Pages 1--52 from SecureCare of Iowa

Serving: The Central and Eastern Iowa areas
Enrollment in this Plan is limited; You must live or work in our Geographic Service area to enroll. See page 7 for requirements.

Enrollment codes for this Plan:
3Q1 Self Only 3Q2 Self and Family

Authorized for distribution by the:
United States Office of Personnel Management

Retirement and Insurance Service http:// www. opm. gov/ insure RI 71-xxx

RI 73-654

For changes
in benefits
see page 8. 1
1 Page 2 3
2002 SecureCare of Iowa 2 Table of Contents
Table of Contents
Introduction................................................................................................................................................................................................ 4
Plain Language........................................................................................................................................................................................... 4
Inspector General Advisory ....................................................................................................................................................................... 5
Section 1. Facts about this HMO plan....................................................................................................................................................... 6
We also have point-of service (POS) benefits.......................................................................................................................... 6
How we pay providers ............................................................................................................................................................. 6
Who provides my health care? ................................................................................................................................................. 6
Your Rights .............................................................................................................................................................................. 7
Service Area............................................................................................................................................................................. 7
Section 2. How we change for 2002 ......................................................................................................................................................... 8
Program-wide changes ............................................................................................................................................................. 8
Changes to this Plan ................................................................................................................................................................. 8
Section 3. How you get care ..................................................................................................................................................................... 9
Identification cards................................................................................................................................................................... 9
Where you get covered care ..................................................................................................................................................... 9
Plan providers .................................................................................................................................................................... 9
Plan facilities ..................................................................................................................................................................... 9
What you must do to get covered care ..................................................................................................................................... 9
Primary care....................................................................................................................................................................... 9
Specialty care..................................................................................................................................................................... 9
Hospital care .................................................................................................................................................................... 10
Circumstances beyond our control ......................................................................................................................................... 11
Services requiring our prior approval..................................................................................................................................... 11
Section 4. Your costs for covered services.............................................................................................................................................. 12
Copayments ..................................................................................................................................................................... 12
Deductible........................................................................................................................................................................ 12
Coinsurance ..................................................................................................................................................................... 12
Your out-of-pocket maximum................................................................................................................................................ 12
Section 5. Benefits .................................................................................................................................................................................. 13
Overview................................................................................................................................................................................ 13
(a) Medical services and supplies provided by physicians and other health care professionals ....................................... 14
(b) Surgical and anesthesia services provided by physicians and other health care professionals.................................... 21
(c) Services provided by a hospital or other facility, and ambulance services.................................................................. 24
(d) Emergency services/ accidents ..................................................................................................................................... 26
(e) Mental health and substance abuse benefits ................................................................................................................ 28
(f) Prescription drug benefits............................................................................................................................................ 29
(g) Special features........................................................................................................................................................... 31
(h) Dental benefits............................................................................................................................................................. 32 2
2 Page 3 4
2002 SecureCare of Iowa 3 Table of Contents
(i) Non-FEHB benefits available to Plan members .......................................................................................................... 33
Section 6. General exclusions --things we don't cover.......................................................................................................................... 34
Section 7. Filing a claim for covered services........................................................................................................................................ .35
Section 8. The disputed claims process................................................................................................................................................... 36
Section 9. Coordinating benefits with other coverage............................................................................................................................. 38
When you have…
Other health coverage ..................................................................................................................................................... 38
Original Medicare ........................................................................................................................................................... 38
Medicare managed care plan........................................................................................................................................... 40
TRICARE/ Workers' Compensation/ Medicaid ....................................................................................................................... 40
Other Government agencies ................................................................................................................................................... 41
When others are responsible for injuries ................................................................................................................................ 41
Section 10. Definitions of terms we use in this brochure........................................................................................................................ 42
Section 11. FEHB facts ........................................................................................................................................................................... 43

Coverage information............................................................................................................................................................. 43
No pre-existing condition limitation .............................................................................................................................. 43
Where you get information about enrolling in the FEHB Program ............................................................................... 43
Types of coverage available for you and your family.................................................................................................... 43
When benefits and premiums start................................................................................................................................. 43
Your medical and claims records are confidential ......................................................................................................... 44
When you retire............................................................................................................................................................. 44
When you lose benefits .......................................................................................................................................................... 44
When FEHB coverage ends ........................................................................................................................................... 44
Spouse equity coverage................................................................................................................................................. 44
Temporary Continuation of Coverage (TCC) ............................................................................................................... 44
Converting to individual coverage ................................................................................................................................ 45
Getting a Certificate of Group Health Plan Coverage................................................................................................... 45
Long term care insurance is coming later in 2002 ................................................................................................................................... 46
Index ........................................................................................................................................................................................................ 47
Summary of benefits ................................................................................................................................................................................ 51
Rates........................................................................................................................................................................................... Back cover 3
3 Page 4 5
2002 SecureCare of Iowa 4 Introduction
Introduction
SecureCare of Iowa
11141 Aurora Avenue
Des Moines, Iowa, 50322

This brochure describes the benefits of SecureCare of Iowa under our contract (CS 2744) with the Office of Personnel Management
(OPM), as authorized by the Federal Employees Health Benefits law. 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, 2002, unless those benefits are also shown in this brochure.

