PARTICIPATING IN THE DOD/FEHB

DEMONSTRATION PROJECT

RI 70-15

Revised November 2000

Federal

Employees 

Health 

Benefits 

Plans

All 

Aboard for 

Health!

United States Office of 

Personnel Management

Retirement and Insurance

Service

The 2001 Guide to

Be sure to visit our web site at www.opm.gov/insure

and the DoD web site at www.tricare.osd.mil/fehbp
Program Features

● No Waiting Periods. You can use your benefits as soon as your coverage becomes effective.

● A Choice of Coverage. Choose between self only or self and family.

● A Choice of Plans and Options. Select from Fee-for-Service, Health Maintenance Organization, or

Point of Service plans.

● A Government Contribution. The Government pays 72 percent of the average premium toward the

total cost of your premium, but not more than 75 percent of the total premium for any plan.

● Premium Payment Deductions from your check. For details see page 3.

● Annual Enrollment Opportunity. Each year during the 3-year demonstration project you can enroll

or change your health plan enrollment.

● Continued Group Coverage. Eligible participants can continue coverage following divorce or death.

Contact the Information Processing Center for more information.

● Coverage After FEHB Ends. You or your family members may be eligible for temporary continuation of FEHB coverage when FEHB coverage ends. Contact the DoD Customer Care Center for more

information.

Better Information

Better Choices

Better Health
Page:

Eligibility and Enrollment Requirements................................................................................2

FEHB and You ....................................................................................................................................4

Of Note for 2001

Selecting a Health Plan

Benefits

Cost

Quality

Patient Safety

How the Plan Works

FEHB Online.......................................................................................................................................9

Plan Comparisons:

Nationwide Fee-for-Service Plans Open to All..............................................................................11

Health Maintenance Organization Plans and Plans Offering a Point of Service Product...........15

Table of Contents

1

Things to Remember

■✔ A number of plans withdrew from the FEHB Program. 

Make sure your plan will be offered in 2001.

■✔ Be aware of benefit changes for 2001.

■✔ Check the premium for 2001.

The information in the 2001 Guide to Federal Employees Health Benefits (FEHB) Plans 

gives you an overview of the FEHB Program and its participating plans. Before you make 

any final decisions about health plans, read the plan brochures.
If you are eligible to enroll in a plan under the regular FEHB Program, you are not eligible to enroll under the

DoD/FEHBP Demonstration Project.

Eligibility and Enrollment Requirements

Who is Eligible

DoD determines who is eligible to enroll in FEHB. 

Generally, you may enroll if:

● You are an active or retired uniformed service 

member and are eligible for Medicare, 

● You are a dependent of an active or retired uniformed

service member and are eligible for Medicare, 

● You are a qualified former spouse of an active or

retired uniformed service member and you have not

remarried, or 

● You are a survivor dependent of a deceased active or

retired uniformed service member, and

● You live in one of the ten geographic demonstration

areas. 

If you become elgible for the DoD/FEHBP Demonstration

Project outside of Open Season, contact the DoD Customer Care Center to find out how to enroll and when

your coverage will begin.

If you move to somewhere not in a demonstration area,

your entitlement will end. However, if you move from

one demonstration area to another demonstration area,

you may continue to participate in the demonstration

project. If you were in an HMO or POS plan, you will be

permitted to change your FEHBP plan.

The Demonstration Areas

● Dover AFB, DE area, including most of Delaware and

parts of Maryland

● Commonwealth of Puerto Rico

● Fort Knox, KY area, including parts of Indiana 

bordering Kentucky

● Greensboro/Winston Salem/High Point, NC area 

● Dallas, TX area 

● Humboldt County, CA area 

● Naval Hospital, Camp Pendleton, CA area 

● New Orleans, LA area 

● Coffee County, GA area, including parts of Florida,

Georgia and South Carolina

● Adair County, IA area, including most of Iowa and

parts of Minnesota, South Dakota, Nebraska, Kansas

and Missouri

Using Military Treatment Facilities 

If you elect to enroll in the DoD/FEHBP Demonstration

Project, you will not be eligible to receive care at any

military treatment facilities, including pharmacies at

military treatment facilities. All your care will be

through the health plan you select.

Opportunities to Enroll 

Your next opportunity to enroll is during the 2000 Open

Season, November 13, 2000, through December 11,

2000. You may select coverage for yourself (self-only) or

for you and your family (self and family). Your coverage

will begin January 1, 2001. DoD has set-up a Customer

Care Center (CCC) in Iowa to provide you with information about how to enroll. CCC staff will verify your eligibility and provide you with FEHB Program information,

plan brochures, enrollment instructions and forms. The

toll-free phone number for the CCC is 1-877-DOD-FEHB

(1-877-363-3342).

2

The Department of Defense (DoD) and FEHB Program Demonstration Project

T

he National Defense Authorization Act for 1999, Public Law 105-261, established the DoD/FEHBP Demonstration

Project. It allows some active and retired uniformed service members and their dependents to enroll in the FEHB

Program. The demonstration began in January 2000 and will last for three years. The first opportunity to enroll

was during the 1999 Open Season.
Eligibility and Enrollment Requirements

Dependent Coverage

You can choose self and family coverage for you, your

spouse, and unmarried dependent children under age 22.

Under certain circumstances, your FEHB enrollment

may cover your disabled child 22 years old or older who

is incapable of self-support. Contact the DoD Customer

Care Center for more information.

If you elect a self and family enrollment, and later add

another dependent, e.g., a new child, you do not need to

re-enroll. However, you should contact your plan to add

the new dependent to their records.

Selecting a Plan

You can get brochures from the DoD Customer Care

Center (CCC) by calling toll free 1-877-DOD-FEHB 

(1-877-363-3342). Brochures are also available on our

web site at www.opm.gov/insure. When the CCC sends

you the brochures you request, it will also send you an

enrollment form for you to complete and return to the

CCC. The CCC will verify your eligibility and confirm

your enrollment.

