U.S. Office of Personnel Management www.opm.gov - Recruiting, Retaining and Honoring a World-Class Workforce to Serve the American People

This is a general description of the plan changes. This page is not an official statement of benefits. For that, go to the Benefits descriptions in the Plan Brochure. Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.

• Your share of the non-Postal premium will increase by 13.6% for Self Only coverage or 1.8% for Self and Family coverage.

• Office visit copayments - You now pay a $15 copayment for visits to your primary care physician and a $30 copayment for visits to specialists, including behavioral health specialists.

• Prescription drugs - You now pay $15 for generic formulary drugs, $35 for brand-name formulary. Mail order prescription drugs require 2 copayments for a 90-day supply.

• Prescription drugs - You may now purchase non-formulary drugs for a $50 copayment per 30-day supply.

• Maternity care - You now pay a single $30 copayment for the entire pregnancy.

• Inpatient hospital - You now pay $100 per day up to 3 days for inpatient hospitalization per admission.

• Lab, X-ray and other diagnostic tests - You now pay a $150 copayment for all specialized scanning exams, such as, MRI, CT Scans, PET Scans and SPECT Scans.

• Treatment therapy - You now pay a $30 copayment per treatment for chemotherapy and radiation therapy.

• Skilled nursing facility - You now pay a $50 copayment per day up to 3 days per admission to a skilled nursing facility. All necessary services will be covered up to 100 consecutive days per qualifying condition per calendar year.

• Outpatient hospital or ambulatory surgical center - You now pay a $150 copayment per outpatient surgery or procedure.

• Emergency services - You now pay a $20 copayment per visit to an urgent care center. You now pay a $100 copayment per visit to an emergency room. The Plan will no longer waive the copayment if you are admitted to the hospital.

• Physical, occupational and speech therapies - You now pay a $30 copayment per visit for physical, occupational and speech therapy.

• Out-of-pocket maximum - Your catastrophic protection out of pocket maximum has increased to $5,000 per person or $15,000 per family enrollment.

• Chiropractic services - You will now pay a $15 copayment for chiropractic services. Your visit limit has been reduced to 20 visits per calendar year.

• Vision hardware - We now offer a vision hardware benefit when you see a participating provider. After you pay a $25 copayment toward vision hardware, you will receive either a $100 allowance toward frames and lenses every 24 months or an $85 allowance toward contact lenses every 24 months.