Pages 1--59

ADVANTAGE Health Plan, Inc. http:// www. advantageplan. com
2003
Serving: Most of Indiana
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:
6Y1 Self Only 6Y2 Self and Family

Special notice: This Plan reduced its service area by eliminating Adams, Allen, DeKalb, Gibson, Huntington, Kosciusko, Lagrange, Noble, Porter, Posey, Steuben,
Vanderburgh, Warrick, Wells, Whitley counties, and Defiance county (Ohio) for 2003.

RI 73-803

A Health Maintenance Organization
This Plan has New Health Plan Accreditation by NCQA from February
1, 2001 through February 1, 2004. See the 2003 guide for more information on
accreditation.

For changes in benefits
see page 8. 1.
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Dear Federal Employees Health Benefits Program Participant:
I am pleased to present this Federal Employees Health Benefits (FEHB) Program plan brochure for 2003. The brochure explains all the benefits this health plan offers to its enrollees. Since
benefits can vary from year to year, you should review your plan's brochure every Open Season. Fundamentally, I believe that FEHB participants are wise enough to determine the care
options best suited for themselves and their families.
In keeping with the President's health care agenda, we remain committed to providing FEHB members with affordable, quality health care choices. Our strategy to maintain quality and cost
this year rested on four initiatives. First, I met with FEHB carriers and challenged them to contain costs, maintain quality, and keep the FEHB Program a model of consumer choice and
on the cutting edge of employer-provided health benefits. I asked the plans for their best ideas to help hold down premiums and promote quality. And, I encouraged them to explore all
reasonable options to constrain premium increases while maintaining a benefits program that is highly valued by our employees and retirees, as well as attractive to prospective Federal
employees. Second, I met with our own FEHB negotiating team here at OPM and I challenged them to conduct tough negotiations on your behalf. Third, OPM initiated a comprehensive
outside audit to review the potential costs of federal and state mandates over the past decade, so that this agency is better prepared to tell you, the Congress and others the true cost of mandated
services. Fourth, we have maintained a respectful and full engagement with the OPM Inspector General (IG) and have supported all of his efforts to investigate fraud and waste within the
FEHB and other programs. Positive relations with the IG are essential and I am proud of our strong relationship.

The FEHB Program is market-driven. The health care marketplace has experienced significant increases in health care cost trends in recent years. Despite its size, the FEHB Program is not
immune to such market forces. We have worked with this plan and all the other plans in the Program to provide health plan choices that maintain competitive benefit packages and yet keep
health care affordable.
Now, it is your turn. We believe if you review this health plan brochure and the FEHB Guide you will have what you need to make an informed decision on health care for you and your
family. We suggest you also visit our web site at www. opm. gov/ insure.

Sincerely,

Kay Coles James Director 2.
2 Page 3 4
Notice of the Office of Personnel Management's
Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
By law, the Office of Personnel Management (OPM), which administers the Federal Employees Health Benefits (FEHB) Program, is required to protect the privacy of your personal medical information. OPM is also required to give you this notice to tell you how
OPM may use and give out (" disclose") your personal medical information held by OPM.
OPM will use and give out your personal medical information:
To you or someone who has the legal right to act for you (your personal representative), To the Secretary of the Department of Health and Human Services, if necessary, to make sure your privacy is protected,
To law enforcement officials when investigating and/ or prosecuting alleged or civil or criminal actions, and Where required by law.

OPM has the right to use and give out your personal medical information to administer the FEHB Program. For example:
To communicate with your FEHB health plan when you or someone you have authorized to act on your behalf asks for our assistance regarding a benefit or customer service issue.
To review, make a decision, or litigate your disputed claim. For OPM and the General Accounting Office when conducting audits.

OPM may use or give out your personal medical information for the following purposes under limited circumstances:
For Government healthcare oversight activities (such as fraud and abuse investigations), For research studies that meet all privacy law requirements (such as for medical research or education), and
To avoid a serious and imminent threat to health or safety.
By law, OPM must have your written permission (an "authorization") to use or give out your personal medical information for any purpose that is not set out in this notice. You may take back (" revoke") your written permission at any time, except if OPM has
already acted based on your permission.
By law, you have the right to:
See and get a copy of your personal medical information held by OPM. Amend any of your personal medical information created by OPM if you believe that it is wrong or if information is missing,
and OPM agrees. If OPM disagrees, you may have a statement of your disagreement added to your personal medical information.
Get a listing of those getting your personal medical information from OPM in the past 6 years. The listing will not cover your personal medical information that was given to you or your personal representative, any information that you authorized
OPM to release, or that was given out for law enforcement purposes or to pay for your health care or a disputed claim. Ask OPM to communicate with you in a different manner or at a different place (for example, by sending materials to a P. O.
Box instead of your home address). Ask OPM to limit how your personal medical information is used or given out. However, OPM may not be able to agree to
your request if the information is used to conduct operations in the manner described above. Get a separate paper copy of this notice. 3.
3 Page 4 5

For more information on exercising your rights set out in this notice, look at www. opm. gov/ insure on the web. You may also call 202-606-0191 and ask for OPM's FEHB Program privacy official for this purpose.
If you believe OPM has violated your privacy rights set out in this notice, you may file a complaint with OPM at the following address:
Privacy Complaints Office of Personnel Management
P. O. Box 707 Washington, DC 20004-0707

Filing a complaint will not affect your benefits under the FEHB Program. You also may file a complaint with the Secretary of the Department of Health and Human Services.
By law, OPM is required to follow the terms in this privacy notice. OPM has the right to change the way your personal medical information is used and given out. If OPM makes any changes, you will get a new notice by mail within 60 days of the change. The
privacy practices listed in this notice will be effective April 14, 2003. 4.
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5.
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2003 ADVANTAGE Health Plan, Inc. 2 Table of Contents
Table of Contents
Introduction......................................................................................... 4
Plain Language....................................................................................................................................................................................... 4
Stop Health Care Fraud!......................................................................................................................................................................... 4
Section 1. Facts about this HMO plan................................................................................................................................................... 6
How we pay providers.......................................................................................................................................................... 6
Your Rights .......................................................................................................................................................................... 6
Service Area ......................................................................................................................................................................... 7
Section 2. How we change for 2003...................................................................................................................................................... 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 ................................................................................................................................................................. 10
Specialty care ............................................................................................................................................................... 10
Hospital care ................................................................................................................................................................ 11
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 catastrophic protection 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 ................................ 23
(c) Services provided by a hospital or other facility, and ambulance services .............................................................. 27
(d) Emergency services/ accidents ................................................................................................................................. 30
(e) Mental health and substance abuse benefits ............................................................................................................ 32
(f) Prescription drug benefits ........................................................................................................................................ 34
(g) Special features ....................................................................................................................................................... 37
Flexible benefits option ........................................................................................................................................ 37
Services for deaf and hearing impaired ................................................................................................................ 37 6.
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2003 ADVANTAGE Health Plan, Inc. 3 Table of Contents
(h) Dental benefits ....................................................................................................................................................... 38
Section 6. General exclusions --things we don't cover ....................................................................................................................... 39
Section 7. Filing a claim for covered services..................................................................................................................................... 40
Section 8. The disputed claims process ............................................................................................................................................... 41
Section 9. Coordinating benefits with other coverage ........................................................................................................................ 43
When you have other health coverage................................................................................................................................ 43
What is Medicare ........................................................................................................................................................ 43
Medicare managed care plan ...................................................................................................................................... 46
TRICARE and CHAMPVA........................................................................................................................................ 46
Workers' Compensation .............................................................................................................................................. 46
Medicaid ..................................................................................................................................................................... 47
Other Government agencies ........................................................................................................................................ 47
When others are responsible for injuries ..................................................................................................................... 47
Section 10. Definitions of terms we use in this brochure ..................................................................................................................... 48
Section 11. FEHB facts ....................................................................................................................................................................... 49
Coverage information....................................................................................................................................................... 49
No pre-existing condition limitation ........................................................................................................................... 49
Where you get information about enrolling in the FEHB Program............................................................................. 49
Types of coverage available for you and your family ................................................................................................. 49
Children's Equity Act.................................................................................................................................................. 49
When benefits and premiums start .............................................................................................................................. 50
When you retire........................................................................................................................................................... 50
When you lose benefits ............................................................................................................................................... 50
When FEHB coverage ends ........................................................................................................................................ 50
Spouse equity coverage ............................................................................................................................................... 50
Temporary Continuation of Coverage (TCC) ............................................................................................................. 50
Converting to individual coverage .............................................................................................................................. 51
Getting a Certificate of Group Health Plan Coverage ................................................................................................. 51