Some FFS plans require that you join the organization

that sponsors the plan. Membership requirements

and/or limitations also apply to any POS product the FFS

plan offers.

Your new plan will mail you an identification card. If you

need services before you receive your new card, contact

your new plan at the member services number in their

brochure.

Deduction from your Monthly Annuity

After the Government pays its share toward the total 

premium, you pay the rest. Each plan’s premium in this

Guide is the amount that will be withheld in 2001. 

Premiums take effect January 1, 2001, and are reflected

in monthly annuities beginning in February 2001.

If the premium is more than your monthly annuity, you

may pay the amount directly to the DoD Customer Care

Center (CCC), either by Electronic Funds Transfer (EFT)

from your bank account or by check or money order.

The CCC will tell you about these options.

When Your Enrollment Ends

Your enrollment will continue until the end of the

demonstration project, unless you change plans, lose 

eligibility, e.g., move out of the demonstration sites, or

voluntarily cancel your enrollment. You may cancel your

enrollment at any time. However, you will not be able to

enroll again and neither you nor your family members

will be entitled to temporarily continue coverage (see

below).

Eligibility for Temporary Continuation of Coverage (TCC) —

Under this Demonstration Project, the only individual

eligible for TCC is one who ceases to be eligible as a

“member of family” under your self and family enrollment. TCC is available:

● for your covered dependent child if he or she marries

or turns age 22, or

● for your former spouse if you divorce and he or she

does not qualify to enroll as an unremarried former

spouse under title 10, United States Code.

TCC begins the day after enrollment in the DoD/FEHBP

Demonstration Project ends. TCC enrollment terminates

after 36 months or the end of the Demonstration Project,

whichever occurs first. You, your child or another person must notify the CCC when a family member loses 

eligibility for coverage under the DoD/FEHBP Demonstration Project.

TCC is not available if you move out of a DoD/FEHBP

Demonstration Project area, you cancel your coverage, 

or your coverage is terminated for any reason. TCC is

not available when the demonstration project ends.

31-Day Extension and Right To Convert — These provisions do not apply to the DoD/FEHBP Demonstration

Project.

3
4

FEHB and You

Of Note for 2001

● Beginning in 2001, all FEHB plans must offer coverage for mental health and substance abuse that is

identical to medical coverage deductibles, coinsurance, copays, and day and visit limitations. Check

our web site at www.opm.gov/insure and your plan’s

brochure for details.

● Patient Safety: See page 7 for five important steps

you can take to prevent medical error and improve

your healthcare safety.

● In support of the Presidential initiative on plain language, OPM and the FEHB plans are committed to

providing written information that is easy to understand. We worked hard to develop benefit descriptions that are clear, customer-focused, and improve

plan-to-plan comparisons. You will find benefit

descriptions in the plan brochures.

● Patients’ Bill of Rights and Responsibilities: The

President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry recommended consumer protections and quality initiatives that are now fully implemented by all FEHB

plans. Our web site at www.opm.gov/insure lists the

specific types of information that your health plan

must make available to you. You may also contact

your health plan directly for this information.

Selecting a Health Plan

Use this Guide and plan brochures to make your health

plan decision. The Guide is a summary of FEHB plans;

the plan brochures give specific benefit information. You

can get brochures from the health plans or your human

resource office. Our web site, www.opm.gov/insure, provides the Guide, brochures and other helpful information.

You should review the Fee-for-Service plans that are

available nationwide as well as the plans available where

you live or work. 

Before selecting a plan:

● Compare benefits in the brochures,

● Review costs, 

● Consider quality, and

● Understand how the plan works.

Benefits — 

Check to see if the plan offers the type of services you

think you might need. Does it offer a prenatal program? Can you get preventative care? If you have other

insurance coverage, how does the FEHB plan coordinate

benefits with the other plan? Given the trend toward

reducing hospital stays, will your plan pay for home

health care? Because health care is expensive, pay attention to the plan’s annual out-of-pocket maximum to see

how you are protected. See if there are limits on the

number of visits for the services you need. Don’t assume

benefits will be the same as they were last year. Check

the plan brochure for details.

✔ Read plan brochures carefully.

✔ Know what services are covered.

✔ Know what services are not covered.

T

he Federal Employees Health Benefits (FEHB) Program began operation in July 1960. It is the nation’s largest

employer-sponsored health insurance program. Almost 9 million people, including 2.3 million federal employees,

1.9 million retirees, and eligible family members, are members of the Program. 
Cost — 

The premium you pay is an important consideration.

When thinking about premiums, what can you afford

biweekly or monthly? Should you enroll in a High

Option — and pay High Option premiums — if a Standard Option would do?

You also need to consider other costs. If you need to go

to the hospital, how much will you have to pay? What

will you pay for an emergency room visit? If you have

children, what will you pay for a well-child visit? What

will you pay for a prescription?

Do you have to pay a deductible for the services you want?

You share medical expenses by paying a coinsurance (a

percentage of the bill) or a copayment (a fixed dollar

amount). Which option do you prefer? Does the plan

limit the dollar amount it will pay for certain services,

making you pay the rest?

✔ Review the costs summarized in this Guide.

✔ Check plan brochures for specific information.

Quality — 

Reviewing the quality data in this Guide is like reading

about the repair history of different car models

before buying one. The model’s repair record may or

may not predict what your actual experience will be.

However, it gives an indication of how the models compare to one another. You can then be fairly confident

that a car that requires fewer repairs is a less risky purchase. The quality information in this Guide can help

you avoid an uninformed decision.

