RI 70-15

Revised November 1999

Federal Employees

Health Benefits

Plans

United States Office of

Personnel Management

Retirement and

Insurance Service

Participating in the

DoD/FEHBP

Demonstration Project

The 2000 Guide to

Be sure to visit our web site at

www.opm.gov/insure
The U.S. Office of Personnel Management (OPM) administers the Federal Employees Health Benefits

(FEHB) Program, the largest employer-sponsored health insurance program in the world. We

interpret the health insurance laws and write regulations for the FEHB Program. We give advice and help

to agencies and retirement systems so they can process your enrollment changes and deduct your premium.

We also contract with and monitor your plan — and all the other health plans — that pay claims or

provide care to covered members.

This is our commitment to you:

 Your choice of health benefits plans will compare favorably for value and selection with the

private sector.

 When you use the FEHB Guide and plan benefit brochures, you will find they are clear, factual

and give you the information you need.

 When you change plans or options, your new plan will issue your identification card within 15

calendar days after it gets your enrollment form from your agency or retirement system.

 Your fee-for-service plan should pay your claims within 20 work days; if more information is

needed, it should pay within 60 calendar days.

 If you ask us to review a claim dispute with your plan, our decision will be fair and easy to

understand, and we will send it to you within 60 calendar days. If you need to do more before

we can review a claim dispute, we will tell you within 14 work days what you still need to do.

 When you write to us about other matters, we will respond within 30 calendar days after we

get your letter. If we need time to give you a complete response, we will let you know.

Our Commitment to Our Customers

Better Information

Better Choices

Better Health
Page

Eligibility Requirements .............................1

FEHB and You ....................................3

Program Features .................................5

Patients’ Bill of Rights and Responsibilities.................6

Your Links to Information

2000 FEHB Web Site -- www.opm.gov/insure ........................ 7

We’re Y2K OK ........................................... 8

Quality Indicators

Satisfaction Survey ........................................ 9

Accreditation ........................................... 10

A Word About Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Census 2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Plan Comparisions

Nationwide Fee-for-Service Plans Open to All ........................ 13

Health Maintenance Organization Plans and

Plans Offering a Point of Service Product .......................... 17

The information in the 2000 Guide to Federal Employees Health Benefits (FEHB) Plans gives you an

overview of the FEHB Program and its participating plans. Do not make any final decisions about health

plans without first reading the plans’ brochures.

i

Table of Contents
The 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 will last for three years beginning

with the 1999 Open Season for the year 2000.

Open Season enrollments will be effective

January 1, 2000.

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 eight geographic demonstration areas.

If you are eligible to enroll in a plan under the

regular Federal Employees Health Benefits Program, you are not eligible to enroll under the

DoD/FEHBP Demonstration Project.

The Demonstration Areas

 Dover AFB, DE, including most of Delaware

and parts of Maryland

 Commonwealth of Puerto Rico

 Fort Knox, KY, including parts of Indiana bordering Kentucky

 Greensboro/Winston Salem/High Point, NC

 Dallas, TX

 Humboldt County, CA

 Naval Hospital, Camp Pendleton, CA

 New Orleans, LA

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 first opportunity to enroll is during the 1999 Open Season,

November 8, 1999, through December 13, 1999.

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

for you and your family (self and family). Your coverage will begin January 1, 2000. DoD has set-up

an Information Processing Center (IPC) in Iowa to

provide you with information about how to enroll.

IPC 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 IPC is

1-877-DOD-FEHB (1-877-363-3342).

1

Eligibility Requirements

The Department of Defense (DoD) and FEHB Program

Demonstration Project
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.

Open Seasons will also be held in 2000 and 2001,

during which you may enroll if you are eligible and

not already enrolled, change plans or options or

change from self only to self and family. (You may

change from self and family to self only at any

time.) Your coverage will begin January 1 of the

year following the Open Season that you enrolled.

For more information about features you will find

in the FEHB Program, see Program Features on

page 5.

If you become eligible for the DoD/FEHBP Demonstration Project outside of Open Season, contact

the IPC 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.

Web sites - DoD has a web site devoted to the

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. You can also view

information about the FEHB Program and the

demonstration project on the OPM web site at

www.opm.gov.

Your enrollment will continue for up

to 3 years, to 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. This

occurs when a child turns 22, for example, or if

you divorce and your spouse does not qualify to

enroll as an unremarried former spouse under title

10, United States Code.

31-Day Extension and Right To Convert -

These provisions do not apply to the DoD/FEHBP

Demonstration Project.

2

Eligibility Requirements

The Department of Defense (DoD) and FEHB Program

Demonstration Project
The Federal Employees Health Benefits (FEHB)

Program can help you meet your health care

needs. FEHB members enjoy the widest selection

of health plans in the country. You can choose from

any Fee-for-Service (FFS) plans, or Plans offering a

Point of Service (POS) product and Health

Maintenance Organizations (HMO) if you live

within the area serviced by the plan (see page 17).