Long term care insurance is still available ........................................................................................................................................... 52
Index........ ... ........................................................................................................................................................................................ 53
Summary of benefits ............................................................................................................................................................................ 54
Rates....................................................................................................................................................................................... Back cover 7.
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2003 ADVANTAGE Health Plan, Inc. 4 Introduction/ Plain Language/ Advisory
Introduction
This brochure describes the benefits of ADVANTAGE Health Plan, Inc. under our contract (CS 2862) with the Office of Personnel Management (OPM), as authorized by the Federal Employees Health Benefits law. The address for ADVANTAGE
Health Plan, Inc. administrative offices is:
ADVANTAGE Health Plan, Inc. 9490 Priority Way, West Drive
Indianapolis, Indiana 46240
This brochure is the official statement of benefits. No oral statement can modify or otherwise affect the benefits, limitations, and exclusions of this brochure. It is your responsibility to be informed about your health benefits.

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, 2003, unless those benefits are also shown in this brochure.
OPM negotiates benefits and rates with each plan annually. Benefit changes are effective January 1, 2003, and changes are summarized on page 8. Rates are shown at the end of this brochure.

Plain Language
All FEHB brochures are written in plain language 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 ADVANTAGE Health Plan, Inc..

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.

Stop Health Care Fraud!
Fraud increases the cost of health care for everyone and increases your Federal Employees Health Benefits (FEHB) Program premium.
OPM's Office of the Inspector General investigates all allegations of fraud, waste, and abuse in the FEHB Program regardless of the agency that employs you or from which you retired.

Protect Yourself From Fraud -Here are some things you can do to prevent fraud:
Be wary of giving your plan identification (ID) number over the telephone or to people you do not know, except to your doctor, other provider, or authorized plan or OPM representative.
Let only the appropriate medical professionals review your medical record or recommend services. 8.
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2003 ADVANTAGE Health Plan, Inc. 5 Introduction/ Plain Language/ Advisory
Avoid using health care providers who say that an item or service is not usually covered, but they know how to bill us to get it paid.
Carefully review explanations of benefits (EOBs) that you receive from us. Do not ask your doctor to make false entries on certificates, bills or records in order to get us to pay for an item or service.
If you suspect that a provider 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 (317) 553-8933 and explain the situation.
If we do not resolve the issue:

Do not maintain as a family member on your policy: your former spouse after a divorce decree or annulment is final (even if a court order stipulates otherwise); or
your child over age 22 (unless he/ she is disabled and incapable of self support). If you have any questions about the eligibility of a dependent, check with your personnel office if you are employed or with
OPM if you are retired. You can be prosecuted for fraud and your agency may take action against you if you falsify a claim to obtain FEHB or try to
obtain services for someone who is not an eligible family member or who is no longer enrolled in the Plan.

CALL --THE HEALTH CARE FRAUD HOTLINE 202-418-3300
OR WRITE TO: The United States Office of Personnel Management
Office of the Inspector General Fraud Hotline 1900 E Street, NW, Room 6400
Washington, DC 20415 9.
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2003 ADVANTAGE Health Plan, Inc. 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. The Plan is solely responsible for the selection of these
providers in your area. Contact the Plan for a copy of their most recent provider directory.
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. ADVANTAGE Health
Plan pays almost all of its contracting medical groups and other physician networks on a capitation basis. Capitation is a method of payment in which an HMO pays a provider or provider network an agreed upon monthly fee for each member assigned to that
provider or provider network.
Under capitation payment arrangements, the provider network is responsible for paying the physicians, hospitals and ancillary providers who provide the covered services to members. In some cases, the provider network pays the primary care physicians and
specialty physicians on either a capitation basis or on a fee-for-services basis. "Fee-for-service" payment means that the physician bills the provider network for each service he/ she provides, and the provider network pays an agreed upon rate for each service. Some
hospital and ancillary providers are paid on a capitation payment basis, and others are paid on a fee-for-service basis. The provider networks may pay bonuses to, or withhold funds from, their contracted physicians based on how appropriately the physician has
managed the utilization and costs of care for all his/ her members.
If a member believes that his/ her physician is refusing to authorize care when needed, or if it is taking too long to get approvals for specialty care or hospitalization, the member should contact Member Services at 1-800-553-8933 to discuss the concern. A Member
Service Representative will assist in the evaluation of the concern and action.
ADVANTAGE Health Plan members may also contact a Member Service Representative to obtain additional information about provider payment arrangements and incentives.

Your Rights
OPM requires that all FEHB Plans provide certain information to their FEHB members. You may get information about us, our networks, providers, and facilities. OPM's FEHB website (www. opm. gov/ insure) lists the specific types of information that we must
make available to you. Some of the required information is listed below.
ADVANTAGE HMO, Inc. received its Certificate of Authority to operate a prepaid health care delivery system in Indiana on April 27, 2000 and meets the State's financial solvency requirements as of that date.

The Plan was incorporated in November 1999 and began operations as a new health plan on May 1, 2000. The Plan is incorporated in Indiana as a For-profit company
The Plan has no ownership or interest in any health care facilities The Plan and its contracted providers use nationally recognized clinical protocols, practice guidelines and utilization review
standards published by Milliman and Robertson, Inc. and InterQual, to direct a patient's care. 10.
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2003 ADVANTAGE Health Plan, Inc. 7 Section 1
ADVANTAGE HMO, Inc. is a privately held Indiana corporation owned by four Catholic health care systems: Ascension Health, Sisters of St. Francis Health Services, Inc., Saint Joseph's Regional Medical Center, Inc. and Ancilla Systems, Inc. ADVANTAGE
HMO, Inc. is a managed care company licensed to operate a prepaid health plan under a Certificate of Authority issued by the State of Indiana on April 27, 2000. The managed care benefit plans are marketed as "ADVANTAGE Health Plan".

As a Catholic owned organization, ADVANTAGE HMO, Inc. supports the Ethical and Religious Directives for Catholic Health Care Services (Directives). Our organization encourages individuals to apply their values in reaching a decision of conscience in matters of
health.
ADVANTAGE Health Plan includes primary care physicians, specialists, hospitals and other health care providers. Each provider is affiliated with a Provider Network (PN) or Physician Hospital Organization (PHO). All care is coordinated by your selected primary
care physician (PCP), and to the extent possible, services are arranged and provided within your PCP's affiliated network.
The first and most important decision each member must make is the selection of a PCP. The PCP you choose will be your primary health care provider. Your PCP is the key to the HMO Network because he/ she is responsible for coordinating all of your health care
needs. The PCP is committed to providing you with the most appropriate care to meet your medical needs. Your PCP should always be contacted first for your health care needs. Your PCP will arrange for you to be referred to a specialist when medically necessary.
When your PCP authorizes your referral to a specialist, he/ she will obtain a referral authorization number for you. The PCP will also arrange for any hospital stays which may be required.

Specialty providers are generally limited to those participating within your PCP's network. The Provider Directory lists specialists by type of practice and by affiliated network.
If you want more information about us, call 1-800-553-8933, or write to ADVANTAGE Health Plan Member Services, P. O. Box 80069, Indianapolis, IN 46280. You may also contact us by fax at 317-573-2839 or visit our web site at www. advantageplan. com.
Service Area
To enroll with us, you must live in or work in our service area. Members must select a Primary Care Provider within a 30 mile radius of their residence. This is where our providers practice. Our service area includes the following counties: Bartholomew (partial zip
codes, 47201, 47202, 47226, 47246, 47280), Blackford, Boone, Brown, Carroll, Cass, Clay (partial zip codes 47833, 47834, 47837, 47840, 47853, 47857, 47868, 47881), Clinton, Delaware, Elkhart, Fayette, Fulton, Grant, Hamilton, Hancock, Hendricks, Henry,
Howard, Jay, Johnson, LaPorte, Madison, Marion, Marshall, Miami, Monroe, Montgomery, Morgan, Owen (47455, 47456, 47460), Parke, Pulaski, Putnam, Randolph, Rush, Shelby, St. Joseph, Starke, Tippecanoe, Tipton, Wabash, and Wayne.