What is quality health care? Most experts agree that

quality varies at every level of the health care system,

from one plan to another and even from one physician’s

office to another. Quality is just as much a matter of

concern in fee-for-service plans as in HMOs. However,

there are fewer opportunities to measure how they actually deliver care.

Poor quality can mean too much care (e.g., unnecessary

surgery), too little care (e.g., not providing an indicated

diagnostic test), or the wrong care (e.g., improper dose of

a medication). Health plans can affect the quality of care

in the ways they influence the physician’s behavior and

in the ways in which care is delivered. 

● Say you’re considering a plan that offers a list of

physicians from which you must select one. What

does the survey information in this Guide say about

the experiences of others in that plan in “getting

needed care” or “getting care quickly”? 

✔ Check the customer service column to see how

your plan rates.

● Since most people aren’t familiar with the technical

aspects of care, they often make judgments based on

the art of care, e.g., how well the doctor communicates treatment choices to patients. 

✔ See what the survey information says about how

well your plan’s doctors communicate.

● A recent study concluded that health plans that provide better access to care do a better job of delivering

preventive services (e.g., immunizations and checkups). Higher scores on “getting needed care” and

“customer service” also were associated with higher

scores on things the plan does for you and how well

it treats you when you are sick. 

✔ Review your plan’s rating in these areas.

5

FEHB and You
6

FEHB and You

Accreditation is another quality indicator. It is a rigorous

and comprehensive evaluation by independent organizations that assess the quality of the key systems and processes that health care organizations use. It also

includes an assessment of the care and service health

plans deliver in areas such as immunization rates, mammography rates, and member satisfaction. The National

Committee for Quality Assurance, the Joint Commission

on Accreditation of Healthcare Organizations, and the

American Accreditation Healthcare Commission/URAC

are independent, private, not-for-profit organizations

dedicated to assessing and reporting on the quality of

health care organizations. For further details, visit their

web sites at www.ncqa.org, www.jcaho.org and

www.urac.org. 

✔ Is your health plan accredited?

Enrollee survey results in this Guide are not provided by

the health plans. They are solely based on the responses

of enrolled individuals like you. An independent company

surveyed a statistically valid sample of each plans’ members. A plan’s ratings show how well the plan scored

based on the responses of its surveyed members.

The complete questionnaire is on our web site at

www.opm.gov/insure. 

We have summarized the findings in these key areas:

● Getting Needed Care. Did you have problems getting

a referral to a specialist or did you experience delays

in obtaining care?

● Getting Care Quickly. When you called during the

doctor’s regular office hours, did you get the advice

or help you needed? Could you get an appointment

for regular or routine care as soon as you wanted?

● How Well Doctors Communicate. Did your doctor

listen carefully to you and explain things in a way

you could understand? Did he spend enough time

with you?

● Courteous and Helpful Office Staff. Was the doctor’s staff as helpful as you thought they should be?

● Customer Service. When you called your plan’s customer service department, were they helpful? Did

you have paperwork problems? Were the plan’s written materials understandable?

● Claims Processing. Did your plan pay your claims

correctly and in a reasonable time?

● Overall plan satisfaction. How would you rate your

overall experience with your health plan?

A plan may not be rated for one of three reasons:

1. It is new to the FEHB Program, 

2. It has fewer than 500 Federal enrollees, or 

3. It failed to administer the survey as we asked. These

plans are identified with an X.

☎

Call the 

FEHB Fraud Hot

Line

(202) 418-3300

if a provider has billed you for

services you did not receive.
7

List all prescriptions and over-the-counter drugs, such as aspirin and ibuprofen, and dietary supplements, such as vitamins

and herbals. Update this form whenever you have changes.

MEDICATION DOSE

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________

✃Cut out this card and 

keep it with you.

FEHB and You

Prescription errors occur

much more frequently than

they should, often with serious

consequences. Keep a record

of your medicines; share this

information with all of your

doctors.

Medical error and patient safety aren’t well understood by most Americans. When we need vital or risky health care

services, we want to believe that someone else has made sure that we’ll get safe care. Sadly, every hour, 10 Americans die in a hospital due to avoidable errors; another 50 are disabled. Too many patients get the wrong medicines,

the wrong tests and the wrong diagnosis. By asking questions, learning more and understanding your risks, you

can improve the safety of your own health care, and that of your family members. Take these simple steps:

1Speak up if you have questions or concerns. Choose a doctor who you feel comfortable talking to about your

health and treatment. Take a relative or friend with you if this will help you ask questions and understand the

answers. It’s okay to ask questions and to expect answers you can understand. 

2Keep a list of all medicines you take. Tell your doctor and pharmacist about the medicines you take, including

over-the-counter medicines such as aspirin and ibuprofen, and dietary supplements such as vitamins and

herbals. Tell them about any drug allergies you have. Ask the pharmacist about side effects and what foods or

other things to avoid while taking the medicine. When you get your medicine, read the label, including warnings.

Make sure it is what your doctor ordered, and you know how to use it. If the medicine looks different than you

expected, ask the pharmacist about it. 

3Make sure you get the results of any test or procedure. Ask your doctor or nurse when and how you will get theresults of tests or procedures. If you do not get them when expected — in person, on the phone, or in the mail

— don’t assume the results are fine. Call your doctor and ask for them. Ask what the results mean for your care.

4Talk with your doctor and health care team about your options if you need hospital care. If you have more

than one hospital to choose from, ask your doctor which one has the best care and results for your condition.

Hospitals do a good job of treating a wide range of problems. However, for some procedures (such as heart bypass

surgery), research shows results often are better at hospitals doing a lot of these procedures. Also, before you leave

the hospital, be sure to ask about follow-up care, and be sure you understand the instructions.