Some FFS plans participating in the DoD/FEHBP

Demonstration Project 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.

Managed care is an important part of the FEHB

Program. You will find managed care features in all

the plans described in this Guide. Common features of managed care are pre-approval of hospital

stays, the use of primary care providers as “gatekeepers” to coordinate your medical care, and networks of physicians and other providers.

You are fortunate to be able to choose from among

many different health plans competing for your

business. Use this Guide to compare the costs, benefits, and features of different plans. This Guide

shows comparative benefit information for all plans

participating in the DoD/FEHBP Demonstration

Project. The benefit categories we list were chosen

based on enrollee requests, differences among

plans, and simplicity. However, we urge you to

consider the total benefit package, in addition to

service and cost, when choosing a health plan.

The plan brochures tell you what services and supplies are covered and the level of coverage. Look

over the brochures carefully. The brochures reflect

the efforts of OPM and health plan representatives

to eliminate jargon and use plain language. We also

formatted the brochures to ensure they are all organized alike. You can get brochures from DoD’s

Information Processing Center (IPC) by calling toll

free 1-877-DOD-FEHB (1-877-363-3342). They

are also available on our web site at

www.opm.gov/insure. When the IPC sends you

the brochures you request, it will also send you an

enrollment form for you to complete and return to

the IPC. The IPC will verify your eligibility and

confirm your enrollment.

Choosing a plan

Cost — certainly the premium you pay is an

important consideration, but there are some other

things you should consider. 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?

If you need to go to the hospital, how much will

you have to pay? Do you know how much you will

pay for an emergency room visit? If you have children, what will it cost you for a well-child care

visit?

Do you have to pay a deductible for the services

you might use? Your share of medical expenses is

either a coinsurance (a percentage of the bill) or a

copayment (a fixed dollar amount). Which option

do you prefer and what does the plan require? Does

the plan limit the dollar amount it will pay for certain services?

Coverage — check to see if the plan offers the

type of services you think you might need. If you

are 65 or over, how does the plan coordinate coverage with Medicare? If you regularly see an allergist,

do you pay extra for the allergy serum? Does the

plan offer a prenatal program? 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 catastrophic coverage to see how you are protected. See if there are

limits on the number of visits for the services you

need.

How the plan works — if predictable cost,

comprehensive benefits, no paperwork, and a coordinated approach to health care are high priorities,

consider a Health Maintenance Organization

(HMO). Most HMOs require you to select a doc3

FEHB and You
tor to act as your primary care physician, or PCP,

who refers you to specialists. If you don’t use a

plan doctor, the plan usually will not pay for the

services, unless it is an emergency.

A plan offering a Point of Service (POS) product

also has rules about what benefits are covered and

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.

If you are willing to pay a little more in total costs

for the widest choice of doctors, a Fee-for-Service

(FFS) plan might be for you. FFS plans let you

choose your own doctor and allow you to see specialists without a referral. Most FFS plans have Preferred Provider Organizations (PPO) that save you

money if you use these providers.

Some plans offer 24-hour medical advice lines to

help you make health decisions. These programs try

to keep you healthy and avoid unnecessary – and

potentially costly and time-consuming – medical

treatment.

Satisfaction — the experience of health plan

members form the satisfaction ratings in this

Guide. If you are considering joining a FFS plan,

chances are you will file a claim. How quickly does

the plan process claims? Will the plan be responsive

to your questions? As an HMO enrollee, you might

be most interested in how the plan is rated in

access to care and choice of doctors. Also ask your

doctor’s office about experiences with different

health plans.

Accreditations — HMO accreditations reflect

the evaluations of independent, nationally-recognized

organizations. Plans willing to go through an

accreditation review show a commitment to continuous quality improvement and accountability.

Getting the most from a plan

Within any plan, there are things you can do to

minimize your out-of-pocket costs and make the

plan work best for you.

Cost — here are some ideas for getting the best

value for your premium dollar:

 An easy way to save money is to use your

plan’s mail order drug program, if it has one.

 Request generic drugs instead of brand name

drugs.

 Almost all FFS Plans have Preferred Provider

Organizations (PPO, see page 13). Using a

PPO will reduce your out-of-pocket expenses.

If you do not use a PPO provider, your plan

will base its payment on an allowance that

probably will be less than the actual billed

charge. This means you have to pay the difference, which may be more than the

coinsurance amounts stated in this Guide

and the plan brochure. You can reduce the

chance of this happening by discussing fees

in advance with your provider. Remember

that plans set their own allowances.

It is also important to note that all of the services

provided in a PPO hospital may not be covered by

PPO arrangements. Room and board will be covered, but the anesthesia and radiology services may

not be. The only way to find out is to ask ahead of

time.