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.
Note: Not included in our service area is Adams, Allen, Defiance (Ohio), Dekalb, Gibson, Huntington, Kosciosko, Lagrange, Noble, Porter, Posey, Steuben, Vanderburgh and Warrick, Wells and Whitley counties.

The counties listed above decided they were unable to manage the health of their respective constituencies and the resulting financial implications, therefore they withdrew from managing all managed healthcare plans, not just the Federal group.
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. 11.
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2003 ADVANTAGE Health Plan, Inc. 8 Section 2
Section 2. How we change for 2003
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
A Notice of the Office of Personnel Management's Privacy Practices is included. A section on the Children's Equity Act describes when an employee is required to maintain Self and Family coverage.

Program information on TRICARE and CHAMPVA explains how annuitants or former spouses may suspend their FEHB Program enrollment.
Program information on Medicare is revised. By law, the DoD/ FEHB Demonstration project ends on December 31, 2002.

Changes to this Plan
Your share of the non-Postal premium will increase by 19.8% for Self Only or 29.6% for Self and Family.
The Primary Care Physician office visit copay increases from $10 to $15 per visit.
The Specialist office visit copay increases from $15 to $30 per visit.
The Inpatient Hospital admission copay increases from $200 to $400 per admission.
The Emergency services at a Hospital Emergency Room increases from $75 to $125 per visit.
The Prescription drug copay increases from $5/$ 20/$ 45 (generic/ brand/ non-formulary) to $10/$ 30/$ 50 (generic/ brand/ non-formulary) per prescription.

Our service area reduces by 15 counties. 12.
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2003 ADVANTAGE Health Plan, Inc. 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 1-800-553-8933 or write to us at
ADVANTAGE Health Plan, Inc. 9490 Priority Way, West Drive, Indianapolis, Indiana 46240.

Where you get covered care You get care from "Plan providers" and "Plan facilities." You will only pay copayments, and 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 national standards. The Plan's Primary Care Physicians (PCPs) specialize in Family Practice, General Practice, Internal Medicine, and Pediatrics. The
Plan's Specialists are practitioners who have furthered their training in specific areas of health care such as cardiology, surgery, dermatology, and oncology. The Plan arranges
access to a broad range of participating providers through contracting with provider networks who directly contract with PCPs, specialists, hospitals and other facilities
making up that provider network's delivery system.
We list all Plan providers in the provider directory, which we update periodically. This list is also available on our website. You may contact a Member Service Representative
to obtain additional information about participating providers such as: method of compensation, ownership or interest in health care facilities, professional education,
medical school and residency training, current board certification status, number of years in practice, and member satisfaction rates.

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. When you select a PCP, you agree to utilize the physician's affiliated hospital or hospital services. When your physician
authorizes inpatient or outpatient hospital services, you may contact us to obtain more information about the hospital, such as: hospital accreditation status, experience/ volume
in performing certain procedures, and comparable measures of quality and consumer satisfaction.

It depends on the type of care you need. First, you and each family member must choose a primary care physician. This decision is important since your primary care physician
provides or arranges for most of your health care. At the time of enrollment, you are given a Provider Directory to select your PCP.

The ADVANTAGE Health Plan's Provider Directory lists primary care doctors 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 ADVANTAGE Health Plan Member Services
Department at 1-800-553-8933. You can also find out if your doctor participates with the ADVANTAGE Health 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 and is accepting new patients under this Plan. NOTE: When

What you must do to get covered care 13.
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2003 ADVANTAGE Health Plan, Inc. 10 Section 3
you enroll in the ADVANTAGE Health Plan, services (except for emergencies) 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.

Primary care Your primary care physician can be a Family Practice, General Practice, Internal Medicine or Pediatrician. Your primary care physician will provide most of your health
care, or give you a referral to see a specialist.
If you want to change primary care physicians or if your primary care physician leaves the Plan, call us. We will help you select a new one.

Specialty care Your primary care physician will refer you to a specialist for needed care. When you receive a referral from your primary care physician, you must return to the primary care
physician after the consultation, unless your primary care physician authorized a certain number of visits without additional referrals. The primary care physician must provide or
authorize all follow-up care. Do not go to the specialist for return visits unless your primary care physician gives you a referral. However, you may see an
Obstetrician/ Gynecologist, midwife or nurse practitioner affiliated with your PCP provider network for the woman's annual routine examination without a referral. All
other specialty care must be referred and arranged by your PCP in advance. Your PCP will coordinate your total care and work directly with your specialist. When your PCP
authorizes your referral to a specialist, he/ she will obtain a referral authorization number for you. Please do not schedule an appointment with a specialist until you have been
properly authorized to do so.
If your PCP determines that you require treatment for a covered health service that is not available in your PCP's network, he/ she will refer you to an appropriate provider outside
of the network. An out-of-network provider will only be allowed to collect from you the copayment amount listed in your benefit plan that you would be responsible to pay if the
services had been provided by an in-network provider.
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 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 14.
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2003 ADVANTAGE Health Plan, Inc. 11 Section 3
reduce our service area and you enroll in another FEHB Plan, you may be able to continue seeing your specialist for up to 90 days after you
receive notice of the change. Contact us or, if we drop out of the Program, contact your new plan.

If you are in the second or third trimester of pregnancy and you lose access to your specialist based on the above circumstances, you can continue to see your specialist until
the end of your postpartum care, even if it is beyond the 90 days.
Hospital care Your Plan primary care physician or specialist will make necessary hospital arrangements and supervise your care. This includes admission to a skilled nursing or other type of
facility.
If you are in the hospital when your enrollment in our Plan begins, call our customer service department immediately at 1-800-553-8933. 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.
Your primary care physician has authority to refer you for most services. For certain services, however, your physician must obtain approval from us. Before giving approval,
we consider if the service is covered, medically necessary, and follows generally accepted medical practice.

We call this review and approval process Precertification Review. Your physician must obtain Precertification for the following services. These services include but are not
limited to: Diagnostic procedures such as CAT Scans and MRIs
Elective hospital admissions
Transplants
Outpatient surgical procedures

The Precertification Review process is initiated by a physician referral to the appropriate medical management department (most of the Plan's provider networks are delegated
medical management and Precertification Review). A Registered Nurse applying nationally accepted clinical guidelines and criteria performs the review. Any referral not
meeting medical necessity guidelines is referred to a physician consultant. Only a licensed physician will render a denial of the referral and only after consultation with the
requesting physician. All denial letters include the principal reason for denial, specific details regarding your appeal rights, and how to obtain a copy of the actual clinical
guidelines used during the review process. Precertification Review determinations are made within 2 business days of receiving all necessary information unless the request is
urgent. Urgent precertification requests are completed within one business day of receipt. If procedures requiring Precertification are not appropriately reviewed, the services may
be denied for coverage and may result in nonpayment by the Plan.

Services requiring our prior approval 15.
15 Page 16 17
2003 ADVANTAGE Health Plan, Inc. 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 $15 per office visit and when you go in the hospital, you pay $400 per admission.
Deductible 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 50% of our allowance for infertility services and durable medical equipment.

Your catastrophic protection We do not have a catastrophic protection out-of-pocket maximum. out-of-pocket maximum for
coinsurance and copayments 16.
16 Page 17 18
2003 ADVANTAGE Health Plan, Inc. 13 Section 5
Section 5. Benefits --OVERVIEW
(See page 8 for how our benefits changed this year and page 54 for a benefits summary.)

NOTE: This benefits section is divided into subsections. Please read the important things you should keep in mind at the beginning of each subsection. Also read the General Exclusions in Section 6; they apply to the benefits in the following subsections. To obtain
claims forms, claims filing advice, or more information about our benefits, contact us at 1-800-553-8933 or visit our website at www. Advantageplan. com.