5Make sure you understand what will happen if you need surgery. Ask your doctor and surgeon: Who will take

charge of my care while I’m in the hospital? Exactly what will you be doing? How long will it take? What will

happen after the surgery? How can I expect to feel during recovery? Tell the surgeon, anesthesiologist, and nurses

if you have allergies or have ever had a bad reaction to anesthesia. Make sure you, your doctor, and your surgeon

all agree on exactly what will be done during the operation. 

Patient Safety
8

5 Steps to Safer Health Care:

1. Speak up if you have questions or concerns.

2. Keep a list of all the medicines you take.

3. Make sure you get the results of any test or procedure.

4. Talk with your doctor and health care team about your

options if you need hospital care.

5. Make sure you understand what will happen if you need

surgery.

Learn more at www.opm.gov/insure

✃Cut out this card and 

keep it with you.

FEHB and You

How the Plan Works

Different types of plans have different methods for 

getting and paying for care.

● Fee-for-Service — This is a traditional type of insurance in which the health plan will either pay the

medical provider directly or reimburse you once you

have paid the bill and filed an insurance claim for

each covered medical expense. You select the doctor

or hospital of your choice, but you usually must pay

a deductible and coinsurance or copayment. Most

fee-for-service plans have preferred provider organizations (PPO). You save money and avoid paperwork

when you use preferred providers.

● Health Maintenance Organization — This type of

health plan gives you coordinated care through a

network of physicians and hospitals in particular

areas. You usually must get all your care from the

providers that are part of the plan. You pay copayments for most services and rarely pay a deductible

or coinsurance.

● Point of Service — This type of plan also has rules

about what benefits are covered, doctor choice, and

access to specialists, but you can choose any doctor

you like and see specialists without referrals if you

agree to pay more.

There are things you can do to make a plan work best for

you.

● When you need care, use your brochure to find out

about the plan’s rules and coverage for the care you

need. Know what services require precertification,

prior approval, or referral before you use them.

● Use your plan’s mail order drug program if it has

one. You get the convenience of a 90-day supply

instead of a 30-day supply.

● Request generic drugs instead of brand name drugs.

A generic medication is a copy of a brand name drug.

It has the same active ingredients but costs less.

● Get a second or even third opinion before undergoing treatment for a serious illness or injury.

● If you’re in a fee-for-service plan, use the plan’s PPO

if it has one. (Be aware, however, that some of the

services provided in a PPO hospital may not be covered by PPO arrangements. Room and board will be

covered, but anesthesia and radiology, for instance,

will probably be covered under non-PPO benefits.)

● Ask questions. You deserve a voice in your own

health care!
FEHB Online

FEHB Home Page

● The FEHB Handbook for Enrollees and Employing

Offices — detailed and in-depth information about

the FEHB Program

● The FEHB law and regulations

● Information on Disputed Claims, Patients’ Bill of

Rights and Mental Health Parity

● Frequently Asked Questions

● Monthly highlights about different health care issues

and programs

● Information on Medicare and FEHB

● FEHB Facts — a program overview 

Plan Comparison Page

● 2001 Plan Comparison — gives you general information about plans, plan quality, and information

about how to choose a plan

● A link to PlanSmartChoice — an interactive decision

support tool to help you select a plan

● Links to Guides and Brochures — view them on the

web or download them and print them to keep

● Links to other web sites where you can find more

about health care quality 

9

WWW.OPM.GOV/INSURE

There is a new look to the FEHB web site and we’ve added more valuable information to help you choose a health

plan and to learn more about the Program.

We now have two FEHB web pages to make your search for information easier. There is the FEHB Home Page that

has information on the FEHB Program and important information on health care. We also have the Plan Comparison

Page that has all the information you’ll need to make an informed health insurance election.

Here’s what you can find on the two pages:

DoD Web Site

DoD also has a web site devoted to the DoD/FEHBP Demonstration Project. You can view information such as their

Marketing/Beneficiary Education Plan, Frequently Asked Questions, demonstration area locations and zip code lists at

www.tricare.osd.mil/fehbp.
10

Learning about today’s Medicare 

can be beneficial to your health.

Today’s Medicare offers more.

✔ More preventive benefits.

✔ More information.

✔ More help with 

your questions. Medicare Questions?

www.medicare.gov

1-800-MEDICARE

(1-800-633-4227)

Medicare & You Handbook An education program of the

Department of Health and Human

Services and the Health Care

Financing Administration
11

Nationwide Fee-for-Service Plans

Open to All

(Pages 12 through 14)

Fee-for-Service (FFS) Plans with a Preferred Provider Organization (PPO) — A FFS option that allows you to

see medical providers who reduce their charges to the plan; you pay less money out-of-pocket when you use a PPO

provider. When you visit a PPO you usually won’t have to file claims or paperwork. However, going to a PPO hospital does not guarantee PPO benefits for all services received within that hospital. For instance, lab work and

radiology services from independent practitioners within the hospital may not be covered by the PPO agreement.

Fee-for-Service (FFS) Plans (non-PPO) — A traditional type of insurance in which the health plan will either

pay the medical provider directly or reimburse you after you have paid the bill and filed an insurance claim for

each covered medical expense after you receive the service. When you need medical attention, you visit the doctor or hospital of your choice. 

Managed care is an important force in today’s health care. Generally speaking, it is a system that tries to manage

the quality of health care, access to health care, and the cost of that care. The following graph compares the

extent to which different plan types use managed care.

Use of Managed Care Techniques and Concepts

Less More

FFS PPO POS HMO

Important: Some FFS plans also offer a Point of Service product.

Check pages 16–21 for details.

Plan Comparisons
Monthly

Premium

Your Share 

Plan name Self only Self & family

Telephone

number

Enrollment

code

Self Self &

only family

12

◊ Offers a Point of Service product.