OPM negotiates benefits and rates with each plan annually. Benefit changes are effective January 1, 2002, and changes are
summarized on page 8. Rates are shown at the end of this brochure.

Plain Language
Teams of Government and health plans' staff worked on all FEHB brochures to make them responsive, accessible, and understandable
to the public. For instance,

Except for necessary technical terms, we use common words. For instance, "you" means the enrollee or family member; "we" means SecureCare of Iowa

We limit acronyms to ones you know. FEHB is the Federal Employees Health Benefits Program. OPM is the Office of Personnel Management. If we use others, we tell you what they mean first.
Our brochure and other FEHB plans' brochures have the same format and similar descriptions to help you compare plans.
If you have comments or suggestions about how to improve the structure of this brochure, let OPM know. Visit OPM's "Rate Us"
feedback area at www. opm. gov/ insure or e-mail OPM at fehbwebcomments@ opm. gov. You may also write to OPM at the Office of
Personnel Management, Office of Insurance Planning and Evaluation Division, 1900 E Street, NW Washington, DC 20415-3650. 4
4 Page 5 6
2002 SecureCare of Iowa 5 Introduction
Inspector General Advisory
Fraud increases the cost of health care for everyone. If you suspect that a physician,
pharmacy, or hospital has charged you for services you did not receive, billed you twice
for the same service, or misrepresented any information, do the following:

Call the provider and ask for an explanation. There may be an error.
If the provider does not resolve the matter, call us at 888 881-8820 and explain the situation.

If we do not resolve the issue, call or write
THE HEALTH CARE FRAUD HOTLINE
202/ 418-3300
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 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.

Stop health care fraud! 5
5 Page 6 7
2002 SecureCare of Iowa 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 or coinsurance.

Who provides my health care?
SecureCare of Iowa is comprised of three different types of providers: Primary Care Physicians, Participating Specialists and Non-Participating
Providers. Members may access services from participating specialists and non-participating doctors only when they are
referred to these doctors by their primary care doctor. As stated above, Primary Care Physicians are defined as: Family Practice,
Internal Medicine or Pediatrics.

The first and most important decision each member must make is the selection of a primary care doctor. The decision is important
since it is through this doctor that all other health services, particularly those of specialists, are obtained. It is the responsibility of your
primary care doctor to obtain any necessary authorizations from the Plan before referring you to a specialist or making arrangements
for hospitalization. Services of other providers are covered only when there has been a referral by the member's primary care doctor
with the following exceptions: 1) members may seek services from a participating OB/ GYN for annual exams and for pregnancies,
and 2) members may also seek care from the contracted mental health and substance abuse provider without authorization from the
member's primary care doctor.

The Plan's provider directory lists primary care doctors (family practitioners, pediatricians, and internists), with their locations and
phone numbers, and notes whether or not the doctor is accepting new patients. Directories are updated on a regular basis and are
available at the time of enrollment or upon request by calling the Customer Service Department at (515) 331-7838 or (888) 881-8820;
you can also find out if your doctor participates with this Plan by calling this number. If you are interested in receiving care from a
specific provider who is listed in the directory, call the provider to verify that he or she still participates with the Plan and is accepting
new patients. Important note: When you enroll in this Plan, services (except for emergency benefits) are provided through the Plan's
delivery system; the continued availability and/ or participation of any one doctor, hospital, or other provider, cannot be guaranteed.

If you enroll, you will be asked to let the Plan know which primary care doctor( s) you've selected for you and each member of your
family by sending a selection form to the Plan. If you need help choosing a doctor, call the Plan. Members may change their doctor
selection by notifying the Plan 30 days in advance. 6
6 Page 7 8
2002 SecureCare of Iowa 7 Section 1
Your Rights
OPM requires that 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.

If you want more information about us, call 515-331-7838, or write to SecureCare of Iowa, 11141 Aurora Avenue, Des Moines, Iowa,
50322. You may also contact us by fax at 515-331-7848 or visit our website at www. securecareofiowa. com

Service Area
To enroll with us, you must live or work in our service area. This is where our providers practice. Our service area is:
Appanoose, Adair, Audubon, Benton, Black Hawk, Bremer, Buchanan, Butler, Carroll, Cedar, Cerro Gordo, Chickasaw, Dallas,
Davis, Delaware, Fayette, Floyd, Franklin, Grundy, Guthrie, Hancock, Hardin, Howard, Iowa, Jasper, Johnson, Keokuk, Kossuth,
Linn, Louisa, Madison, Marshall, Mitchell, Monroe, Palo Alto, Polk, Story, Tama, Warren, Washington, Wayne, Winnebago, Wright
and Worth 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 benefits. 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. 7
7 Page 8 9
2002 SecureCare of Iowa 8 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 speech therapy benefits by removing the requirement that services must be required to restore functional speech. (Section
5( a))

Changes to this Plan
Your share of the non-Postal premium will increase by 0.4% for Self Only or decrease -2.2% for Self and Family.
We changed the address for sending disputed claims to OPM. (Section 8)
We now cover certain intestinal transplants. (Section 5( b))
We changed speech therapy benefits by removing the requirement that services must be required to restore functional speech. (Section 5( a)) 8
8 Page 9 10
2002 SecureCare of Iowa 9 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 1-888-881-8820.

