Cover Page

Page numbers referenced within this brochure apply only to the printed brochure

SAMBA Health Benefit Plan

www.SambaPlans.com
Customer Service 800-638-6589

2024



IMPORTANT:
  • Rates
  • Changes for 2024
  • Summary of Benefits
A Fee-for-Service Plan (High and Standard Option) with a Preferred Provider Organization

This plan's health coverage qualifies as minimum essential coverage and meets the minimum value standard for the benefits it provides.  See page 7 for details.  This plan is accredited.  See page 12.

Sponsored and administered by: the Special Agents Mutual Benefit Association (SAMBA)

Who may enroll in this Plan:  All Federal employees, Tribal employees, and annuitants who are eligible to enroll in the Federal Employees Health Benefits Program (FEHB) may enroll in the SAMBA Health Benefit Plan.

To become a member:  Employees and annuitants enrolling in the SAMBA Health Benefit Plan will automatically become members of the Special Agents Mutual Benefit Association.

Membership dues: There are no membership dues.



 

Enrollment codes for this Plan:

    441 Self Only - High Option
    443 Self Plus One - High Option
    442 Self and Family - High Option
    444 Self Only - Standard Option

    446 Self Plus One - Standard Option
    445 Self and Family - Standard Option



Federal Employees Health Benefits Program seal
OPM Logo