Alliance Health Plan 202/939-6325 1R1 1R2 209.89 418.51

APWU Health Plan◊ 800/222-2798 471 472 308.15 663.65

Blue Cross and Blue Shield-High local phone # 101 102 151.97 301.86

Blue Cross and Blue Shield-Std◊ local phone # 104 105 74.23 175.30

GEHA Benefit Plan-High 800/821-6136 311 312 109.25 221.78

GEHA Benefit Plan-Std 800/821-6136 314 315 59.58 135.42

Mail Handlers-High 800/410-7778 451 452 103.16 246.72

Mail Handlers-Std 800/410-7778 454 455 75.53 182.97

NALC 703/729-4677 321 322 135.57 266.28

Postmasters-High 703/683-5585 361 362 406.77 858.21

Postmasters-Std 703/683-5585 364 365 219.33 456.02

Nationwide Fee-for-Service Plans Open to All

How to read this chart:

The table below highlights selected features that may help you narrow your choice of health plans. An (*) in any column means an

exception to the general rule for that particular plan. See the applicable column description for details. Always consult plan

brochures before making your final decision. 

The Deductibles shown are the amount of covered expenses that you pay before your health plan begins to pay. 

Calendar Year deductibles for families are two or more times the per person amount shown. Check the plan brochure for details.

In some plans your combined Prescription Drug purchases from mail order and local pharmacies count toward the deductible.

In other plans only purchases from local pharmacies count. Some plans (*) require each family member to meet a per person

deductible. Check the plan brochure for details.
13

Plan name

Benefit

type

Alliance Health Plan PPO $100 $200* $150 $2,000 10% 10% 10% 10% 10% 20% 20%

Non-PPO $300 $200* $250 $3,000 30% 30% 30% 30% 30% 20% 20%

APWU Health Plan PPO $250 None None $4,000 10% 10% 10% 10% 10% $5/20% $5/20%

Non-PPO $250 None $200 $6,000 30% 30% 30% 30% 30% $5/20% $5/20%

Blue Cross and PPO $150 None None $1,000 5% 5% Nothing Nothing 5% $8 $14 

Blue Shield-High Non-PPO $150 None $100 $2,700 20% 20% 30% 30% 20% $8 $14 

Blue Cross and PPO $250 None $100 $3,000 10% 10% Nothing Nothing 10% $12 $20 

Blue Shield-Std Non-PPO $250 None $300 $5,000 25% 25% 30% 30% 25% $12 $20 

GEHA Benefit Plan-High PPO $300 None None $2,500 10% 10% Nothing 10% 10% $10 $30 

Non-PPO $300 None None $3,500 25% 25% Nothing 25% 25% $10 $30 

GEHA Benefit Plan-Std PPO $450 None None $3,000 15% 15% 15% 15% 15% $15 50%

Non-PPO $450 None None $4,000 35% 35% 35% 35% 35% $15 50%

Mail Handlers-High PPO $150 $250* None $2,500 10% 10% Nothing Nothing 10% $10 $30 

Non-PPO $150 $250* $250 $4,000 30% 30% Nothing Nothing 30% $10 $45 

Mail Handlers-Std PPO $200 $600* $150 $4,000 10% 10% Nothing Nothing 10% $10 $40 

Non-PPO $200 $600* $300 $4,000 30% 30% Nothing Nothing 30% $10 $55 

NALC PPO $250 None None $3,000 15% 15% Nothing Nothing 15% $12 $25 

Non-PPO $300 $25 $100 $3,500 30% 30% 20% 20% 30% $12 $25 

Postmasters-High PPO $200 $100 None $3,000 10% 10% 10% 10% 10% $10/20% $25/20% 

Non-PPO $400 $150 $150 $3,500 20% 20% 25% 25% 20% $10/20% $25/20% 

Postmasters-Std PPO $250 $100 None $3,500 10% 10% 10% 10% 10% $15/20% $30/20%

Non-PPO $500 $150 $250 $5,000 30% 30% 30% 30% 30% $15/20% $30/20%

Medical-Surgical — You pay

Deductible Copay ($)/Coinsurance (%)

Annual Mail order 

Per person Per stay Out-of-pocket Hospital prescription

hospital Maximum drugs

Calendar Prescription inpatient Outpatient Inpatient Outpatient Brand

year drug Doctors tests R&B Other other Generic Name

The Per Stay Hospital Inpatient deductible is what you pay each time you are admitted to a hospital.

The Annual Out-of-pocket Maximum is the amount of certain covered charges the plan will require you to pay during the year. 

What you pay for Doctors inpatient visits and for surgical services is shown. 

Your share of Outpatient Tests — provided, or ordered, and billed by a physician or physicians’ group — is shown.

Your share of Hospital Inpatient Room and Board and Other (e.g., nursing, supplies, and medications) covered charges are shown,

usually after any per stay deductible. Services provided and billed by the hospital for outpatient care (other than surgery) are shown

as Hospital Outpatient Other expenses.

Finally, what you pay for Generic and Brand name drugs purchased through Mail Order is shown. In some cases you pay the greater

of either the copayment or coinsurance shown. If you pay more for non-preferred drugs, that amount is shown on the non-PPO line.
14

Plan

Plan name code

Alliance Health Plan 1R f f hh h f *

APWU Health Plan 47 f f ff f f f

Blue Cross and Blue Shield-High 10 * * ** * * h

Blue Cross and Blue Shield-Std 10 * * ** * * h

GEHA Benefit Plan-High 31 h * *h h h h

GEHA Benefit Plan-Std 31

Mail Handlers-High 45 * * ** * * f

Mail Handlers-Std 45 * * ** * * f

NALC 32 h h hh h h h

Postmasters-High 36 h * h* * * h

Postmasters-Std 36 h * h* * * h

Enrollee Survey Results

h above average, * average, f below average

Nationwide Fee-for-Service Plans Open to All

Enrollee Survey Results — See page 6 for a description.