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

Plan providers Plan providers are physicians 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 NCQA standards.
SecureCare documents the credentialing and re-credentialing of M. D. s, D. O. s, D. P. M. s,
D. C. s, O. D. s, P. A. s, and all other licensed independent practitioners. SecureCare does
not credential physicians who practice exclusively within the inpatient setting
(pathologists, radiologists, anesthesiologist, and etc.)

The credentialing process takes approximately sixty to ninety days to complete from the
time a complete application is received (all documents requested have been provided).
All applicants' credentials are collected and verified prior to review and assessment by
the Credentials Committee.
We list Plan providers in the provider directory, which we update periodically. The list is
also on our website, which is updated daily.

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, which is updated daily.

What you must do It depends on the type of care you need. First, you and each family member
to get covered care must choose a primary care physician. This decision is important since your primary care physician provides or arranges for most of your health care. You will select a primary

care physician at the time you fill out the enrollment form for you and all of you covered
dependents. Each covered member of you family may select a different PCP. Your PCP
will be notified of your selection. If you do not select a PCP during your initial
enrollment, SecureCare of Iowa will designate a PCP. The PCP's name will appear on
your SecureCare of Iowa Member Identification Card. You may change your PCP once
per month by calling SecureCare of Iowa's Customer Service Department at 1-888-881-8820.
You must make the request before the 15 th of the month to be effective on the first
day of the following month.

Primary care Your primary care physician can be a family practitioner, internal medicine physician 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
primary care physician give you a referral. However, you may receive the following 9
9 Page 10 11
2002 SecureCare of Iowa 10 Section 3
Section 3. How you get care (continued)
selected medical services from a participating SecureCare of Iowa provider without a
referral:

Routine OB/ GYN Visit – Annual examination and laboratory work associated with the routine gynecological exam only. All other OB/ GYN services must be received
or coordinated through your PCP.
OB/ Maternity Care – You may self-refer to a participating obstetrician or family practice physician for maternity care including prenatal visits, delivery and

postpartum care.
Mental Health – Please call the telephone number listed in your provider directory for mental health to arrange for these services. Your primary care physician cannot

coordinate this care for you. It must be coordinated through SecureCare of Iowa's
Mental Health Case Coordinator.

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 be able to coordinate with the
specialist and complex case manager 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.
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. 10
10 Page 11 12
2002 SecureCare of Iowa 11 Section 3
If you are in the hospital when your enrollment in our Plan begins, call our customer
service department immediately at 1 888 881-8820. 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.

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.

Services requiring our Your primary care physician has authority to refer you for most services.
prior approval 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 preauthorization. Your physician must obtain
approval for the following but not limited to these services: Chiropractic Services,
Disease Education Programs, Durable Medical Equipment, Home Health Care, Hospice
Care, Occupational Therapy, Outpatient Surgeries, Outpatient Testing, Physician
Specialist, Physical Therapy, Podiatry Services, Speech Therapy, Organ Transplants,
Mental Health/ Substance Abuse care and services by a non-participating provider. These
services will be denied without prior approval. 11
11 Page 12 13
2002 SecureCare of Iowa 12 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, facility, pharmacy, etc., when you receive services.

Example: When you see your primary care physician you pay a copayment of $10 per
office visit and when you go in the hospital, you pay $100 per admission.

Deductible A deductible is a fixed expense you must incur for certain covered services and supplies before we start paying benefits for them. We do not have a deductible

Coinsurance Coinsurance is the percentage of our negotiated fee that you must pay for your care.
Example: In our Plan, you pay 10% of our allowance for infertility services and durable
medical equipment.

Your catastrophic protection
out-of-pocket maximum for,
coinsurance and
copayments

After your coinsurance totals $1000 per person or $2000 per family enrollment in any
calendar year, you do not have to pay any more for covered services. However,
copayments do not count toward your out-of-pocket maximum, and you must continue
to pay copayments.

Be sure to keep accurate records of your coinsurance payments since you are
responsible for informing us when you reach the maximum. 12
12 Page 13 14
2002 SecureCare of Iowa 13 Section 5
Section 5. Benefits – OVERVIEW
(See page 8 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 888 881-8820 or at our website at
www. securecareofiowa. com.
(a) Medical services and supplies provided by physicians and other health care professionals........................................................ 14-20

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 .................................................... 21-23
Surgical procedures
Reconstructive surgery
Oral and maxillofacial surgery
Organ/ tissue transplants
Anesthesia

(c) Services provided by a hospital or other facility, and ambulance services .................................................................................. 24-25
Inpatient hospital
Outpatient hospital or ambulatory surgical center
Extended care benefits/ skilled nursing care facility benefits
Hospice care
Ambulance