Quality — talk openly with your health plan and

providers about the kind of quality you want. Is

your HMO rated by a national accrediting organization? Ask your surgeon how frequently he or she

performs the procedure you are considering. If you

are pregnant, ask your obstetrician the percentage

of cases in which he or she performs a caesarean

section and how that compares with the local average. Is your doctor proposing an invasive approach

to treatment when a more conservative one is just

as effective? Does your doctor discuss possible drug

interactions when prescribing a new medication for

you?

No one has a greater stake in your health than you.

Understand how your plan works and don’t be shy

about asking questions. An informed consumer is a

better decision maker.

4

FEHB and You
5

No waiting periods. Your retirement system

sets the effective date of your coverage. You can use

your FEHB benefits as soon as your coverage is

effective — there are no waiting periods, required

medical examinations or restrictions because of age

or physical condition.

A choice of coverage. You can choose self

only coverage just for you, or 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 DoD’s Information

Processing Center for more information.

A choice of plans and options.

 Fee-for-Service plans

 Plans offering a Point of Service product

 Health Maintenance Organizations

A Government Contribution. The Government contributes toward the total cost of your premium. In 2000, the Government will pay up to

$2,049.60 for each self only enrollment and

$4,575.24 for each self and family enrollment, but

not more than 75% of the total premium for any

plan.

Deduction from your Monthly Annuity

for your share. 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 2000. Premiums take effect

January 1, 2000 and are reflected in monthly

annuities beginning in February, 2000.

If the premium is more than your monthly annuity,

you may pay the amount directly to DoD’s Information Processing Center (IPC), either by Electronic Funds Transfer (EFT) from your bank

account or by check or money order. The IPC will

tell you about these options.

Annual enrollment Opportunities. Each

year during the 3-year demonstration project you

will have the opportunity to enroll or change plans.

The 1999 Open Season is from November 8

through December 13, during which you may

enroll if you are eligible.

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.

Continued group coverage. The FEHB

Program offers continued FEHB coverage:

 for your former spouse if you divorce and he

or she has a qualifying court order (contact

the Information Processing Center for more

information), or

 for your family if you die while you covered

them.

Coverage after FEHB ends. The FEHB

Program offers temporary continuation of FEHB

coverage (TCC):

 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 their 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 IPC 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.

If you lose coverage under the FEHB Program, you

should automatically receive a Certificate of Group

Health Plan Coverage from the last FEHB Plan to

cover you. If not, the plan must give you one on

request. This certificate may be important to qualify for benefits if you join a non-FEHB plan.

Program Features

Some of our important Program features are:
6

The President’s Advisory Commission on Consumer Protection and Quality in the Health Care

Industry has recommended a Patients’ Bill of

Rights and Responsibilities that are a mainstay of

the FEHB Program. The following are consumer

protections and quality initiatives you can count on

from your FEHB plan.

 Transitional care. If you have a chronic or disabling condition and your health plan

terminates your provider’s contract (unless the

termination is for cause), you may be able to

continue seeing your provider for up to 90

days after the notice of termination. If you are

in the second or third trimester of pregnancy,

you may continue seeing your OB/GYN until

the end of your postpartum care.

If you have a chronic or disabling condition or

are in your second or third trimester of pregnancy and your health plan drops out of the

FEHB Program, you may be able to continue

seeing your provider if you enroll in a new

FEHB plan. You may continue to see your

current specialist after your old enrollment

ends, even if he or she is not associated with

your new plan, for up to 90 days after you

receive the termination notice or through the

end of postpartum care, and pay no greater

cost than if your old enrollment had not

ended.

 Medical records. You are allowed to review

and obtain copies of your medical records on

request. You may ask that a physician amend a

record that is not accurate, relevant, or complete. If the physician does not amend your

record, you may add a brief statement to the

record.

 Direct access to women’s health care providers

for routine and preventive health care services.

 Coverage of emergency department services

for screening and stabilization without authorization if you have reason to believe serious

injury or disability would otherwise result.

 Direct access to a qualified specialist within

your network of providers if you have complex or serious medical conditions that need

frequent specialty care. Authorizations, when

required by a plan, will be for an adequate

number of direct access visits under an

approved treatment plan.

 The elimination of “gag rules” in provider

contracts that could limit communication

about medically necessary treatment.

 Extensive information about plan characteristics and performance, provider network

characteristics, physician and health care facility characteristics, and care management.

OPM’s 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.

The health care system works best when enrollees

take the time to become informed. As responsible

consumers, you should:

 Read and understand your health benefits coverage, limitations, and exclusions, health plan

processes, and procedures to follow when

seeking care.

 Work with your physician in developing and

carrying out a treatment plan.

 Practice healthy habits.