Overall 

plan

satisfaction 

Getting 

needed

care

Getting 

care

quickly

How well 

doctors

communicate 

Courteous

and 

helpful 

office staff 

Customer 

service

Claims 

processing 
15

Health Maintenance Organization Plans

and Plans Offering a Point of Service Product

(Pages 16 through 21)

Health Maintenance Organization (HMO) — A health plan that provides care through a network of physicians and hospitals in particular geographic or service areas. HMOs coordinate the health care service you receive and free you from completing paperwork or

being billed for covered services. Your eligibility to enroll in an HMO is determined by where you live or, for some plans, where you

work. Some HMOs are affiliated with or have arrangements with HMOs in other service areas for non-emergency care if you travel

or are away from home for extended periods. Plans that offer reciprocity discuss it in their brochure.

● The HMO provides a comprehensive set of services — as long as you use the doctors and hospitals affiliated with the

HMO. HMOs charge a copayment for primary physician and specialist visits and generally no deductible or coinsurance

for inhospital care.

● Most HMOs ask you to choose a doctor or medical group to be your primary care physician (PCP). Your PCP provides

your general medical care. In many HMOs, you must get authorization or a “referral” from your PCP to see other

providers. The referral is a recommendation by your physician for you to be evaluated and/or treated by a different physician or medical professional. The referral ensures that you see the right provider for the care most appropriate to your

condition.

● Care received from a provider not in the plan’s network is not covered unless it’s emergency care or the plan has a

reciprocity arrangement.

Plans Offering a Point of Service (POS) Product — A product offered by an HMO or FFS plan that has features of both.

In an HMO, the POS product lets you use providers who are not part of the HMO network. However, you pay more for using these

non-network providers. You usually pay higher deductibles and coinsurances than you pay with a plan provider. You will also need

to file a claim for reimbursement, like in a FFS plan. The HMO plan wants you to use its network of providers, but recognizes that

sometimes enrollees want to choose their own provider.

In a FFS plan, the plan’s regular benefits include deductibles and coinsurance. But in some locations, the plan has set up a POS network of providers similar to what you would find in an HMO, which means you usually must select a primary care physician and

obtain a referral to see other providers. The plan encourages you to use these providers, usually by waiving the deductibles and applying a copayment that is smaller than the normal coinsurance. Generally there is no paperwork when you use a network provider.

The POS plans have two rows for “In Network” and “Out of Network” benefits. In Network shows what you pay if you go to the plan’s

providers; Out of Network shows what you pay if you decide not to go to the plan’s providers.

Managed care is an important force in today’s health care. Generally speaking, managed care is a system of health care delivery that

tries to manage the quality of health care, access to health care, and the cost of that care. The following graph compares the extent

to which different plan types use managed care.

Use of Managed Care Techniques and Concepts

Less More

FFS PPO POS HMO

Plan Comparisons
Health Maintenance Organization (HMO) and Point of Service (POS) Plans

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan

brochures before making your final decision.

Primary Care Doctor Office shows what you pay for each office visit 

to your primary care doctor. 

Hospital per Stay Deductible/Copay is the amount you pay when you

are admitted into a hospital. A (#) means you also pay a share of the

room and board charges; check with the plan. 

Monthly

premium

your share 

Self only Self & family

Telephone

number

Enrollment

code

Self Self &

Plan name – location only family

California

Aetna U.S. Healthcare - Southern California area 800/537-9384 2X1 2X2 99.17 142.52

Blue Cross- HMO - Most of California 800/235-8631 M51 M52 58.14 168.78

Blue Shield of CA Access+ - Most of California 800/334-5847 SJ1 SJ2 109.68 211.77

CIGNA HealthCare of California - Northern/Southern California 800/832-3211 9T1 9T2 139.12 229.19

Health Net - Most of California 800/522-0088 LB1 LB2 141.27 200.80

Kaiser Permanente - Southern California 800/464-4000 621 622 86.11 136.33

Maxicare Southern California - Southern California 800/234-6294 CM1 CM2 49.58 104.11

PacifiCare Health Plans - Most of California 800/624-8822 CY1 CY2 94.06 234.19

Delaware

Aetna U.S. Healthcare-High -All of Delaware 800-537-9384 SU1 SU2 361.71 674.35

Aetna U.S. Healthcare-Std - All of Delaware 800-537-9384 SU4 SU5 295.17 547.67

Florida

Av-Med Health Plan - Gainesville area 800/882-8683 JF1 JF2 150.30 363.07

Indiana

Aetna U.S. Healthcare - Southern Indiana 800-537-9384 7L1 7L2 171.45 293.88

Humana Health Plan - Southern Indiana 888/393-6765 D21 D22 84.29 229.66

M*Plan - Central/NE/SW Indiana 317/571-5320 IN1 IN2 183.37 331.89

Iowa

Coventry Health Care of Iowa - Des Moines/Central Iowa/Waterloo 800/257-4692 SV1 SV2 135.90 222.75

John Deere Health Plan - Central/Eastern Iowa 800/247-9110 YH1 YH2 153.64 258.22

16
Enrollee Survey Results — See page 6 for a description. 

An (X) means the plan did not conduct the survey as we asked.

Accredited — A (✔) means the plan is accredited by the National

Committee for Quality Assurance; the Joint Commission on 

Accreditation of Healthcare Organizations; and/or the American

Accreditation Healthcare Commission/URAC.

Prescription Drugs, Generic, Brand Name shows what you pay for prescriptions

when you use a plan pharmacy. If two brand name amounts are listed, the first is

what you pay for “formulary” drugs (drugs on the plan’s preferred list); the second

is what you pay for non-formulary drugs. Some plans charge different amounts

for some drugs and for mail orders. In many plans, if you get the brand name

instead of the generic drug, you also pay the difference between the two.