(d) Emergency services/ accidents...................................................................................................................................................... 26-27
Medical emergency Ambulance Accidental injury

(e) Mental health and substance abuse benefits...................................................................................................................................... 28
(f) Prescription drug benefits ............................................................................................................................................................ 29-30
(g) Special features ................................................................................................................................................................................. 31
Flexible benefits option 24 hour nurse line Complex Case Management Pulmonary Rehabilitation

(h) Dental benefits .................................................................................................................................................................................. 32
(i) Non-FEHB benefits available to Plan members ............................................................................................................................... 33

Summary of benefits ................................................................................................................................................................................ 51 13
13 Page 14 15
2002 SecureCare of Iowa 14 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.
We have no calendar year deductible
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 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 visit

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 visit 14
14 Page 15 16
2002 SecureCare of Iowa 15 Section 5 (a)
Preventive care, adult You pay
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

$10 per visit

Prostate Specific Antigen (PSA test) – one annually for men age 40 and older $10 per 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

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

Nothing

Not covered: Physical exams required for obtaining or continuing
employment or insurance, attending schools or camp, or travel.
All charges.

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

Nothing

Preventive care, children
Childhood immunizations recommended by the American Academy
of Pediatrics

Well-child care charges for routine examinations, immunizations and
care (through age 16)

Nothing

Examinations, such as:
Eye exams through age 17 to determine the need for vision
correction.

Ear exams through age 17 to determine the need for hearing
correction

$10 per visit

Maternity care
Complete maternity (obstetrical) care, such as:
Prenatal care
Delivery
Postnatal care

Nothing 15
15 Page 16 17
2002 SecureCare of Iowa 16 Section 5 (a)
Maternity care (continued) You pay
Note: Here are some things to keep in mind:
You do not need to pre-certify your normal delivery; see certificate of
coverage 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 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).

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
$50 copay

Surgically implanted contraceptives
Injectable contraceptive drugs
Intrauterine devices (IUDs)
Note: We cover oral contraceptives under the prescription drug benefit.

$10 per visit

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

Infertility services You pay
Diagnosis and treatment of infertility, such as:
Artificial insemination:
Intravaginal insemination (IVI)
Intracervical insemination (ICI)
Intrauterine insemination (IUI)
Fertility drugs
Note: We cover injectable fertility drugs under medical benefits and
oral fertility drugs under the prescription drug benefit.

10% per visit 16
16 Page 17 18
2002 SecureCare of Iowa 17 Section 5 (a)
Infertility services (continued) You pay
Not covered:
Assisted reproductive technology (ART) procedures, such as:
In vitro fertilization
Embryo transfer, gamete GIFT and zygote ZIFT
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 visit

Allergy serum Nothing
Not covered: provocative food testing and sublingual allergy
desensitization
All charges.

Treatment therapies
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 23.

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.
Call 1-888-881-8820 for preauthorization. We will ask you to submit
information 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.

$10 per visit

Physical and occupational therapies You pay
Physical therapy, occupational therapy and speech therapy --
60 visits per condition for the services of each of the following:
Qualified physical 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.

$10 per visit 17
17 Page 18 19
2002 SecureCare of Iowa 18 Section 5 (a)
Physical and occupational therapies (continued) You pay
Not covered:
Long-term rehabilitative therapy
Exercise programs
Cardiac rehabilitation

All charges.

Speech therapy
60 visits per condition for the services of speech therapists $10 per visit

Hearing services (testing, treatment, and supplies)
Hearing testing for children through age 17 (see Preventive care,
children)
$10 per visit

Not covered:
All other hearing testing
Hearing aids, testing and examinations for them

All charges.

Vision services (testing, treatment, and supplies)
Eye exam to determine the need for vision correction for children
through age 17 (see preventive care, children)
$10 per visit

Not covered:
Eyeglasses or contact lenses and, after age 17, examinations for them
Eye exercises and orthoptics
Radial keratotomy and other refractive surgery

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 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. 18
18 Page 19 20
2002 SecureCare of Iowa 19 Section 5 (a)
Orthopedic and prosthetic devices You pay
Artificial limbs and eyes; stump hose
Externally worn breast prostheses and surgical bras, including
necessary replacements, following a mastectomy

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

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

10% of charges

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

Prosthetic replacements provided less than 3 years after the last one
we covered

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 these
items if there has been prior authorization :

Hospital beds;
Standard wheelchairs;
Crutches;
Walkers;
Blood glucose monitors; and
Insulin pumps.
Note: Call us at 1-888-881-8820 as soon as your Plan physician
prescribes this equipment. We will arrange with a health care provider
to rent or sell you durable medical equipment at discounted rates and
will tell you more about this service when you call.

10% of charges

Not covered: Motorized wheelchairs All charges. 19
19 Page 20 21
2002 SecureCare of Iowa 20 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 that does not include a
medical component and is not diagnostic, therapeutic, or
rehabilitative.

All charges.

Chiropractic
Manipulation of the spine and extremities
Adjunctive procedures such as ultrasound, electrical muscle
stimulation, vibratory therapy, and cold pack application

$10 per visit

Not covered:
Acupuncture
Naturopathic services
Hypnotherapy
Biofeedback

All charges.