Patients’ Bill of Rights and

Responsibilities
7

 2000 Plan Information – gives you

access to general information about plans,

plan quality indicators (including detailed survey results that are not printed in this Guide),

plan brochures, and information about how to

choose a plan. You can link to other web sites

with valuable information about health plans,

including those plans participating in the

FEHB Program. You can also view, download

and print the Guides to Federal Employees

Health Benefits Plans.

 Health Plan Profiler is an easy-to-use

web tool that lets you create plan profiles and

summaries. You also can link to FEHB plan

web sites from the Health Plan Profiler. Since

most plans have web sites, we have deleted the

web site column in this Guide.

 PlanSmartChoice is a link to an interactive survey tool for help in selecting a plan.

Based on individual preferences that you enter,

PlanSmartChoice will rank specific health

plans.

 DoD/FEHBP Demonstration Project

gives you special information about the demonstration and links you to DoD’s TRICARE

web site.

 Patients’ Bill of Rights – gives you

information about the Patients’ Bill of Rights

and the principle areas of rights and responsibilities. You can also link to the full text of

the Patients’ Bill of Rights and related background information.

 Rate Us – is a new feature where you can

answer specific questions about our site. We

still have our section for your comments and

suggestions. Let us know what you think.

Your Links to Information

2000 Web Site -- www.opm.gov/insure

Our 2000 FEHB web site gives current and valuable information to help you choose a health plan. Visit us

at www.opm.gov/insure.

You will find our site even more informative and easier to use than last year. You can link to most of our

topics directly from the home page this year. We still have our Health Plan Profiler (HPP) that lets you

view and print summary information about health plans. This year, enrollees in all states can use our interactive decision tool to narrow their health plan search.

You can download and print plan brochures and other materials, access definitions by clicking hyperlinks,

and use automated links to navigate to other sites where you can find information about the Patients’ Bill

of Rights, mental health, health care quality and general health care information. When you visit

www.opm.gov/insure you will see these choices and more:
8

Your Links to Information

We’re Y2K OK

The United States Office of Personnel Management is prepared for the year 2000 (Y2K). Our systems are

updated, tested, and ready. We have also worked hard with our participating plans to help them get ready.

We want you to be ready, too. If you would like more information, we can help! Here are three ways you

can get free help:

1. Call the Federal Year 2000 Information Center toll free at 1-888-USA4-Y2K (1-888-872-4925)

2. Call OPM’s toll-free Fax-Back Line at 1-877-750-0177 (Select a topic from the menu and received

faxed information immediately)

3. Visit our Y2K HELP site on the Internet at www.opm.gov/Y2K/help

Additionally, Government agencies and organizations within the pharmaceutical industry supply system

have worked closely together to prepare for Y2K and its potential impact on the supply of medications.

Y2K should not affect your ability to receive your normal supply of medications. To receive the medications you need, continue to get a normal refill of your medication when you have a 5 to 7 day supply

remaining, and be sure to carry your FEHB insurance card with you.

✆ Call the FEHB Fraud Hot Line

(202) 418-3300

if a provider has billed you for services you did not receive.
What the survey asked health plan enrollees:

 Getting Needed Care. Did you have

problems getting a referral to a specialist?

Did you experience delays in obtaining care?

Did you have problems getting the care you

and your doctor believed necessary?

 Getting Care Quickly. When you called

during regular office hours, did you get the

advice or help you needed? Could you get an

appointment for regular or routine health care

as soon as you wanted?

 How Well Doctors Communicate.

Did the doctors or other health providers listen carefully to you? Did they explain things

in a way you could understand? Did they

spend enough time with you?

 Courteous and Helpful Office

Staff. Did the doctor or some other provider’s staff treat you with courtesy and

respect? Was the staff as helpful as you

thought they should be?

 Customer Service. Were you helped

when you called your plan’s customer service

department? Did you have problems with

paperwork for your plan? Was it hard to find

and understand information in the plan’s written materials?

 Claims Processing. Did your plan handle your claims in a reasonable time? Did

they handle your claims correctly?

 Overall Plan Satisfaction. How

would you rate your overall experience with

your health plan?

9

Quality Indicators

Satisfaction Survey

OPM and FEHB plans and enrollees participated this year in a broad-based survey effort with other public

and private employers by using the Consumer Assessment of Health Plans Survey. This survey is a widely

accepted tool for obtaining customer feedback on their experiences with their health plans. Before you join

a plan, it may help to know what people who use the plan say about it. The survey results are not provided or

influenced by the health plans; they are solely based on the responses of enrolled individuals like yourself. The complete questionnaire (59 questions) is on our web site at www.opm.gov/insure, but for ease of presentation

in this Guide we have summarized findings in the following key areas:

A plan may not be rated for one of three reasons: 1) it is new to the FEHB Program, 2) the plan has

fewer than 500 Federal subscribers, or 3) the plan failed to administer the survey as we asked. We have

identified the plans in this last category with an X.

