident, a stroke, or developing multiple sclerosis, etc.
We hope you will never need long term care, but everyone should have a plan just in case. Many people now consider long term care insurance to be vital to their

financial and retirement planing.
Yes, it can be very expensive. A year in a nursing home can exceed $50,000. Home care for only three 8-hour shifts a week can exceed $20,000 a year. And that's
before inflation!
Long term care can easily exhaust your savings. Long term care insurance can protect your savings.

Not FEHB. Look at the "Not covered" blocks in sections 5( a) and 5( c) of your FEHB brochure. Health plans don't cover custodial care or a stay in an assisted
living facility or a continuing need for a home health aide to help you get in and out
of bed and with other activities of daily living. Limited stays in skilled nursing
facilities can be covered in some circumstances.
Medicare only covers skilled nursing home care (the highest level of nursing care) after a hospitalization for those who are blind, age 65 or older or fully disabled. It

also has a 100-day limit.
Medicaid covers long term care for those who meet their state's poverty guidelines, but has restrictions on covered services and where they can be received. Long term

care insurance can provide choices of care and preserve your independence.
Employees will get more information from their agencies during the LTC open enrollment period in the late summer/ early fall of 2002.
Retirees will receive information at home.
Our toll-free teleservice center will begin in mid-2002. In the meantime, you can learn more about the program on our web site at www. opm. gov/ insure/ ltc.

Many FEHB enrollees think that their health plan and/ or Medicare will cover their long-term care needs. Unfortunately, they are WRONG!
How are YOU planning to pay for the future custodial or chronic care you may need? You should consider buying long-term care insurance.

What is long term care
(LTC) insurance?

I'm healthy. I won't need
long term care. Or, will I?

Is long term care expensive?
But won't my FEHB plan, Medicare or Medicaid cover
my long term care?

When will I get more information on how to apply for this new
insurance coverage?

How can I find out more about the
program NOW? 49
49 Page 50 51
2002 Health Alliance Plan 50 Index
Index
Do not rely on this page; it is for your convenience and may not show all pages where the terms appear.
Accidental injury 35 Allergy tests 17
Alternative treatment 21 Allogeneic (donor) bone marrow transplant 24
Ambulance 27, 29 Anesthesia 29
Autologous bone marrow transplant 24 Biopsies 22
Blood and blood plasma 26 Breast cancer screening 14,15
Casts 26 Changes for 2002 07
Chemotherapy 18 Childbirth 16
Chiropractic 21 Cholesterol tests 14
Claims 38 Coinsurance 11
Colorectal cancer screening 14 Congenital anomalies 22
Contraceptive devices and drugs 16, 33 Coordination of benefits 41
Crutches 20
Deductible 11 Definitions 45

Dental care 35 Diagnostic services 13
Disputed claims review 39 Donor expenses (transplants) 24
Dressings 26 Durable medical equipment (DME) 20
Educational classes and programs 21 Emergency 28
Experimental or investigational 37 Eyeglasses 19
Family planning 16 Fecal occult blood test 14
General Exclusions 37

Hearing services 19 Home health services 21
Hospice care 27 Home nursing care 21
Hospital 26 Immunizations 15
Infertility 17 Inhospital physician care 13
Inpatient Hospital Benefits 26 Insulin 33
Laboratory and pathological services 14, 27
Magnetic Resonance Imagings (MRIs) 14
Mail Order Prescription Drugs 36 Mammograms 14, 15
Maternity Benefits 16 Medicaid 44
Medicare 41 Mental Conditions/ Abuse
Benefits 30 Newborn care 16
Non-FEHB Benefits 36 Nurse
Licensed Practical Nurse 21 Nurse Anesthetist 26
Registered Nurse 21 Nursery charges 16
Obstetrical care 16 Occupational therapy 18
Ocular injury 19 Office visits 13
Oral and maxillofacial surgery 23 Orthopedic devices 20
Out-of-pocket expenses 11 Outpatient facility care 27
Oxygen 26, 27 Pap test 14

Physical examination 13, 15 Physical therapy 18
Physician 13 Pre-admission testing 27
Precertification 10, 26 Preventive care, adult 14
Preventive care, children 15 Prescription drugs 32
Preventive services 14, 15 Prostate cancer screening 14
Prosthetic devices 20 Psychologist 30
Radiation therapy 18 Room and board 26
Second surgical opinion 13 Skilled nursing facility care 27
Smoking cessation 21 Speech therapy 18
Splints 26 Sterilization procedures 22
Subrogation 44 Substance abuse 30
Surgery 22 Anesthesia 25
Oral 23 Outpatient 27
Reconstructive 23 Syringes 33
Temporary continuation of coverage 47
Transplants 24 Treatment therapies 18

Vision services 19 Well-child care 15
Wheelchairs 20 Workers' compensation 43
X-rays 14 50
50 Page 51 52
2002 Health Alliance Plan 51 Summary
Summary of benefits for Health Alliance Plan -2002
Do not rely on this chart alone. All benefits are provided in full unless indicated and are subject to the definitions,
limitations, and exclusions in this brochure. 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.

We only cover services provided or arranged by Plan physicians, except in emergencies.

Benefits You Pay Page
Medical services provided by physicians:
Diagnostic and treatment services provided in the office................ Office visit copay: $10 primary care; $10 specialist 13

Services provided by a hospital:
Inpatient .......................................................................................
Outpatient.....................................................................................

Nothing 26
27
Emergency benefits:
In-area.........................................................................................
Out-of-area..................................................................................

Nothing 29
29
Mental health and substance abuse treatment ................................... Regular cost sharing. 30
Prescription drugs ............................................................................. $2 copay per prescription unit or refill 32
Dental Care ................................................................................... For accidental injuries, you pay no copayment
for the office visit. 35

Vision Care ................................................................................... $10 per office visit 19 51
51 Page 52
2002 Health Alliance Plan 52
2002 Rate Information for
Health Alliance Plan

Non-Postal rates apply to most non-Postal enrollees. If you are in a special enrollment category, refer
to the FEHB Guide for that category or contact the agency that maintains your health benefits
enrollment.

Postal rates apply to career Postal Service employees. Most employees should refer to the FEHB
Guide for United States Postal Service Employees, RI 70-2. Different postal rates apply and special
FEHB guides are published for Postal Service Nurses, RI 70-2B; and for Postal Service Inspectors and
Office of Inspector General (OIG) employees (see RI 70-2IN).

Postal rates do not apply to non-career postal employees, postal retirees, or associate members of any
postal employee organization who are not career postal employees. Refer to the applicable FEHB
Guide.

Non-Postal Premium Postal Premium
Biweekly Monthly Biweekly
Type of Enrollment Code Gov't Share Your Share Gov't Share Your Share USPS Share Your Share

Self Only 521 $92.80 $30.93 $201.06 $67.02 $109.81 $13.92
Self and Family 522 $233.41 $104.42 $484.06 $226.24 $263.75
$64.08 52

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