Educational classes and programs
$10 per visit Coverage is limited to:
Diabetic Education -Diabetic Education provides information on the
disease process on an outpatient basis to the Type I or Type II diabetic.
Individuals eligible for diabetic education meet the following criteria:

New diagnosis of diabetes
Poor control as evidenced by the appropriate laboratory findings
A change in treatment such as no medication to any type of
medication or from oral diabetes medication to insulin

The coverage for diabetic education includes up to ten (10) hours of
initial outpatient self-management training within a continuous twelve-month
period and up to one (1) hour of follow up each year.

Nutritional Counseling -This service may be covered in
circumstances where you need education to improve your
understanding and management of your nutritional requirements.
Some examples of conditions are:

Glucose Intolerance
High Blood Pressure
High Cholesterol
Morbid Obesity 20
20 Page 21 22
2002 SecureCare of Iowa 21 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 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.

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.).
YOUR PHYSICIAN MUST GET PRECERTIFICATION OF SOME SURGICAL PROCEDURES. Please refer to the precertification information shown in Section 3 to be sure which services require precertification and
identify which surgeries require precertification.

I M
P O
R T
A N
T

Benefit Description You pay
Surgical procedures
A comprehensive range of services, such as:
Operative procedures
Treatment of fractures, including casting
Normal pre-and post-operative care by the surgeon
Correction of amblyopia and strabismus
Endoscopy procedures
Biopsy procedures
Removal of tumors and cysts
Correction of congenital anomalies (see Reconstructive surgery)
Surgical treatment of morbid obesity --a condition in which an individual weighs 100 pounds or 100% over his or her normal

weight according to current underwriting standards; eligible
members must be age 18 or over
Insertion of internal prosthetic devices. See 5( a) – Orthopedic and prosthetic devices for device coverage information

$10 per visit

Voluntary sterilization
Note: Generally, we pay for internal prostheses (devices) according to
where the procedure is done. For example, we pay Hospital benefits for
a pacemaker and Surgery benefits for insertion of the pacemaker.

$50 copay

Not covered:
Reversal of voluntary sterilization
Routine treatment of conditions of the foot; see Foot care.

All charges.

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

$10 per visit 21
21 Page 22 23
2002 SecureCare of Iowa 22 Section 5( b)
Reconstructive surgery (continued) You pay
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.

$10 per visit

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 this procedure
performed on an inpatient basis and remain in the hospital up to 48
hours after the procedure.

$10 per visit

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

Other surgical procedures that do not involve the teeth or their
supporting structures.

$10 per visit

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. 22
22 Page 23 24
2002 SecureCare of Iowa 23 Section 5( b)
Organ/ tissue transplants You pay
Limited to:
Cornea
Heart
Heart/ lung
Kidney
Kidney/ Pancreas
Liver
Lung: Single –Double
Pancreas
Allogeneic 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) -Triage Alliance, Inc.
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.

$10 per visit

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

Anesthesia
Professional services provided in:
Hospital (inpatient)
Nothing

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

$10 per visit 23
23 Page 24 25
2002 SecureCare of Iowa 24 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).

I M
P O
R T
A N
T

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.

$100 per admission

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

Nothing

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

Private nursing care

All charges. 24
24 Page 25 26
2002 SecureCare of Iowa 25 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

Not covered: blood and blood derivatives not replaced by the member All charges
Extended care benefits/ skilled nursing care facility benefits
Skilled nursing facility (SNF) and extended care: Limited to 62 days
per admission.
Nothing

Not covered: custodial care All charges
Hospice care
No benefit All charges

Ambulance
Local professional ambulance service when medically appropriate Nothing 25
25 Page 26 27
2002 SecureCare of Iowa 26 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.
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
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 is an accidental injury?
Restorative services and supplies necessary to promptly repair (but not replace) sound natural teeth are covered. The need for
these services must result from an accidental injury. You pay a $10 copay per visit. Services must be provided within six months
of the accidental injury. Accidental injury does not include damages as a result of biting or chewing.

Benefit Description You pay
Emergency within our service area
Emergency care at a doctor's office $10 per visit

Emergency care at an urgent care center $30 per visit
Emergency care as an outpatient or inpatient at a hospital, including
doctors' services
$50 per visit, co-pay waived if admitted to
the hospital.

Not covered: Elective care or non-emergency care All charges.

Emergency outside our service area
Emergency care at a doctor's office $10 per visit

Emergency care at an urgent care center $30 per visit
Emergency care as an outpatient or inpatient at a hospital, including
doctors' services $50 per visit, co-pay waived if admitted to the hospital

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. 26
26 Page 27 28
2002 SecureCare of Iowa 27 Section 5( d)
Ambulance You pay
Professional ambulance service when medically appropriate.
See 5( c) for non-emergency service.
Nothing 27
27 Page 28 29
2002 SecureCare of Iowa 28 Section 5( e)
Section 5 (e). Mental health and substance abuse benefits
I M
P O
R T
A N
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.
For facility care, there is an inpatient co-pay of $100 per admission.
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.