FEHB plans also participated in a separate child’s survey, but this data was not available for publication at

the time this Guide went to print.

The Ratings. A plan’s numbers show how well the plan scored for each question. For overall satisfaction the highest value is a 1. The other scores are on a scale of 3 (highest) to 1 (lowest). The numbers atop

each category show the national average for the plan type (i.e., fee-for-service compared to fee-for-service

and HMO/POS compared to HMO/POS). For more information about individual plan ratings, visit our

web site at www.opm.gov/insure.
The National Committee for Quality Assurance

(NCQA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

are independent, private, not-for-profit organizations dedicated to assessing and reporting on the

quality of health care organizations. These organizations are completely independent of the health

plans and issue their accreditation results without

the approval of the health plans they review. We

encourage all FEHB plans to get accreditation from

a national accrediting organization, that will evaluate their systems and processes and confer accreditation much like educational accrediting institutions confer accreditation to schools.

Quality includes 1) the perception of the quality of

care received and 2) the quality of medical care

provided. The first is measured by annual satisfaction surveys. The second is measured in part by

accreditation. As an employer, accreditation to us

means accountability to a customer and validation

of selected measures of a health plan’s operations.

Enrollees can be assured that an independent organization has performed an unbiased assessment of a

health plan’s systems and found them to be of a

particular quality. We think an accredited plan

offers value to your health plan decision making.

Note: There are various reasons why a plan is not

accredited; check with the plan for an explanation.

10

Quality Indicators

Accreditation

Accreditation is a rigorous and comprehensive evaluation process where independent organizations assess

the quality of the key systems and processes that managed care organizations (specifically, an HMO or POS

plan) use. Accreditation also includes an assessment of the care and service plans are delivering in important areas of public concern such as immunization rates, mammography rates, and member satisfaction.

Both NCQA and JCAHO have multiple levels of accreditation.

To find a plan’s specific level of accreditation, visit our web site

at www.opm.gov/insure.
11

A Word About Medicare

An education program of the Department of Health and Human Services 

and the Health Care Financing Administration

www.medicare.gov

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.

To learn more,call:

(1-800-MEDICARE)

(1-800-633-4227)
12

Census 2000

By law, the Census Bureau cannot share your answers with others, including welfare agencies,

the Immigration and Naturalization Service, the Internal Revenue Service, courts, police, and the

military. All census workers are sworn to secrecy. Individual answers are combined with others

to produce statistical summaries. No one can connect your answers with your name and address. 

Census 2000 Will Help Our Government Allocate

Resources and Make Better Decisions

Census 2000...

• Providing vital information for planning 

schools, hospitals, roads, and more

• Alerting rescuers to how many people 

will need their help in disaster areas

• Informing government leaders about 

who we are and what we need

• Apportioning Congress and determining

representative voting districts

An accurate census is important to your agency

—and it’s important to YOU!

Part-Time Job Opportunities

New Office of Personnel Management regulations

allow federal workers in participating agencies 

to moonlight on Census 2000. Federal and 

military annuitants also can apply for a waiver 

to work on the census.Visit our website at

www.census.gov or call 1-888-325-7733 toll 

free for information on testing and hiring 

in your area.The U.S. Census Bureau is an 

equal opportunity employer.
13

Plan Comparisons

Nationwide Fee-for Service Plans

Open to All

(Pages 14 through 16)

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

to see independent medical providers who reduce their charges to the plan, which means you pay less money

out-of-pocket than when you use a non-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, but room and board would be.

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

either reimburse you or pay the medical provider directly for each covered medical expense after you receive

the service. When you need medical attention, you visit the doctor or hospital of your choice. After receiving

medical treatment, you file a claim to your health plan and it pays a benefit, but you usually must first pay a

deductible and coinsurance or a copayment. These plans use some managed care features such as a precertification and utilization review to control costs.

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

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

Check pages 18-21 for details.
Plan name Telephone

number

Enrollment

code

Self Self &

only family

Monthly

Premium

Your Share

Self only Self & family

14

◊ Offers a Point of Service product.

Alliance Health Plan 202/939-6325 1R1 1R2 207.83 421.39

APWU Health Plan◊ 800/222-2798 471 472 129.65 278.07

Blue Cross and Blue Shield-High local phone # 101 102 143.63 291.09

Blue Cross and Blue Shield-Std◊ local phone # 104 105 65.09 144.69

GEHA Benefit Plan 800/821-6136 311 312 99.06 200.78

Mail Handlers-High 800/410-7778 451 452 95.98 234.32

Mail Handlers-Std 800/410-7778 454 455 70.63 175.85

NALC 703/729-4677 321 322 128.81 258.98

Postmasters-High 703/683-5585 361 362 286.43 605.26

Postmasters-Std 703/683-5585 364 365 174.07 364.74

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 and we have tried to explain those exceptions here under the applicable column

heading. 