(a) Medical services and supplies provided by physicians and other health care professionals ....................................................... 14-22
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................................................. 23-26
Surgical procedures Reconstructive surgery Oral and maxillofacial surgery Organ/ tissue transplants
Anesthesia
(c) Services provided by a hospital or other facility, and ambulance services .............................................................................. 27-29
Inpatient hospital Outpatient hospital or ambulatory surgical center Extended care benefits/ skilled nursing care facility benefits Hospice care
Ambulance
(d) Emergency services/ accidents.................................................................................................................................................. 30-31 Medical emergency Ambulance

(e) Mental health and substance abuse benefits ............................................................................................................................. 32-33
(f) Prescription drug benefits ........................................................................................................................................................ 34-36
(g) Special features ............................................................................................................................................................................. 37 Flexible benefits option

Services for deaf and hearing impaired
(h) Dental benefits .............................................................................................................................................................................. 38
Summary of benefits ............................................................................................................................................................................ 54 17.
17 Page 18 19
2003 ADVANTAGE Health Plan, Inc. 14 Section 5( a)
Section 5 (a). Medical services and supplies provided by physicians and other health care professionals
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Here are some important things to keep in mind about these benefits:
Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure 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, or valuable information about how cost sharing works. Also read Section 9 about coordinating benefits with other coverage, including with Medicare.

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

$15 per office visit to your primary care physician
$30 per visit to a specialist

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

Nothing

At home (within the service area) $25 per visit
Lab, X-ray and other diagnostic 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, $15 per office visit
to your Primary Care Physician or $30 per office visit to a specialist 18.
18 Page 19 20
2003 ADVANTAGE Health Plan, Inc. 15 Section 5( a)
Preventive care, adult
Routine screenings, such as:
Routine physical exam
Total Blood Cholesterol once every three years
Colorectal Cancer Screening, including

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

$15 per office visit

Routine Prostate Specific Antigen (PSA) test one annually for men age 40 and older $15 per office visit
Routine pap test
Note: The office visit is covered if pap test is received on the same day; see Diagnosis and Treatment, above.
$15 per office visit

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

$15 per office visit

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, ages 19 and over (except as provided for under Childhood immunizations)

Influenza vaccines, annually
Pneumococcal vaccine, age 65 and over

$15 per office visit

Preventive care, children
Childhood immunizations recommended by the American Academy of Pediatrics $15 per office visit

Preventive care, children continued on next page 19.
19 Page 20 21
2003 ADVANTAGE Health Plan, Inc. 16 Section 5( a)
Preventive care, children (continued) You Pay
Well-child care charges for routine examinations, immunizations and care (through age 22)

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
Examinations done on the day of immunizations ( through age 22)

$15 per office visit

Maternity care You pay
Complete maternity (obstetrical) care, such as: Prenatal care

Delivery Postnatal care

Note: Here are some things to keep in mind: You do not need to precertify your normal delivery.
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).

$15 for first visit only

Not covered: Routine sonograms to determine fetal age, size or sex All charges.
Family planning You Pay
A broad range of voluntary family planning services, limited to:
Voluntary sterilization Surgically implanted contraceptives (such as Norplant)

Injectable contraceptive drugs (such as Depo provera) Intrauterine devices (IUDs)
Diaphragms
NOTE: We cover oral contraceptives under the prescription drug benefit.

50% of actual charges

Not covered: reversal of voluntary surgical sterilization, genetic counseling, All charges. 20.
20 Page 21 22
2003 ADVANTAGE Health Plan, Inc. 17 Section 5( a)
Infertility services You pay
Diagnosis and treatment of infertility, such as:
Artificial insemination:
intravaginal insemination (IVI) intracervical insemination (ICI)

intrauterine insemination (IUI)

50% of actual charges for each procedure

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

Zygote transfer Services and supplies related to excluded ART procedures

Injectable or oral fertility drugs
Cost of donor sperm
Cost of donor egg

All charges.

Allergy care
Testing and treatment
Allergy injection
$15 per office visit

Allergy serum Nothing
Not covered: provocative food testing and sublingual allergy desensitization All charges. 21.
21 Page 22 23
2003 ADVANTAGE Health Plan, Inc. 18 Section 5( a)
Treatment therapies You pay
Chemotherapy and radiation therapy
Note: High dose chemotherapy in association with autologous bone marrow transplants are limited to those transplants listed under

Organ/ Tissue Transplants on page 26.
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 your Plan physician for preauthorization. GHT must be medically

necessary, and authorized by your Plan physician before you begin treatment. If you do not obtain authorization 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.

$15 per office visit

Physical and occupational therapies
Up to two (2) consecutive months 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 when there has been a total or partial loss of bodily function due to illness or injury.

Cardiac rehabilitation following a heart transplant, bypass surgery or a myocardial infarction, is provided for up to a three (3) month period.

$15 per office visit
Nothing per visit during covered inpatient admission.

Not covered:
long-term rehabilitative therapy
exercise programs

All charges. 22.
22 Page 23 24
2003 ADVANTAGE Health Plan, Inc. 19 Section 5( a)
Speech therapy
Up to three (3) months per condition for the services of the following:

-Speech therapists

50% of actual charges

Hearing services (testing, treatment, and supplies) You pay
First hearing aid and testing only when necessitated by accidental injury

Hearing testing for children through age 17 (see Preventive care, children)
$15 per office visit

Not covered: all other hearing testing
hearing aids, testing and examinations for them
All charges.

Vision services (testing, treatment, and supplies)
One pair of eyeglasses or contact lenses to correct an impairment directly caused by accidental ocular injury or intraocular surgery
(such as for cataracts)
$15 per office visit

Eye exam to determine the need for vision correction for children through age 17 (see Preventive care, children)
Annual eye refractions
Note: See Preventive care, children for eye exams for children

$15 per office 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. 23.
23 Page 24 25
2003 ADVANTAGE Health Plan, Inc. 20 Section 5( a)
Foot care You pay
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.
$15 per office visit

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

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

treatment is by open cutting surgery)

All charges.

Orthopedic and prosthetic devices
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.

Nothing

Corrective orthopedic appliances for non-dental treatment of temporomandibular joint (TMJ) pain dysfunction syndrome. 50% 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 2 years after the last one we covered

All charges. 24.
24 Page 25 26
2003 ADVANTAGE Health Plan, Inc. 21 Section 5( a)
Durable medical equipment (DME)
Rental or purchase, at our option, including repair and adjustment, of durable medical equipment prescribed by your Plan physician, such as

oxygen and dialysis equipment. Under this benefit, we also cover:
hospital beds;
wheelchairs;
crutches;
walkers;
blood glucose monitors; and
insulin pumps.
Note: Call your Plan physician who will prescribe this equipment and direct you to a contracted supplier.

50% of all charges

Not covered: Motorized wheel chairs
Swimming pools and spas
Exercise equipment
Repair of DME when malfunction is directly a result of misuse or neglect

All charges.

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.

Transparenteral Therapy (TPN)
Sleep Apnea Studies
Ventillator Management
Wound Care

$30 per office visit

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

Up to two (2) consecutive months per condition for the services of Chiropractors.

$30 per office visit

Not covered: Labs, x-rays, diagnostic testing All charges. 25.
25 Page 26 27
2003 ADVANTAGE Health Plan, Inc. 22 Section 5( a)
Alternative treatments You pay
No Benefits All Charges

Educational classes and programs
Coverage is limited to: Smoking Cessation if enrolled in an approved smoking cessation

program. Approved prescription drugs are subject to the prescription copay.

Diabetes self-management Asthma disease management
Note: You may call our health education department at 317-573-2922 for a list of approved classes.

Nothing

Not Covered:
Over-the-counter smoking cessations aids More than one (1) smoking cessation class per calendar year and

no more than three (3) classes per lifetime.

All Charges

Pervasive Developmental Disorder (PDD) Pervasive Developmental Disorder is defined as a neurological condition,
including Asperger's syndrome and autism, as defined in the most recent edition of the Diagnostic and Statistical manual of Mental Disorders of the
American Psychiatric Association.
Benefits for Pervasive Developmental Disorder include but are not limited to:
Evaluation and Testing to confirm diagnosis Physical, speech, occupational therapy
Dietary evaluation
Benefits are limited to treatment that is prescribed by a physician in accordance with the patient's treatment plan.
No other exclusions or limitations in this brochure that conflict with this benefit apply.

$15 per office visit to your primary care physician
$30 per visit to a specialist
$400 per (inpatient) admission; limited to two (2) copayments per member per
calendar year

$100 per (outpatient) admission 26.
26 Page 27 28
2003 ADVANTAGE Health Plan, Inc. 23 Section 5( b)
Section 5 (b). Surgical and anesthesia services provided by physicians and other health care professionals
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Here are some important things to keep in mind about these benefits:
Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure 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.