I M
P O
R T
A N
T

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

Diagnostic tests $10 per 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

$100 per admission

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 obtain a treatment plan and follow all of the following authorization processes: To obtain preauthorization for mental health
benefits, please contact the Plan at 1-515-331-7877 or 1-888-881-8820.

Limitation We may limit your benefits if you do not obtain a treatment plan. 28
28 Page 29 30
2002 SecureCare of Iowa 29 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 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.

Some drugs require a prior approval
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

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 may fill the prescription at a plan pharmacy, or by mail. You must fill the prescription at a plan pharmacy, or by mail for a maintenance medication.

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 31-day supply or 100 unit supply, whichever is less; 240
milliliters of liquid (8 oz); 60 grams of ointment, creams or topical preparation; or one commercially prepared
unit (i. e. one inhaler, one vial ophthalmic medication or insulin). If there is no generic equivalent available,
you will still have to pay the brand name copay. For prescriptions on which the physician has written refills, a
certain percentage of the original prescription must be used before the prescription can be refilled. These
percentages are as follows:
For a prescription with a one (1) to fourteen (14) days supply, seventy percent (70%) of the prescription must be used.

For a prescription with a fifteen (15) to thirty-four (34) days supply, eighty percent (80%) of the prescription must be used.
For a prescription with a thirty-five (35) to one hundred two (102) days supply, seventy percent (70%) of the prescription must be used.

Why use generic drugs? Generic drugs offer a safe and economic way to meet your prescription drug needs. The
generic name of a drug is its chemical name; the name brand is the name under which the manufacturer advertises and
sells a drug. Under federal law, generic and name brand drugs must meet the same standards fro safety purity, strength,
and effectiveness. A generic prescription costs you – and us – less than a name brand prescription.

When you have to file a claim. If you utilize a non-participating pharmacy, you should pay for the
prescription in full and then submit the claim on a SecureCare of Iowa Prescription Claim Form for reimbursement.
Please send your prescription claim form and receipt for your prescription to: SecureCare of Iowa, Customer Service
Department, 11141 Aurora Avenue, Des Moines, IA 50322

Prescription drug benefits begin on the next page. 29
29 Page 30 31
2002 SecureCare of Iowa 30 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:

Drugs and medicines that by Federal law of the United States require
a physician's prescription for their purchase, except as excluded
below.

Insulin
Disposable needles and syringes for the administration of covered
medications are covered under the durable medical equipment benefit.

Drugs for sexual dysfunction (see Prior authorization below)
All FDA approved oral contraceptive drugs (injectable contraceptive
drugs and contraceptive devices are covered under Medical and
Surgical Benefits, see page 21 )

Intravenous fluids and medication for home use, implantable drugs,
and some injectable drugs are covered under Medical and Surgical
Benefits.

Nicotine patches are covered if you complete a smoking cessation
program (the cost of the smoking cessation program is not covered)

$5 or 25% of the cost, whichever is greater,
per prescription unit or refill.

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

Here are some things to keep in mind about our prescription drug
program:

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.

We do not use a formulary.

Not covered:
Drugs and supplies for cosmetic purposes
Vitamins, nutrients and food supplements even if a physician
prescribes or administers them

Nonprescription medicines
Drugs obtained at a non-Plan pharmacy except for out-of-area
emergencies

Medical supplies such a dressings and antiseptics
Drugs to enhance athletic performance
Smoking cessation drugs and medication, except you will be
reimbursed for nicotine patches after completion of a smoking
cessation program.

All Charges 30
30 Page 31 32
2002 SecureCare of Iowa 31 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.

Complex Case Management This is provided as a service to you and your physician. SecureCare of Iowa has registered nurse available to assist in coordinating your healthcare needs when your
medical condition requires services from numerous specialists. The complex case
manager works to keep all the providers aware of the services and ensures that your care
and benefits are maximized.

Pulmonary Rehabilitation This service is provided on an outpatient basis if you have conditions in which your breathing affects your ability to complete the tasks of daily living. This program assists you
in learning how to return to the highest level of functional ability allowed by your pulmonary
disease. 31
31 Page 32 33
2002 SecureCare of Iowa 32 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.

Plan dentists must provide or arrange your care.
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
P O
R T
A N
T
Accidental injury benefit You pay

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

$10 per office visit

Dental benefits
We have no other dental benefits. 32
32 Page 33 34
2002 SecureCare of Iowa 33 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 t
Fees you pay for these services do not count toward FEHB deductibles or out-of-pocket maximums.

Wellness Program SecureCare of Iowa subscribers are eligible to participate in the SecureCare Health Test at no charge, if you live or work in Polk County.
This test includes the following components:

Health Survey
Height/ Weight/ Blood Pressure
Body Fat Composition
Blood Screening
Cancer Risk Assessment

Employees who participate in this program will receive a complete
explanation of their results. A copy of the results will be forwarded to
the member's Primary Care Doctor.