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 usually several times the amount shown for individuals and the entire family collectively

contributes towards that amount. However, some plans require 3 family members to meet the per person deductible before the family deductible is considered met (*).

Some plans apply Prescription Drug purchases to the Calendar Year deductible (CY). Some plans apply a separate deductible to

the combined purchase of mail order drugs and drugs from local pharmacies (C), while others apply it to drugs purchased from local

pharmacies only (L). Some plans (*) require each family member to meet a per person deductible.

The Per Stay Hospital Inpatient deductible is what you pay each time you are admitted to a hospital.
15

Plan name

Benefit

type

Medical-Surgical — You pay

Deductible Coinsurance (%)/Copay ($)

Catastrophic Mail Order 

Per Person Per Stay Limit Hospital Prescription

Hospital Drugs

Calendar Prescription Inpatient Outpatient Inpatient Outpatient

Year Drug Doctors Tests R&B Other Other Generic Brand

The Catastrophic Limit is the maximum amount of certain covered charges the plan will require you to pay during the year. Some

plans (*) require each family member to meet the limit.

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 covered charges (e.g., nursing, supplies, and medications) are shown,

usually after any per stay deductible. Services provided and billed by the hospital outpatient department (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.

Taken together, you can use the highlighted features to compare the richness of plan benefits, but always consult plan brochures

before making your final decision.

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

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

APWU Health Plan PPO $250 $50L None $2,000 10% 10% 10% 10% 10% $7 $25

Non-PPO $250 $50L $200 $3,500 30% 30% 30% 30% 30% $7 $25

Blue Cross and PPO $150 None None $1,000 5% 5% Nothing Nothing $10 $8 $14

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

Blue Cross and PPO $200 None None $2,000 10% 10% Nothing Nothing $25 $12 $20

Blue Shield-Std Non-PPO $200 None $250 $3,750 25% 25% 30% 30% $150/d $12 $20

GEHA Benefit Plan 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

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

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

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

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

NALC PPO $275 $25L None $3,000 15% 15% Nothing Nothing 15% $12 $25

Non-PPO $275 $25L $100 $3,500 30% 30% 20% 20% 30% $12 $25

Postmasters-High PPO $200 $50 None $2,500 10% 10% Nothing Nothing 10% $5 $12

Non-PPO $275 $100 $150 $2,500 15% 20% Nothing 15% 20% $5 $12

Postmasters-Std PPO $200 $50 None $3,000 10% 10% Nothing Nothing 10% $10 $20

Non-PPO $350 $100 $250 $4,500 30% 30% 30% 30% 30% $10 $20
16

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all FFS plans shown in heading)

Plan

Plan name code

Nationwide Fee-for-Service Plans Open to All

Satisfaction Indicators — See page 7 for a description of these results. Overall plan satisfaction (.82) Getting needed care (2.85)

Getting carequickly (2.53)How well doctorscommunicate(2.50)Courteous andhelpful officestaff (2.63)Customer service (2.50)Claims processing(2.39)

Alliance Health Plan 1R 0.85 2.88 2.60 2.55 2.73 2.45 2.44

APWU Health Plan 47 0.74 2.81 2.50 2.47 2.59 2.37 2.26

Blue Cross and Blue Shield-High 10 0.77 2.85 2.40 2.45 2.54 2.43 2.36

Blue Cross and Blue Shield-Std 10 0.77 2.85 2.40 2.45 2.54 2.43 2.36

GEHA Benefit Plan 31 0.88 2.85 2.54 2.50 2.64 2.64 2.54

Mail Handlers-High 45 0.77 2.83 2.46 2.42 2.58 2.47 2.26

Mail Handlers-Std 45 0.77 2.83 2.46 2.42 2.58 2.47 2.26

NALC 32 0.70 2.77 2.52 2.48 2.64 2.40 2.26

Postmasters-High 36 0.84 2.87 2.60 2.57 2.71 2.42 2.42

Postmasters-Std 36 0.84 2.87 2.60 2.57 2.71 2.42 2.42
17

Plan Comparisons

Health Maintenance Organization Plans

and Plans Offering a Point of Service Product

(Pages 18 through 21)

A change from prior years: We grouped together the HMO and POS plans to make your plan review easier. You can

tell the POS plans because they have two rows for “In Network” and “Out of Network.” 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.

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 benefit brochure under How to Get Benefits.

• 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 an 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 an 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.

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
Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

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

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.