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.

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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; has a body mass
index (BMI) over 40 kilograms/ meter2; or has a BMI over 35 kilograms/ meter2 and a high risk co-morbid condition. In addition
the eligible members must be age 18 or over, has failed to lose a significant amount of weight or has regained weight despite
compliance with a medically supervised, mutlidisciplinary, n on-surgical program including low calorie or very low calorie diet,
supervised exercise, behavioral modification and support and treatment of co-morbid condition; does not have a correctable cause
for obesity; and is being treated in a surgical program with experience in obesity surgery including but not only surgeons, but
also a multidisciplinary team including all of the following: Preoperative medical consultation and approval
Preoperative psychiatric consultation and approval
Nutritional counseling
Exercise counseling
Psychological counseling
Support group meetings

$30 per office visit 27.
27 Page 28 29
2003 ADVANTAGE Health Plan, Inc. 24 Section 5( b)
Surgical procedures (continued) You pay Insertion of internal prosthetic devices. See 5( a) Orthopedic and
prosthetic devices for device coverage information.
Treatment of burns
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.

$30 per office visit

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

Reconstructive surgery You pay Surgery to correct a functional defect
Surgery to correct a condition caused by injury or illness if:
the condition produced a major effect on the member's appearance and

the condition can reasonably be expected to be corrected by such surgery
Surgery to correct a condition that existed at or from birth and is a significant deviation from the common form or norm. Examples of
congenital anomalies are: protruding ear deformities; cleft lip; cleft palate; birth marks; webbed fingers; and webbed toes.

$30 per office 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 the procedure performed on an inpatient basis and remain in the hospital up to 48
hours after the procedure.
Not covered: Cosmetic surgery any surgical procedure (or any portion of a
procedure) performed primarily to improve physical appearance through change in bodily form, except repair of accidental injury

Surgeries related to sex transformation
Surgical procedures for body fat reduction, such as liposuction

All charges. 28.
28 Page 29 30
2003 ADVANTAGE Health Plan, Inc. 25 Section 5( b)
Oral and maxillofacial surgery You pay
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
Treatment of TMJ, including surgical and non-surgical intervention, corrective orthopedic appliance and physical therapy

$30 per office 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)
Dental work related to TMJ

All charges. 29.
29 Page 30 31
2003 ADVANTAGE Health Plan, Inc. 26 Section 5( b)
Organ/ tissue transplants You pay
Limited to:
Cornea
Heart
Heart/ lung
Kidney
Kidney/ Pancreas
Liver
Lung: Single Double
Pancreas
Allogeneic (donor) bone marrow transplants Autologous bone marrow transplants (autologous stem cell and

peripheral stem cell support) for the following conditions: acute lymphocytic or non-lymphocytic leukemia; advanced Hodgkin's
lymphoma; advanced non-Hodgkin's lymphoma; advanced neuroblastoma; breast cancer; multiple myeloma; epithelial ovarian
cancer; and testicular, mediastinal, retroperitoneal and ovarian germ cell tumors

Intestinal transplants (small intestine) and the small intestine with the
liver or small intestine with multiple organs such as the liver, stomach,
and pancreas National Transplant Program (NTP) -

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

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

Nothing

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

Transplants not listed as covered
Experimental or investigational transplants

All charges

Anesthesia You pay
Professional services provided in
Hospital (inpatient)

Nothing

Professional services provided in
Hospital outpatient department Skilled nursing facility

Ambulatory surgical center Office

$30 per office visit 30.
30 Page 31 32
2003 ADVANTAGE Health Plan, Inc. 27 Section 5( c)
Section 5 (c). Services provided by a hospital or other facility, and ambulance services
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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).

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Benefit Description You pay
Inpatient hospital
Room and board, such as ward, semiprivate, or intensive care accommodations;

general nursing care; and meals and special diets.

NOTE: If you want a private room when it is not medically necessary, you pay the additional charge above the semiprivate room rate.
When your Plan physician determines it is medically necessary, the physician may prescribe private accommodations or private duty
nursing care.

$400 per admission; limited to two (2) copayments per member per calendar year.

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

Inpatient hospital --continued on next page 31.
31 Page 32 33
2003 ADVANTAGE Health Plan, Inc. 28 Section 5( c)
Inpatient hospital (continued) You Pay
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

Take home prescriptions drugs
Hospitalization for dental procedures

All charges.

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.

$100 per admission

Not covered: blood and blood derivatives not replaced by the member All charges.
Extended care benefits/ skilled nursing care facility benefits You pay Extended care benefit: Up to 100 days per calendar year when full-time

skilled nursing care is necessary and confinement in a skilled nursing facility is medically appropriate and determined by your Plan physician
and approved by the Plan
Bed, board and general nursing care
Drugs, biologicals, supplies, equipment ordinarily provided or arranged by the skilled nursing facility when prescribed by the Plan

physician.

$400 per admission

Not covered:
Custodial care, rest cures, domiciliary or convalescent care or homemaker services

Personal comfort items, such as telephone or television

All charges

Inpatient hospital continued nest page 32.
32 Page 33 34
2003 ADVANTAGE Health Plan, Inc. 29 Section 5( c)
Hospice care You Pay
Provided for a terminally ill member in accordance with a treatment plan developed before admission to the Hospice Care Program. The
treatment plan must be approved by ADVANTAGE Health Plan or its designated agent.

Note: Limited to services provided under the direction of a Plan physician who certifies the patient is in the terminal stage of illness,
with a life expectancy of approximately six months or less.

Nothing

Not covered: Independent nursing, homemaker services All charges.
Ambulance You Pay
Local professional ambulance service when medically appropriate 20% of actual charges 33.
33 Page 34 35
2003 ADVANTAGE Health Plan, Inc. 30 Section 5( d)
Section 5 (d). Emergency services/ accidents
I M
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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.

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.

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What is a medical emergency?
A medical emergency is the sudden and unexpected onset of a condition or an injury that you believe endangers your life or could result in serious injury or disability, and requires immediate medical or surgical care. Some problems are emergencies

because, if not treated promptly, they might become more serious; examples include deep cuts and broken bones. Others are emergencies because they are potentially life-threatening, such as heart attacks, strokes, poisonings, gunshot wounds, or
sudden inability to breathe. There are many other acute conditions that we may determine are medical emergencies what they all have in common is the need for quick action.

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

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

To be covered by this Plan, any follow-up care recommended by non-Plan physician must be approved by your Plan physician with a prior referral.
Emergencies outside our service area: Benefits are available for any medically necessary health service that is immediately required because of injury or unforeseen illness.
If you need to be hospitalized, the Plan must be notified within 48 hours or on the first working day following your admission, unless it was not reasonably possible to notify the Plan within that time. If a Plan physician believes care can be
better provided in a Plan facility, you will be transferred when medically feasible with any ambulance charges covered in full.
To be covered by this Plan, any follow-up care recommended by an emergency room physician must be approved by the Plan or provided by a Plan physician.

If you are required to pay for services, submit itemized bills and your receipts to the Plan along with an explanation of the services and the identification information from your ID card. Payment will be sent to you (or the provider if you did not
pay the bill), unless the claim is denied. If it is denied, you will receive notice of the decision, including the reasons for the denial and the provisions of the contract on which denial was based. If you disagree with the Plan's decision, you may
request reconsideration in accordance with the disputed claims procedure described on pages 41-42. 34.
34 Page 35 36
2003 ADVANTAGE Health Plan, Inc. 31 Section 5( d)
Benefit Description You pay
Emergency within our service area
Emergency care at a doctor's office

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

$15 per office visit
$50 per visit

$125 per visit

Not covered: Elective care or non-emergency care All charges.
Emergency outside our service area
Emergency care at a doctor's office Emergency care at an urgent care center

Emergency care as an outpatient or inpatient at a hospital, including doctors' services
$15 per office visit
$50 per visit
$125 per visit

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

All charges.

Ambulance
Professional ambulance service when medically appropriate. Includes air ambulance services when medically appropriate.

