U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

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 14.0% for Self Only or 21.7% for Self and Family for enrollment code PW.

• Your share of the non-Postal premium will increase by 15.1% for Self Only or 25.2% for Self and Family for enrollment code QB.

• Your share of the non-Postal premium will increase by 14.7% for Self Only or 22.5% for Self and Family for enrollment code SG.

• The primary/specialist office visit copayment has increased to $15.

• The inpatient hospital care copayment has increased to $240 per confinement, limited to two copayments per individual, four copayments per family per calendar year. The copayment does not apply to hospital inpatient charges for newborn nursery care.

• The coverage for infertility inpatient and outpatient services will be in accordance with the State mandate and limited to females 21-44 years of age. The $15 copayment will apply per office visit and the $240 inpatient copayment will apply per confinement.

• The coverage for hair prosthesis is now limited to a $200 lifetime maximum.

• The prescription drug copayment has changed from a two tier structure to a three tier structure. The copayment for a 30 day supply has changed to $10 generic, $20 brand, $35 non-formulary. The copayment for a 90 day supply has changed to $20 generic, $40 brand, $70 non-formulary. The medical necessity process for non-formulary excluded drugs has been eliminated.

• The copayment for diabetic durable medical equipment has increased to $15 per item.

• The copayment for diabetic supplies has increased to $15 or 20%, whichever is less.

• The brochure has been clarified to show there is no copayment for preventive care adult routine immunizations when performed during an annual routine physical.

• The brochure has been clarified to show there is no copayment for preventive care children examinations when performed during well child routine visits.