Telephone

number

Enrollment

code

Self Self &

only family

18

Plan name – location

Monthly

Premium

Your Share

Self only Self & family

California

Aetna U.S. Healthcare - Southern California area 800/537-9384 2X1 2X2 50.81 101.62

Blue Shield of CA Access+HMO - Most of California 800/334-5847 SJ1 SJ2 99.47 196.95

Blue Cross CaliforniaCare - Most of California 800/235-8631 M51 M52 55.80 187.87

CIGNA HealthCare of California - Northern/Southern California 800/832-3211 9T1 9T2 155.93 272.20

Health Net - Most of California 800/522-0088 LB1 LB2 53.15 113.28

Kaiser Permanente - Southern California 800/464-4000 621 622 101.29 162.91

Maxicare Southern California - Southern California 800/234-6294 CM1 CM2 43.48 91.28

PacifiCare of California - Most of California 800/624-8822 CY1 CY2 82.48 277.20

Delaware

Aetna U.S. Healthcare - All of Delaware 800/537-9384 NK1 NK2 279.87 520.06

Indiana

Aetna U.S. Healthcare - Southern Indiana 800/537-9384 RD1 RD2 52.69 105.37

Humana Care Plan - Southern Indiana 888/393-6765 181 182 80.38 221.54

Humana Health Plan - Southern Indiana 888/393-6765 D21 D22 80.38 221.54

The M•Plan - Central/NE/SW Indiana 317/571-5320 IN1 IN2 135.85 262.32

Kentucky

Aetna U.S. Healthcare - Lexington/Louisville areas 800/537-9384 RD1 RD2 52.69 105.37

Humana Care Plan - Louisville area 888/393-6765 181 182 80.38 221.54

Humana Health Plan - Lexington/Louisville 888/393-6765 D21 D22 80.38 221.54

Louisiana

Aetna U.S. Healthcare - New Orleans area 800/537-9384 NG1 NG2 53.39 106.78

Blue Cross and Blue Shield-Std - New Orleans area 800/272-3029 104 105 65.09 144.69

Maxicare Louisiana - Baton Rouge/New Orleans areas 800/933-6294 JA1 JA2 49.18 102.89
Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations

Plan name

Primary care doctoroffice copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

19

California

Aetna U.S. Healthcare $10 Nothing $5 $10 0.67 2.52 2.20 2.37 2.43 2.35 2.10

Blue Shield of CA Access+HMO $10 Nothing $6 $6 0.64 2.64 2.36 2.60 2.54 2.28 1.89 N

Blue Cross CaliforniaCare $10 Nothing $5 $10 0.69 2.53 2.21 2.28 2.43 2.33 2.43 N

CIGNA HealthCare of California $10 Nothing $5 $10 0.65 2.48 2.19 2.28 2.33 2.30 2.16 N

Health Net $10 Nothing $5 $10 0.72 2.59 2.35 2.35 2.48 2.35 2.27 N

Kaiser Permanente $10 Nothing $5 $5 0.87 2.74 2.32 2.40 2.58 2.50 2.12 N

Maxicare Southern California $10 Nothing $5 $10 0.69 2.47 2.18 2.32 2.41 2.37 2.85

PacifiCare of California $10 Nothing $5 $10 0.71 2.51 2.24 2.34 2.44 2.44 2.31 N

Delaware

Aetna U.S. Healthcare $10 Nothing $5 $10

Indiana

Aetna U.S. Healthcare $10 Nothing $5 $10 0.62 2.57 2.45 2.49 2.56 2.28 1.84

Humana Care Plan $10 Nothing $5 $10 0.70 2.70 2.31 2.44 2.54 2.32 2.97

Humana Health Plan $10 Nothing $5 $10 0.72 2.62 2.39 2.47 2.55 2.32 2.17

The M•Plan $10 Nothing $5 $10 0.77 2.66 2.47 2.47 2.57 2.43 2.18 N

Kentucky

Aetna U.S. Healthcare $10 Nothing $5 $10 0.62 2.57 2.45 2.49 2.56 2.28 1.84

Humana Care Plan $10 Nothing $5 $10 0.70 2.70 2.31 2.44 2.54 2.32 2.97

Humana Health Plan $10 Nothing $5 $10 0.72 2.62 2.39 2.47 2.55 2.32 2.17

Louisiana

Aetna U.S. Healthcare $10 Nothing $5 $10 X XXX X X X

Blue Cross and - In-Network $10 Nothing $5 $15 X XXX X X X N

Blue Shield-Std - Out-of-Network 25% 30% 45% 45%

Maxicare Louisiana - In-Network $10 Nothing $7 $12 0.75 2.65 2.21 2.41 2.46 2.43 2.76

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

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)
Health Maintenance Organization (HMO) and Point of Service (POS) Plans by State

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

Primary Care Doctor Office shows what you pay for each

office visit to your primary care doctor. A (*) means a POS plan

pays non-plan doctors based on a fee schedule.