See 5( c) for non-emergency service.
20% of actual charges 35.
35 Page 36 37
2003 ADVANTAGE Health Plan, Inc. 32 Section 5( e)
Section 5 (e). Mental health and substance abuse benefits
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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: Please remember that all benefits are subject to the definitions, limitations, and exclusions in this

brochure and are payable only when we determine they are medically necessary.
Be sure to read Section 4, Your costs for covered services, for valuable information about how cost sharing works. Also read Section 9 about coordinating benefits with other coverage, including with
Medicare.
YOU MUST GET PREAUTHORIZATION OF THESE SERVICES. See the instructions after the benefits description below.

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Benefit Description You pay
Mental health and substance abuse benefits
All diagnostic and treatment services recommended by a Plan provider and contained in a treatment plan that we approve. The treatment plan

may include services, drugs, and supplies described elsewhere in this brochure.

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

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

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

Medication management
Diagnostic tests

Nothing if you receive these services during your office visit; otherwise, $30 per visit

Mental health and substance abuse benefits -continued on next page 36.
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2003 ADVANTAGE Health Plan, Inc. 33 Section 5( e)
Mental health and substance abuse benefits (continued) You pay
Services provided by a hospital or other facility
Services in approved alternative care settings such as partial
hospitalization, half-way house, residential treatment, full-day hospitalization, facility based intensive outpatient treatment

$400 per admission; limited to two (2) copayments per member per calendar year

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:
Mental Health and Substance Abuse services do not require an authorization from your primary care physician and may be obtained on self-referral basis. However,
the contracting ADVANTAGE providers available to you will depend on the primary care physician you have selected. The Mental Health and Substance
Abuse Service access phone number is listed on the bottom of your ADVANTAGE Health Plan Member ID Card. Inpatient and Outpatient treatment
plans require authorization from a Mental Health and Substance Abuse Plan physician.

If you would like more information about your Mental Health and Substance Abuse benefits, please contact an ADVANTAGE Health Plan Member Service
Representative for assistance.

Limitation We may limit your benefits if you do not obtain a treatment plan. 37.
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2003 ADVANTAGE Health Plan, Inc. 34 Section 5( f)
Section 5 (f). Prescription drug benefits
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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.

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

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There are important features you should be aware of. These include: Who can write your prescription. A licensed prescriber must write the prescription.

Where you can obtain them. You must fill the prescription at a plan pharmacy, or by mail for a maintenance medication
We use a formulary. A formulary is a list of generic and brand-name prescription medications that have been approved by the Food and Drug Administration (FDA). ADVANTAGE Health Plan has a team of
physicians and pharmacists that meets regularly throughout the year to review and update that list. It includes medications for most conditions treated outside the hospital. Your physician can use the list to
select medications that are appropriate to meet your healthcare needs, while helping you maximize your prescription drug benefit.

We have an open formulary. If your physician believes a name brand product is necessary or there is no generic available, your physician may prescribe a name brand drug from a formulary list. This list of
name brand drugs is a preferred list of drugs that we selected to meet patient needs at a lower cost. To order a prescription drug brochure, call 1-800-553-8933.

Your health plan/ employer has chosen a prescription drug program that has three different co-pay levels. This program allows you to pay a lower copay for covered drugs that are on the formulary. We cover
non-formulary drugs prescribed by a Plan doctor, but at a higher copay.
If a prescription for a non-formulary medication is written, the pharmacist will receive an on-line message at the pharmacy. The pharmacist should contact the physician to request a change to a
formulary product. If the physician is unwilling to change, or is unavailable, the pharmacist will dispense the prescription as written. Patients will be required to pay a higher copay when a non-formulary product
is dispensed. This policy will reflect the patient's prescription drug benefit.
These are the dispensing limitations. Prescription drugs prescribed by a plan or referral doctor and obtained at a plan pharmacy will be dispensed up to a 30-day supply; or one commercially prepared unit
(i. e. one inhaler, one vial ophthalmic medication or insulin). You pay a $10 copay per prescription unit or refill for generic drugs or a $30 copay per prescription unit or refill for name brand drugs when generic
substitution is not available. You pay a $50 copay for non-formulary drugs. When generic substitution is available, but you request the name brand drug or non-formulary drug, you pay the price difference and
the required copay per prescription unit or refill as written. You will always pay the appropriate copayment or the actual cost of the drug, whichever is less.

If your physician orders more than a 30 day supply of covered drugs, up to a 90 day supply, mail service is available. Initially you request your prescription information by completing a Pharmacare Mailer and
enclosing your original written prescription. If you are currently taking a medication, you must call your physician's office and request a new prescription for the maximum day supply. You pay a $20 copay per
generic, a $60 copay per name brand (when generic is not available), and $100 for non-formulary for up to a 90 day supply. When generic substitution is available, but you request the name brand or non-formulary
drug, you pay the price difference and the required copay. 38.
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2003 ADVANTAGE Health Plan, Inc. 35 Section 5( f)
Pharmacare's system incorporates on-line drug reviews at the point of dispensing medications. Elements reviewed include, Drug-Drug Interaction, Refill Too Soon, Therapeutic Duplication, Duplication of
Therapy, Over Dosage and Under Dosage.
A generic equivalent will be dispensed if it is available, unless your physician specifically requires a name brand. If you receive a name brand drug when a Federally-approved generic drug is available, and your

physician has not specified Dispense as Written for the name brand drug, you have to pay the difference in cost between the name brand drug and the generic.

Why use generic drugs? Generic drugs are lower-priced drugs that are the therapeutic equivalent to more expensive brand-name drugs. They must contain the same active ingredients and must be equivalent in strength
and dosage to the original brand-name product. Generics cost less than the equivalent brand-name product. The U. S. Food and Drug Administration sets quality standards for generic drugs to ensure that these drugs meet
the same standards of quality and strength as brand-name drugs.
You can save money by using generic drugs. However, you and your physician have the option to request a name-brand if a generic option is available. Using the most cost-effective medication saves money.

When you have to file a claim. You will not be required to file claims with this plan.

Benefit Description You pay
Covered medications and supplies
We cover the following medications and supplies prescribed by a Plan physician and obtained from a Plan pharmacy or through our mail order

program:

Covered medications and supplies
Drugs and medicines that by Federal law of the United States require a physician's prescription for their purchase, except those
listed as Not covered. Insulin
Disposable needles and syringes for the administration of covered medications
Drugs for sexual dysfunction are limited. Contact the Plan for dose limitations, such as, Viagra quantity limited to 6 tabs/ month
Oral and injectable contraceptive drugs and devices
Growth hormone

$10 per generic
$30 per name brand
$50 per non-formulary
50% coinsurance for lifestyle drugs

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

Covered medications and supplies continued on next page 39.
39 Page 40 41
2003 ADVANTAGE Health Plan, Inc. 36 Section 5( f)
Covered medications and supplies (continued) You pay
Not covered medications and supplies:
Drugs and supplies for cosmetic purposes
Drugs to enhance athletic performance
Fertility drugs
Drugs obtained at a non-Plan pharmacy; except for out-of-area emergencies

Vitamins, nutrients and food supplements even if a physician prescribes or administers them
Nonprescription medicines

All charges. 40.
40 Page 41 42
2003 ADVANTAGE Health Plan, Inc. 37 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.

Services for deaf and hearing impaired Toll Free 1-800-743-3333 41.
41 Page 42 43
2003 ADVANTAGE Health Plan, Inc. 38 Section 5( h)
Section 5 (h). Dental benefits
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Here are some important things to keep in mind about these benefits:
Please remember that all benefits are subject to the definitions, limitations, and exclusions in this brochure and are payable only when we determine they are medically necessary.

Plan dentists must provide or arrange your care.
We have no calendar year deductible.
We cover hospitalization for dental procedures only when a nondental physical impairment exists which makes hospitalization necessary to safeguard the health of the patient. See Section 5 (c) for inpatient hospital benefits. 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.

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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.
$ 30

Dental benefits You pay
We have no other dental benefits. All charges 42.
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2003 ADVANTAGE Health Plan, Inc. 39 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.
Services, drugs, or supplies you receive without charge while in active military service. 43.
43 Page 44 45
2003 ADVANTAGE Health Plan, Inc. 40 Section 7
Medical, hospital and drug benefits
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 or coinsurance.