Plan name

California

Aetna U.S. Healthcare $10 None $5 $10/$25 *f f ff ** ✔

Blue Cross- HMO $10 None $5 $10 *f f ff ** ✔

Blue Shield of CA Access+ $10 None $6 $6 f* f ff ** ✔

CIGNA HealthCare of California $10 None $5 $10 ff f ff ff ✔

Health Net $10 None $5 $10/$15 *f * ** **

Kaiser Permanente $10 None $10 $10 ** f ff h* ✔

Maxicare Southern California $10 None $5 $10/$25 *f f *f *f ✔

PacifiCare Health Plans $10 None $5 $15 *f f ff ** ✔

Delaware

Aetna U.S. Healthcare-High $10 None $5 $10/$25

Aetna U.S. Healthcare-Std $15 $240 $10 $15/$30

Florida

Av-Med Health Plan $10 None $5 $5 *f f ** h* ✔

Indiana

Aetna U.S. Healthcare $10 None $5 $10/$25

Humana Health Plan $10 None $5 $10/$25 ** * ** f*

M*Plan $10 None $5 $10/$30 hh h *h ** ✔

Iowa

Coventry Health Care of Iowa $10 None $5 or 25%* $5 or 25%* *h h ** ** ✔

John Deere Health Plan $10 $100 $5 $15/$30 hh h *h *h ✔

17

Overall plansatisfaction Getting needed care Getting care quickly How well doctorscommunicate Courteous and helpful office staff Customer service Claims processing Accredited

Prescription 

drugs

Primary

care 

doctor

office

copay

Hospital

per 

stay

deductible/

copay Generic Brand

name

Enrollee Survey Results

h above average, * average, f below average
Health Maintenance Organization (HMO) and Point of Service (POS) Plans

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan

brochures before making your final decision.

Primary Care Doctor Office shows what you pay for each office visit 

to your primary care doctor. 

Hospital per Stay Deductible/Copay is the amount you pay when you

are admitted into a hospital. A (#) means you also pay a share of the

room and board charges; check with the plan. 

Monthly

premium

your share 

Self only Self & family

18

Kansas

Blue Cross and Blue Shield-Std - Most of Kansas 800/432-0379 104 105 74.23 175.30

Humana Kansas City, Inc.-High -Kansas City area 888/393-6765 MS1 MS2 61.44 165.34

Humana Kansas City, Inc.-Std - Kansas City area 888/393-6765 MS4 MS5 47.62 114.24

Kaiser Permanente - Kansas City area 913/642-2662 HA1 HA2 77.63 260.06

Kentucky

Aetna U.S. Healthcare - Lexington/Louisville areas 800-537-9384 7L1 7L2 171.45 293.88

Humana Health Plan - Louisville area 888/393-6765 D21 D22 84.29 229.66

Louisiana

Aetna U.S. Healthcare - New Orleans area 800/537-9384 NG1 NG2 66.06 126.79

Blue Cross and Blue Shield-Std - New Orleans area 800/272-3029 104 105 74.23 175.30

Maxicare Louisiana - Baton Rouge/New Orleans areas 800/933-6294 JA1 JA2 55.46 116.47

Maryland

Free State Health Plan - All of Maryland 800/445-6036 LD1 LD2 182.52 315.98

MD-IPA - All of Maryland 800/251-0956 JP1 JP2 82.01 134.81

Minnesota

Blue Cross and Blue Shield-Std - All of Minnesota 800/859-2128 104 105 74.23 175.30

HealthPartners Classic-High -Minneapolis/St. Paul areas 952/883-5000 531 532 92.52 140.07

HealthPartners Classic-Std - Minneapolis/St. Paul areas 952/883-5000 534 535 62.42 124.84

HealthPartners Health Plan - Minneapolis/St. Paul/St. Cloud areas 952/883-5000 HQ1 HQ2 114.25 179.44

Telephone

number

Enrollment

code

Self Self &

Plan name – location only family
Enrollee Survey Results — See page 6 for a description. 

An (X) means the plan did not conduct the survey as we asked.

Accredited — A (✔) means the plan is accredited by the National

Committee for Quality Assurance; the Joint Commission on 

Accreditation of Healthcare Organizations; and/or the American

Accreditation Healthcare Commission/URAC.

19

Plan name

Overall plansatisfaction Getting needed care Getting care quickly How well doctorscommunicate Courteous and helpful office staff Customer service Claims processing Accredited

Prescription 

drugs

Primary

care 

doctor

office

copay

Hospital

per 

stay

deductible/

copay Generic Brand

name

Enrollee Survey Results

h above average, * average, f below average

Prescription Drugs, Generic, Brand Name shows what you pay for prescriptions

when you use a plan pharmacy. If two brand name amounts are listed, the first is

what you pay for “formulary” drugs (drugs on the plan’s preferred list); the second

is what you pay for non-formulary drugs. Some plans charge different amounts

for some drugs and for mail orders. In many plans, if you get the brand name

instead of the generic drug, you also pay the difference between the two.