Hospital Room Copay/Coinsurance is your share of hospital room and

board charges. This is separate from any per admission deductible. A (*)

means a POS plan pays non-plan hospitals based on a fee schedule.

Telephone

number

Enrollment

code

Self Self &

only family

20

Plan name – location

Monthly

Premium

Your Share

Self only Self & family

Maryland

Free State Health Plan - All of Maryland 800/445-6036 LD1 LD2 261.21 482.78

MD-IPA - All of Maryland 800/251-0956 JP1 JP2 62.66 116.46

Prudential HealthCare HMO - Most of Maryland 800/856-0764 JB1 JB2 250.92 462.11

North Carolina

PARTNERS NHP of NC - Most of North Carolina 800/942-5695 EQ1 EQ2 54.95 109.88

UHC of North Carolina - Central/Eastern/Western 800/999-1147 XM1 XM2 157.62 359.97

Puerto Rico

Triple-S - All of Puerto Rico 787/749-4777 891 892 53.50 126.65

Texas

Aetna U.S. Healthcare - Dallas/Ft. Worth areas 800/537-9384 TS1 TS2 164.77 289.86

APWU Health Plan - Eastern and Central Texas 800/222-2798 471 472 129.65 278.07

Humana Health Plan of Texas - Dallas/Ft. Worth and Austin areas 888/393-6765 TW1 TW2 59.71 180.07

NYLCare Health Plans SW - Dallas/Ft. Worth/East & West Texas 800/486-3040 V21 V22 43.26 86.52

PacifiCare of Texas - S Ant/Hston/Glvston/Da/Ft Wor/Glf Coast 800/825-9355 GF1 GF2 81.08 273.58

Texas Health Choice, L. C. - Dallas/Ft Worth areas 972/458-5000 UK1 UK2 102.27 164.86
Prescription Drugs, Generic, Brand shows what you pay for prescriptions when

you use a plan pharmacy. Some plans charge different amounts for refills (*), select

drugs and mail orders. In many plans, if you get the brand name instead of a generic

substitution, you also pay the difference between the two. Where a copay/coinsurance

are both shown, you pay the greater amount. Some POS plans pay a non-plan pharmacy only what they would have paid a plan pharmacy (#); you pay the difference. 

Satisfaction Indicators — See page 7 for a description

of these results. An (X) means the plan did not conduct

the survey as we asked.

Accreditation status — N = National Committee for

Quality Assurance; J = Joint Commission on Accreditation of Healthcare Organizations

Plan name

Primary care doctoroffice copayHospital roomcopay/coinsurancePrescription drugs,genericPrescription drugs,brand

Plan performance based on enrollee rating 

Overall satisfaction- on a scale of 1 (highest) to 0 (lowest) 

All others- on a scale of 3 (highest) to 1 (lowest)

(average for all HMO/POS plans shown in heading)

21

Overall plansatisfaction (.74)Getting needed care (2.66)Getting care quickly (2.39)How well doctorscommunicate (2.46)Courteous and helpful office staff (2.55)Customer service (2.44)Claims processing (2.22)Accreditation statusNCQA (N) JCAHO (J)

Maryland

Free State Health Plan - In-Network $10 Nothing $10 $20 0.74 2.69 2.38 2.53 2.56 2.43 2.25 N

- Out-of-Network 20% 20% $10 $20

MD-IPA $10 Nothing $5 $10 0.74 2.65 2.42 2.46 2.56 2.53 2.33 N

Prudential HealthCare HMO $10 Nothing $5 $15 0.69 2.65 2.38 2.46 2.58 2.23 1.89 N

North Carolina

PARTNERS NHP of NC $10 Nothing $10 $10 0.82 2.74 2.46 2.44 2.54 2.54 2.41 N

UHC of North Carolina $10 Nothing $10 $15 0.82 2.83 2.48 2.52 2.62 2.59 2.45 N

Puerto Rico

Triple-S - In-Network $7.50 Nothing Nothing $10 0.90 2.93 2.27 2.56 2.55 2.64 2.19

- Out-of-Network $7.50 All over Nothing $10 $60/day

Texas

Aetna U.S. Healthcare $10 Nothing $5 $10 0.64 2.59 2.32 2.44 2.54 2.32 2.88 N

APWU Health Plan - In-Network $10 Nothing 20%* 20%*

- Out-of-Network 30% 30% 40% 40%

Humana Health Plan of Texas $10 Nothing $5 $10 0.64 2.57 2.38 2.46 2.55 2.19 2.25 N

NYLCare Health Plans SW $10 Nothing $5 $10 0.70 2.53 2.28 2.36 2.47 2.43 2.22 N

PacifiCare of Texas $10 Nothing $5 $10 X XX X X XX

Texas Health Choice, L. C. $10 Nothing $6 $12 0.76 2.56 2.36 2.32 2.50 2.28 2.24 N