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:
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 1-800-553-8933.
When you must file a claim --such as for services you receive outside of the Plan's service area --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: ADVANTAGE Health Plan, Inc. ATTN: HMO Claims
P. O. Box 80069 Indianapolis, IN 46280

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. 44.
44 Page 45 46
2003 ADVANTAGE Health Plan, Inc. 41 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: ADVANTAGE Health Plan, Inc., Appeals and Grievance Coordinator or Appeals Committee, 9490 Priority Way, West Drive, Indianapolis, Indiana 46240; 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, Health Benefits Contracts Division 3, 1900 E Street, NW, Washington, DC 20415-3630. 45.
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2003 ADVANTAGE Health Plan, Inc. 42 Section 8
The Disputed Claims process (Continued)
Send OPM the following information:
A statement about why you believe our decision was wrong, based on specific benefit provisions in this brochure;
Copies of documents that support your claim, such as physicians' letters, operative reports, bills, medical records, and explanation of benefits (EOB) forms;

Copies of all letters you sent to us about the claim;
Copies of all letters we sent to you about the claim; and
Your daytime phone number and the best time to call.

Note: If you want OPM to review more than one claim, you must clearly identify which documents apply to which claim.
Note: You are the only person who has a right to file a disputed claim with OPM. Parties acting as your representative, such as medical providers, must include a copy of your specific written consent with the review request.

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

5 OPM will review your disputed claim request and will use the information it collects from you and us to decide whether our decision is correct. OPM will send you a final decision within 60 days. There are no other administrative appeals.
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 1-800-553-8933 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 may call OPM's Health Benefits Contracts Division 3 at 202/ 606-0737 between 8 a. m. and 5 p. m. eastern time. 46.
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2003 ADVANTAGE Health Plan, Inc. 43 Section 9
Section 9. Coordinating benefits with other coverage
When you have other health coverage You must tell us if you or a covered family member have coverage 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 withheld from your monthly Social Security check or your retirement
check.
If you are eligible for Medicare, you may have choices in how you get your health care. Medicare + Choice is the term used to describe the various health plan choices available
to Medicare beneficiaries. The information in the next few pages shows how we coordinate benefits with Medicare, depending on the type of Medicare managed care plan
you have.
The Original Medicare Plan (Original Medicare) is available everywhere in the United States. It is the way everyone used to get Medicare benefits and is the way most people
get their Medicare Part A and Part B benefits now. You may go to any doctor, specialist, or hospital that accepts Medicare. The Original Medicare Plan pays its share and you pay
your share. Some things are not covered under Original Medicare, like prescription drugs.

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

The Original Medicare Plan (Part A or Part B) 47.
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2003 ADVANTAGE Health Plan, Inc. 44 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 then provide
secondary benefits for covered charges. You will not need to do anything. To find out if you need to do something to file your claims, call us at 1-800-553-8933 or
www. advantageplan. com.
We do not waive any costs if the Original Medicare Plan is your primary payer.

(Primary payer chart begins on next page.) 48.
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2003 ADVANTAGE Health Plan, Inc. 45 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) Areanactiveemployee with theFederalgovernment(including whenyouora familymemberare eligibleforMedicaresolely becauseofadisability), .

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 49.
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2003 ADVANTAGE Health Plan, Inc. 46 Section 9
Medicare managed care plan If you are eligible for Medicare, you may choose to enroll in and get your Medicare benefits from a Medicare managed care plan. These are health care choices (like HMOs)
in some areas of the country. In most Medicare managed care plans, you can only go to doctors, specialists, or hospitals that are part of the plan. Medicare managed care plans
provide all the benefits that Original Medicare covers. Some cover extras, like prescription drugs. To learn more about enrolling in a Medicare managed care plan,
contact Medicare at 1-800-MEDICARE (1-800-633-4227) or at www. medicare. gov.
If you enroll in a Medicare managed care plan, the following options are available to you:
This Plan and our Medicare managed care plan: You may enroll in our Medicare managed care plan and also remain enrolled in our FEHB plan. In this case we do not
waive cost-sharing for your FEHB coverage.
This Plan and another plan's Medicare managed care plan: You may enroll in another plan's Medicare managed care plan and also remain enrolled in our FEHB plan.
We will still provide benefits when your Medicare managed care plan is primary, 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 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 and CHAMPVA TRICARE is the health care program for eligible dependents of military persons, and retirees of the military. TRICARE includes the CHAMPUS program. CHAMPVA
provides health coverage to disabled Veterans and their eligible dependents. If TRICARE or CHAMPVA and this Plan cover you, we pay first. See your TRICARE or
CHAMPVA Health Benefits Advisor if you have questions about these programs.
Suspended FEHB coverage to enroll in TRICARE or CHAMPVA: If you are an annuitant or former spouse, you can suspend your FEHB coverage to enroll in a one of
these programs, eliminating your FEHB premium. (OPM does not contribute to any applicable plan premiums.) 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 under the program.

Workers' Compensation We do not cover services that:

If you do not enroll in Medicare Part A or Part B 50.
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2003 ADVANTAGE Health Plan, Inc. 47 Section 9
you need because of a workplace-related illness or injury that the Office of Workers' Compensation Programs (OWCP) or a similar Federal or State agency determines they
must provide; or
OWCP or a similar agency pays for through a third-party injury settlement or other similar proceeding that is based on a claim you filed under OWCP or similar laws.

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

Medicaid When you have this Plan and Medicaid, we pay first.
Suspended FEHB coverage to enroll in Medicaid or a similar State-sponsored program of medical assistance: If you are an annuitant or former spouse, you can
suspend your FEHB coverage to enroll in a one of these State programs, eliminating your FEHB 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 under the State
program.

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 for injuries 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. 51.
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2003 ADVANTAGE Health Plan, Inc. 48 Section 10
Section 10. Definitions of terms we use in this brochure
Calendar year January 1 through December 31 of the same year. For new enrollees, the calendar year begins on the effective date of their enrollment and ends on December 31 of the same
year.

Coinsurance Coinsurance is the percentage of our allowance that you must pay for your care. See page 12.

Copayment A copayment 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. See page 12.

ADVANTAGE Health Plan has available participating specialists, sub-
investigational services specialists, and a referral center to assist with the review and determination of experimental treatment, procedures, drugs or devices. Your PCP must request an

approval, before the service date, regarding the recommended treatment or services that is to be reviewed. A review with Technology Evaluation Center (TEC) is done to
determine the feasibility of the recommended treatment. If a review of new technology is made on your behalf by your PCP, ADVANTAGE Health Plan will notify you of the
determination for coverage within one business day following the determination. Review for urgent and emergent determinations will be communicated within 72 hours. For
further information about the Medical Technology Assessment, please contact a Member Service Representative at 1-800-553-8933.

Medical necessity Medical necessity means health services or supplies that are skilled care; are required for the treatment of illness or injury; are consistent with your symptoms or diagnosis; are
appropriate treatments with regard to standards of accepted medical practice; are not primarily for your convenience, your family's convenience or the convenience of any
health care provider; are not experimental, investigational or unproven; and do not exceed the level of care which is needed to provide a safe, adequate, and appropriate
diagnosis of treatment.

A health service does not meet medical necessity if your symptoms or condition indicates that it would be safe to provide the service or supply in a less comprehensive setting. The
fact that a physician or other health care provider has furnished, ordered, or approved a service or supply does not, alone, make that service or supply a medical necessity.

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: We determine our allowance based on the lesser of the fee arrangement between ADVANTAGE Health Plan and the provider, or the billed charge.
When covered services are provided by a Plan provider you are not responsible for charges above the allowance.

Us/ We Us and we refer to ADVANTAGE Health Plan, Inc.
You You refers to the enrollee and each covered family member.

Experimental or investigational services 52.
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2003 ADVANTAGE Health Plan, Inc. 49 Section 11
Section 11. FEHB facts
No pre-existing condition We will not refuse to cover the treatment of a condition that you had limitation before you enrolled in this Plan solely because you had the condition before you enrolled.

Where you can get information See www. opm. gov/ insure. Also, your employing or about enrolling in the retirement office 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 your FEHB coverage. These materials tell you:

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.

Children's Equity Act OPM has implemented the Federal Employees Health Benefits Children's Equity Act of 2000. This law mandates that you be enrolled for self and family coverage in the Federal
Employees Health Benefits (FEHB) Program, if you are an employee subject to a court or administrative order requiring you to provide health benefits for your child( ren).