Kansas

Blue Cross and - In-Network $15 None $10 $20 *h hhh*h Blue Shield-Std - Out-of-Network 25% $300 45% 45%

Humana Kansas City, Inc.-High $10 None $5 $10/$25 f* **f** ✔

Humana Kansas City, Inc.-Std $15 $100 $10 $20/$35 f* **f** ✔

Kaiser Permanente $10 None $5 $5 ** *f*h* ✔

Kentucky

Aetna U.S. Healthcare $10 None $5 $10/$25

Humana Health Plan $10 None $5 $10/$25 ** ***f*

Louisiana

Aetna U.S. Healthcare $10 None $5 $10/$25 ** f**hf

Blue Cross and - In-Network $15 None $10 $20 

Blue Shield-Std h* f*fhh ✔

- Out-of-Network 25% $300 45% 45%

Maxicare Louisiana - In-Network $10 None $7 $15/$25 *f f*fff

- Out-of-Network 20% 20% N/A N/A

Maryland

Free State Health Plan - In-Network $10 None $10 $20/$35 ** ***** ✔

- Out-of-Network 20% $200# $10 $20/$35

MD-IPA $10 None $5 $10/$25 hh ***h* ✔

Minnesota

Blue Cross and - In-Network $15 None $10 $20 hh h*h*h Blue Shield-Std - Out-of-Network 25% $300 45% 45%

HealthPartners Classic-High $10 None $8 $8 ** * ** h* ✔

HealthPartners Classic-Std $15 $200 $10 $10 ** * ** h* ✔

HealthPartners Health Plan $10 None $8 $8 ** * ** h* ✔

* You pay the greater amount
Health Maintenance Organization (HMO) and Point of Service (POS) Plans

How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan

brochures before making your final decision.

Primary Care Doctor Office shows what you pay for each office visit 

to your primary care doctor. 

Hospital per Stay Deductible/Copay is the amount you pay when you

are admitted into a hospital. A (#) means you also pay a share of the

room and board charges; check with the plan. 

Monthly

premium

your share 

Self only Self & family

20

Missouri

BlueCHOICE - St. Louis/Central/SW/Poplar Bluff areas 800/634-4395 9G1 9G2 126.12 200.24

Health Partners of the Midwest - St. Louis and Columbia areas 800/338-4123 RN1 RN2 139.58 268.84

Humana Kansas City, Inc.-High -Kansas City area 888/393-6765 MS1 MS2 92.04 224.85

Humana Kansas City, Inc.-Std - Kansas City area 888/393-6765 MS4 MS5 54.69 125.74

Kaiser Permanente - Kansas City area 913/642-2662 HA1 HA2 45.95 118.55

Mercy Health Plans/Premier - East/Central Missouri 800/327-0763 7M1 7M2 105.32 161.59

Prudential HealthCare HMO - St. Louis area 800/856-0764 VZ1 VZ2 153.75 258.44

North Carolina

PARTNERS NHP of NC - Most of North Carolina 800/942-5695 EQ1 EQ2 172.92 296.79

UHC of North Carolina - Central/Eastern/Western areas 800/999-1147 XM1 XM2 184.19 319.32

Puerto Rico

Triple-S - All of Puerto Rico 787/749-4777 891 892 57.10 135.19

Texas

APWU Health Plan - Eastern and Central Texas 800/222-2798 471 472 308.15 663.65

HMO Blue Texas - Dallas/Ft. Worth/Amarillo/East & West Texas 800/486-3040 YX1 YX2 122.55 196.04

PacifiCare Health Plans - S Ant/Hston/Glvston/Da/Ft Wor/Glf Coast 800/531-3341 GF1 GF2 94.06 230.57

Texas Health Choice, L. C. - Dallas/Ft. Worth areas 972/458-5000 UK1 UK2 94.17 140.88

Telephone

number

Enrollment

code

Self Self &

Plan name – location only family
Enrollee Survey Results — See page 6 for a description. 

An (X) means the plan did not conduct the survey as we asked.

Accredited — A (✔) means the plan is accredited by the National

Committee for Quality Assurance; the Joint Commission on 

Accreditation of Healthcare Organizations; and/or the American

Accreditation Healthcare Commission/URAC.

21

Plan name

Overall plansatisfaction Getting needed care Getting care quickly How well doctorscommunicate Courteous and helpful office staff Customer service Claims processing Accredited

Prescription 

drugs

Primary

care 

doctor

office

copay

Hospital

per 

stay

deductible/

copay Generic Brand

name

Enrollee Survey Results

h above average, * average, f below average

Prescription Drugs, Generic, Brand Name shows what you pay for prescriptions

when you use a plan pharmacy. If two brand name amounts are listed, the first is

what you pay for “formulary” drugs (drugs on the plan’s preferred list); the second

is what you pay for non-formulary drugs. Some plans charge different amounts

for some drugs and for mail orders. In many plans, if you get the brand name

instead of the generic drug, you also pay the difference between the two.

Missouri

BlueCHOICE $10 None $5 $10/$15 fh * ** f* ✔

Health Partners of the Midwest $10 None $7 $12/$25 ** * ** **

Humana Kansas City, Inc.-High $10 None $5 $10/$25 f* * *f ** ✔

Humana Kansas City, Inc.-Std $15 $100 $10 $20/$35 f* * *f ** ✔

Kaiser Permanente $10 None $5 $5 ** * f* h* ✔

Mercy Health - In-Network $10 None $7 $12 hh h ** hh Plans/Premier - Out-of-Network 30% None# $7 $12 

Prudential HealthCare HMO $10 None $5 $15/$25 ff * ** ff ✔

North Carolina

PARTNERS NHP of NC $10 $250 $10 $10 h* * ** hh ✔

UHC of North Carolina $10 None $10 $15/$25 hh h hh hh ✔

Puerto Rico

Triple-S - In-Network $7.50 None $2 $5/$10** hh f h* h*

- Out-of-Network $7.50* None# $2 $5/$10** 

Texas

APWU Health Plan - In-Network $10 None $5 or 25%* $5 or 25%*

- Out-of-Network 30% $200 $5 or 45%* $5 or 45%*

HMO Blue Texas $10 $100 $5 $10/$25 ff f ** *f ✔

PacifiCare Health Plans $10 None $5 $15 ff f ** ff

Texas Health Choice, L. C. $10 None $6 $12/50% ff f ff ff ✔

* Plus 10%; see plan brochure for details

**See plan brochure for details

* You pay the greater amount. See plan brochure for details.
See page 5 

for a message

that can save

your life!