This program was developed to treat persons with cardiac disease. This
Program is approved when criteria have been met for medical necessity.
You pay a 30% coinsurance if you have been approved to complete the
program.

Benefits on this page are not part of the FEHB contract. 33
33 Page 34 35
2002 SecureCare of Iowa 34 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 or when the pregnancy is the result of an act of rape or incest ;

Services, drugs, or supplies related to sex transformations; or
Services, drugs, or supplies you receive from a provider or facility barred from the FEHB Program. 34
34 Page 35 36
2002 SecureCare of Iowa 35 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, coinsurance, or deductible.

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 and hospital 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 1-888-881-8820.
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: SecureCare of Iowa, Claims Department,
P. O. Box 7953, Lake Forest, IL 60045-7953

Prescription drugs For all claims, complete a SecureCare of Iowa prescription claim form and attach your receipt.

Submit your claims to: SecureCare of Iowa, Attn: Pharmacy Claims, 11141
Aurora Avenue, Des Moines, IA 50322

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. 35
35 Page 36 37
2002 SecureCare of Iowa 36 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: SecureCare of Iowa, 11141 Aurora Avenue, Des Moines, IA 50322; 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.

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. 36
36 Page 37 38
2002 SecureCare of Iowa 37 Section 8
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 1-888-881-8820
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/ 606-0755 between 8 a. m. and 5 p. m. eastern time. 37
37 Page 38 39
2002 SecureCare of Iowa 38 Section 9
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.

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 with held 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
managed care 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 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, or precertified as required. We will not waive any of our
copayments, coinsurance, and deductibles.

(Primary payer chart begins on next page.)

Section 9. Coordinating benefits with other coverage 38
38 Page 39 40
2002 SecureCare of Iowa 39 Section 9
The following chart illustrates whether the Original Medicare 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 …

Please note, if your Plan physician does not participate in Medicare, you will have to file a claim with Medicare 39
39 Page 40 41
2002 SecureCare of Iowa 40 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 1-888-881-8820.

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 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 (if you use our Plan
providers), but we will not waive any of our copayments, 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 enroll in Medicare Part A or Part B 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 members, 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 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. 40
40 Page 41 42
2002 SecureCare of Iowa 41 Section 9
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 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. 41
41 Page 42 43
2002 SecureCare of Iowa 42 Section 10
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. See page 12.

Copayment A co-payment is a fixed amount of money you pay when you receive covered services. See page 12.
Covered services Care we provide benefits for, as described in this brochure.
Deductible A deductible is a fixed amount of covered expenses you must incur for certain covered services and supplies before we start paying benefits for those services. We do not have
a deductible. See page 12.

Experimental or
investigational services If the scientific evidence supports the safety and efficiency of a particular therapy (state-of-the-art or cutting edge), it is potentially available to our members. SecureCare of Iowa

is a provider owned health plan, and as a result, our physicians play a key role in making
these therapeutic decisions.

Plan allowance Plan allowance is the amount we use to determine our payment and your coinsurance for covered services. Plans determine their allowances in different ways. We determine our
allowance as follows: SecureCare of Iowa bases the allowed amount on the negotiated
fee or per diem schedules we have with our participating providers. Participating
providers accept the plan allowance as payment in full.

Us/ We Us and we refer to SecureCare of Iowa.
You You refers to the enrollee and each covered family member.

Section 10. Definitions of terms we use in this brochure 42
42 Page 43 44
2002 SecureCare of Iowa 43 Section 11
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
about enrolling in the can answer your questions, and give you a Guide to Federal Employees
FEHB Program 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 Self Only coverage is for you alone. Self and Family coverage is for
for you and your family 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.

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.

The benefits in this 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 January 1. 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.

Section 11. FEHB facts
When benefits and
premiums start 43
43 Page 44 45
2002 SecureCare of Iowa 44 Section 11
Your medical and claims We will keep your medical and claims information confidential. Only
records are confidential 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 If you are divorced from a Federal employee or annuitant, you may not coverage 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.

Tempory continuation If you leave Federal service, or if you lose coverage because you no longer qualify as a of coverage (TCC) 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.
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. 44
44 Page 45 46
2002 SecureCare of Iowa 45 Section 11
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
Group Health Plan Coverage The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a Federal 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
questions. 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. 45
45 Page 46 47
2002 SecureCare of Iowa 46 Long Term Care Insurance
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:

What is long term care (LTC) insurance?
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 care in a nursing home, in an assisted living facility, 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.
I'm healthy. I won't need long term care. Or, will I?
76% of Americans believe they will never need long term care, but the facts are that about half of 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 you should have a plan just in case. LTC insurance may be vital to your financial and retirement planning.

Is long term care expensive?
Yes. A year in a nursing home can exceed $50,000 and only three 8-hour shifts a week can exceed $20,000 a year, that's before inflation!

