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.

• We will no longer offer the high option benefit in 2004. However, we have merged the standard and high options to offer an enhanced standard option for 2004.

• If you were enrolled in the High Option in 2003 your non-postal premium will increase by 7.4% for Self Only coverage or decrease by 25.3% for Self and Family coverage.

• If you were enrolled in the Standard Option in 2003 your non-postal premium will increase by 50.35% for Self Only coverage or 41.94% for Self and Family coverage.

• Office visits - You now pay a $10 copayment for office visits to a primary care physician (PCP) and a $40 copayment for office visits to specialists, including behavioral health specialists.

• Prescriptions drugs - You now pay $10 for generic formulary drugs and, $35 for brand name formulary drugs and $50 for non-formulary drugs. You pay two copayments for a mail order 90-day supply.

• Maternity care - You now pay a single $10 copayment for the entire pregnancy.

• Allergy injections - When not in conjunction with an office visit, you now pay a $10 copayment in a PCP's office and $20 in a specialist's office.

• Physical, occupational and speech therapies - You now pay a $20 copayment for physical, occupational and speech therapy.

• Cardiac rehabilitation - You now pay a $20 copayment for each visit.

• Inpatient hospital - You now pay $150 per day up to 5 days per admission.

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

• Outpatient hospital or ambulatory surgical center - You now pay a $50 copayment for medical, non-surgical services, performed in these settings.

• Skilled nursing facility - You now pay a $50 copayment per day up to 5 days per admission.

• Emergency services (within the service area) - You now pay a $40 copayment for emergency care received in a PCP's office after regular office hours, specialist's office or urgent care center.

• Emergency services (outside the service area) - You now pay a $40 copayment for emergency care received in a PCP's office, specialist's office or urgent care center.

• Emergency services - The Plan will no longer waive your $100 emergency room copayment if you are admitted to the hospital.

• Ambulance - You now pay a $75 copayment per trip.

• Catastrophic out-of-pocket maximum - Your out of pocket maximum has increased to $5,000 per self only enrollment. It remains $10,000 per self and family enrollment.

• Dental - We will now offer a Preferred Provider Option (PPO) dental plan, which is subject to a calendar year deductible of $50 per person or $150 per family. We pay a maximum $1,000 in benefits per person per year. We pay a percentage of the contracted provider reduced rate for in-network providers. In-network providers will not balance bill members. We will pay a percentage of our scheduled fee allowance for out-of-network providers.

• Orthodontic services - The Plan will no longer cover orthodontic services. Members who are currently in a treatment plan or begin a new treatment plan prior to the end of the 2003 contract year can continue to receive the current orthodontia benefits until the treatment plan is completed.