If this law applies to you, you must enroll for self and family coverage in a health plan that provides full benefits in the are where your children live or provide documentation to
your employing office that you have obtained other health benefits coverage for your children. If you do not do so, your employing office will enroll you involuntarily as
follows: 53.
53 Page 54 55
2003 ADVANTAGE Health Plan, Inc. 50 Section 11
If you have no FEHB coverage, your employing office will enroll you for self and family coverage in the Blue Cross and Blue Shield Service Benefit Plan's Basic
Option.
If you have a self only enrollment in a fee-for-service plan or in an HMO that serves the area where your children live, your employing office will change your enrollment
to self and family in the same option of the same plan; or If you are enrolled in an HMO that does not serve the area where your children live,
your employing office will change your enrollment to self and family in the Blue Cross and Blue Shield Service Benefit Plan's Basic Option.

As long as the court/ administrative order is in effect, and you have at least one child identified in the order who is still eligible under the FEHB Program, you cannot cancel
your enrollment, change to self only, or change to a plan that doesn't serve the area in which your children live, unless you provide documentation that you have other coverage
for the children. If the court/ administrative order is still in effect when you retire, and you have at least one child still eligible for FEHB coverage, you must continue your
FEHB coverage into retirement (if eligible) and cannot make any changes after retirement. Contact your employing office for further information.

When benefits and The benefits in this brochure are effective on January 1. If you joined this Plan premiums start 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.

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. This is the case even

when the court has ordered your former spouse to supply health coverage to you. But, you may be eligible for your own FEHB coverage under the spouse equity law or
Temporary Continuation of Coverage (TCC). 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. You can also download the guide from OPM's website, www. opm. gov/ insure.
Temporary 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. 54.
54 Page 55 56

2003 ADVANTAGE Health Plan, Inc. 51 Section 11
Enrolling in TCC. Get the RI 79-27, which describes TCC, and the RI 70-5, the Guide to Federal Employees Health Benefits Plans for Temporary Continuation of Coverage
and Former Spouse Enrollees, from your employing or retirement office or from www. opm. gov/ insure. It explains what you have to do to enroll.

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

If you leave Federal service, your employing office will notify you of your right to convert. You must apply in writing to us within 31 days after you receive this notice.
However, if you are a family member who is losing coverage, the employing or retirement office will not notify you. You must apply in writing to us within 31 days
after you are no longer eligible for coverage.
Your benefits and rates will differ from those under the FEHB Program; however, you will not have to answer questions about your health, and we will not impose a waiting
period or limit your coverage due to pre-existing conditions.
Getting a Certificate of The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a Federal Group Health Plan law that offers limited Federal protections for health coverage availability and continuity
Coverage 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. 55.
55 Page 56 57

2003 ADVANTAGE Health Plan, Inc. 52 Long Term Care Insurance
Long Term Care Insurance Is Still Available!
Open Season for Long Term Care Insurance
You can protect yourself against the high cost of long term care by applying for insurance in the Federal Long Term Care Insurance Program.
Open Season to apply for long term care insurance through LTC Partners ends on December 31, 2002. If you're a Federal employee, you and your spouse need only answer a few questions about your health during Open Season.
If you apply during the Open Season, your premiums are based on your age as of July 1, 2002. After Open Season, your premiums are based on your age at the time LTC Partners receives your application.

FEHB Doesn't Cover It
Neither FEHB plans nor Medicare cover the cost of long term care. Also called "custodial care", long term care helps you perform the activities of daily living such as bathing or dressing yourself. It can also provide help you may need due to a
severe cognitive impairment such as Alzheimer's disease.
You Can Also Apply Later, But
Employees and their spouses can still apply for coverage after the Federal Long Term Care Insurance Program Open Season ends, but they will have to answer more health-related questions.
For annuitants and other qualified relatives, the number of health-related questions that you need to answer is the same during and after the Open Season.

You Must Act to Receive an Application
Unlike other benefit programs, YOU have to take action you won't receive an application automatically. You must request one through the toll-free number or website listed below.
Open Season ends December 31, 2002 act NOW so you won't miss the abbreviated underwriting available to employees and their spouses, and the July 1 "age freeze"!

Find Out More Contact LTC Partners by calling 1-800-LTC-FEDS (1-800-582-3337) (TDD for the hearing impaired: 1-800-843-3557) or visiting www. ltcfeds. com to get more information and to request an application. 56.
56 Page 57 58
2003 ADVANTAGE Health Plan, Inc. 53 Index
Index
Do not rely on this page; it is for your convenience and may not show all pages where the terms appear.
Accidental injury 19 Allergy tests 17
Alternative treatment 22 Allogenetic (donor) bone marrow
transplant 18 Ambulance 28
Anesthesia xx Autologous bone marrow transplant 18
Blood and blood plasma 27 Breast cancer screening 25
Casts 27 Catastrophic protection out-of-pocket
maximum 12 Changes for 2003 8
Chemotherapy 18 Chiropractic 22
Cholesterol tests 15 Claims 40
Coinsurance 12 Colorectal cancer screening 15
Congenital anomalies 23 Contraceptive devices and drugs 35
Coordination of benefits 45 Covered charges 45
Crutches 21 Deductible 12
Definitions 27 Dental care 25
Diagnostic services 27 Disputed claims review 40
Donor expenses (transplants) 25 Dressings 27
Durable medical equipment (DME) 21 Educational classes and programs 22
Effective date of enrollment 48 Emergency 7
Experimental or investigational 39

Eyeglasses 19 Family planning 16
Fecal occult blood test 15 Fraud 4
General Exclusions 39 Hearing services 19
Home health services 22 Hospice care 29
Home nursing care 22 Immunizations 15
Infertility 17 Inpatient Hospital Benefits 27
Insulin 21 Laboratory and pathological
services 28 Machine diagnostic tests 14
Magnetic Resonance Imagings (MRIs) 11
Mail Order Prescription Drugs 34 Mammograms 14
Maternity Benefits 16 Medicaid 46
Medically necessary 7 Medicare 43
Members 6 Mental Conditions/ Substance
Abuse Benefits 32 Non-FEHB Benefits 49
Obstetrical care 16 Occupational therapy 18
Ocular injury 19 Office visits 6
Oral and maxillofacial surgery 25 Orthopedic devices 20
Outpatient facility care 28 Oxygen 21
Pap test 14

Physical examination 6 Physical therapy 18
Precertification 11 Preventive care, adult 15
Preventive care, children 15 Prescription drugs 22
Prior approval 11 Prostate cancer screening 15
Prosthetic devices 20 Psychologist 32
Radiation therapy 18 Renal dialysis 44
Room and board 27 Second surgical opinion 14
Skilled nursing facility care 11 Smoking cessation 22
Speech therapy 19 Splints 27
Sterilization procedures 16 Subrogation 46
Substance abuse 32 Surgery 23
Anesthesia 26 Oral 25
Outpatient 28 Reconstructive 13
Syringes 35 Temporary continuation of
coverage 49 Transplants 25
Treatment therapies 18 Vision services 19
Wheelchairs 21 Workers' Compensation 46
X-rays 14 57.
57 Page 58 59
2003 ADVANTAGE Health Plan, Inc. 54 Summary
Summary of benefits for the ADVANTAGE Health Plan, Inc. 2003
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: $15 primary care; $30 specialist 14

Services provided by a hospital:
Inpatient ............................................................................................
Outpatient .........................................................................................
$400 per admission copay

$100 Per admission copay
27

28
Emergency benefits:
In-area .............................................................................................
Out-of-area......................................................................................
$125 per visit

$125 per visit
30
30
Mental health and substance abuse treatment ..................................... Regular cost sharing 32

Prescription drugs................................................................................. $10 Generic; $30 Name Brand; $50 Non-formulary 34

Dental Care........................................................................................ No benefit. 38
Vision Care........................................................................................ $15 Copay per visit for annual eye refraction 19
Special features: Flexible benefits option; Services for deaf and hearing impaired 37 58.
58 Page 59
2003 Rate Information for ADVANTAGE Health Plan, Inc.
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

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

High Option Self Only

High Option Self & Family
6Y1
6Y2
$109.30
$249.62
$36.72
$93.23
$236.82
$540.84
$79.56
$202.00
$129.03
$294.70
$16.99
$48.15 59.

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