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 19.5% for Self Only or 19.4% for Self and Family.

• The office visit copay will increase form $10 to $15.

• There is a $250 calendar year deductible under Self Only coverage and $500 under Self and Family coverage for medical services. There is a separate calendar year deductible of $250 under Self Only coverage and $500 under Self and Family coverage for mental health and substance abuse services. Previously, we did not have a calendar year deductible for medical coverage or mental health/substance abuse services.

• Members pay 20% of the allowable charges for all professional care, including but not limited to surgical procedures, rehabilitative therapy, and anesthesia services. Previously, members did not pay coinsurance for these services.

• Members pay 20% of the allowable charges for all diagnostic laboratory tests, x-rays, and pathology services. Previously, members did not owe anything for these services other than the office visit copay.

• The out-of-pocket maximum for medical services will be $1,000 under Self Only coverage and $2,000 under Self and Family. There is a separate out-of-pocket maximum for Mental Health Services. Previously, the out-of-pocket maximum was $500 under Self Only coverage and $1,500 under Self and Family coverage. See page 12 for a list of services that do not count toward the out-of-pocket maximum.

• Growth hormone therapy (GHT) is now covered under the Prescription Drug benefits and subject to the applicable prescription drug copay. Previously, GHT was a covered home health care benefit and members paid nothing.

• The prescription drug copays for formulary generic and name brand drugs are now $10 and $20 respectively. Previously, these copays were $5 generic and $15 brand formulary.

• Your hospital emergency room copay has increased from $50 to $75.

• We now have a $5,000 annual maximum for prosthetic devices.

• We now cover ostomy supplies up to a $500 maximum per calendar year. Members pay 40% coinsurance.