LTC can easily exhaust your savings but LTC insurance can protect it.
But won't my FEHB plan, Medicare or Medicaid cover my long term care?
Not FEHB. Look under "Not covered" in sections 5( a) and 5( c) of your FEHB brochure. Custodial care, assisted living, or continuing home health care for activities of daily living are not covered. Limited stays in skilled nursing facilities

can be covered in some circumstances.
Medicare only covers skilled nursing home care after a hospitalization with a 100 day limit.
Medicaid covers LTC for those who meet their state's guidelines, but restricts covered services and where they can be received. LTC insurance can provide choices of care and preserve your independence.

When will I get more information?
Employees will get more information from their agencies during the late summer/ early fall of 2002.
Retirees will receive information at home.

How can I find out more about the program NOW?
A toll-free telephone number will begin in mid-2002. You can learn more about the program now at www. opm. gov/ insure/ ltc.

Long Term Care Insurance Is Coming Later in 2002!
Many FEHB enrollees think their health plan and/ or Medicare covers long-term care. Unfortunately, they are WRONG! How are YOU planning to pay for the future custodial or chronic care you may need? Consider buying long term care
insurance. 46
46 Page 47 48
2002 SecureCare of Iowa 47 Index
Do not rely on this page; it is for your convenience and may not show all pages where the terms appear
Accidental injury 32
Allergy tests 17 Alternative treatment 23

Allogenetic( donor) bone marrow transplants 23
Ambulance 27 Anesthesia 23
Autologous bone marrow transplant 23 Biopsies 21
Blood and blood plasma 24 Breast cancer screening 15
Changes for 2002 8 Chemotherapy 17
Childbirth 15
Chiropractic 20
Cholesterol tests 15 Claims 45

Coinsurance 12 Colorectal cancer screening 15
Congenital anomalies 21 Contraceptive devices and drugs 16, 29
Coordination of benefits 38 Covered providers 6
Crutches 19 Deductible
12 Definitions 42

Dental care 32 Diagnostic services 14
Disputed claims review 36 Durable medical equipment (DME) 19
Educational classes and programs 20
Effective date of enrollment 9 Emergency 26

Experimental or investigational 35
Eyeglasses 18 Family planning 16
Fecal occult blood test 15 General Exclusions 34
Hearing services 18
Home health services 20 Hospice care 25

Home nursing care 20 Immunizations 15
Infertility 16 Inhospital physician care 24
Inpatient Hospital Benefits 24 Insulin 29
Laboratory and pathological
services 14 Magnetic Resonance Imagings

(MRIs) 14 Mail Order Prescription Drugs 29
Mammograms 15 Maternity Benefits 15
Medicaid 44 Medicare 44
Mental Conditions/ Substance Abuse Benefits 28
Newborn care 15 Non-FEHB Benefits 33
Occupational therapy 17 Ocular injury 18
Office visits 14 Oral and maxillofacial surgery 22
Orthopedic devices 19 Out-of-pocket expenses 12

Outpatient facility care 24 Pap test 15
Physical therapy 17 Preventive care, adult 15
Preventive care, children 15 Prescription drugs 29
Preventive services 15 Prior approval 11
Prostate cancer screening 15 Prosthetic devices 9
Psychologist 28 Radiation therapy 17
Room and board 24 Second surgical opinion 21
Skilled nursing facility care 25 Smoking cessation 30
Speech therapy 18 Subrogation 41
Surgery 21 Anesthesia 23
Oral 23 Outpatient 25
Reconstructive 22 Syringes 31
Temporary continuation of coverage
44 Transplants 23

Vision services 18
Well child care 15
Wheelchairs 19 Workers' compensation 40

X-rays 25

Index 47
47 Page 48 49
2001 SecureCare of Iowa 48 Notes
NOTES: 48
48 Page 49 50
2001 SecureCare of Iowa 49 Notes
NOTES: 49
49 Page 50 51
2001 SecureCare of Iowa 50 Notes
NOTES: 50
50 Page 51 52
2001 SecureCare of Iowa 51 Summaryof Benefits
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 14

Services provided by a hospital:
Inpatient ........................................................................................................................
Outpatient .....................................................................................................................
$100 per admission copay
$50 outpatient hospital copay
$30 urgent care center copay

24
25

Emergency benefits:
In-area...........................................................................................................................

Out-of-area ...................................................................................................................
$10 per office visit
$50 outpatient hospital copay
$30 urgent care center copay

$50 outpatient hospital copay
$30 urgent care center copay

26
26

Mental health and substance abuse treatment ................................................................... Regular cost sharing. 28
Prescription drugs .............................................................................................................. $5 co-pay or 25% of charges,
whichever is greater
29

Dental Care ........................................................................................................................ No benefit. 32
Vision Care ........................................................................................................................ No benefit. 18
Special features: Flexible benefits option, Complex Case Management, Pulmonary Rehabilitation 31

Summary of benefits for SecureCare of Iowa – 2002 51
51 Page 52
2001 SecureCare of Iowa 52 Summary of Rate Information
2002 Rate Information for
SecureCare of Iowa Health 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

Central and Eastern Iowa areas

Self Only 3Q1 $75.67 $25.22 $163.95 $54.65 $89.54 $11.35

Self and Family 3Q2 $198.23 $66.07 $429.49 $143.16 $234.57 $29.73 52

Page Navigation Panel