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Standard Option Summary of Benefits

Medical Coverage  
You Pay

 

PPO

Non-PPO

Calendar Year Deductible

$350 per person, limited to $700 per family

$450 per person, limited to $1,125 per family

We added "(No deductible)" to show when the calendar-year deductible does not apply.

Annual Physical Exam for Adults
(age 18 and over)

$20 copayment (No deductible)

Not Covered

Well-Child Care

Nothing (No deductible)

All charges after the Plan has paid $75 per child per calendar year (No deductible)

Preventive Screenings
Includes cholesterol screenings, mammograms, PAP tests, PSA tests, urinalysis, bone density screenings, colon cancer screenings, and more

Nothing (No deductible)

30% of the Plan's allowance and any difference between our allowance and the billed amount

Maternity Care

Nothing (No deductible)

30% of the Plan's allowance and any difference between our allowance and the billed amount

Doctor's Office Visits

$20 copayment per office visits for adults, $10 copayment for dependent children under age 22 (No deductible)

30% of the Plan's allowance and any difference between our allowance and the billed amount (No deductible)

Lab, X-ray and Diagnostic Tests

10% of the Plan's allowance

30% of the Plan's allowance and any difference between our allowance and the billed amount

Lab Savings Program

Nothing for covered lab tests with the Lab Savings Program with Quest® Diagnostics (No deductible)

Chiropractic Care

$15 copayment per office visit, and all charges after
the Plan has paid the $2,500 combined alternative,
chiropractic and rehabilitative therapies maximum
(No deductible)

30% of the Plan's allowance and any difference between our allowance and the billed amount, and all charges after the Plan has paid the $2,500 combined alternative,
chiropractic and rehabilitative therapies maximum
(No deductible)

Hospitalization

 

 

 

Maternity

$200 per-admission copayment, nothing for covered room & board and 15% of the Plan’s allowance for hospital ancillary services (No deductible)


Nothing (no deductible)

$400 per-admission copayment, 30% of the Plan’s
allowance and any difference between our allowance and
the billed amount (No deductible)

Surgery and Anesthesia

10% of the Plan's allowance

30% of the Plan's allowance and any difference between our allowance and the billed amount

Emergency Treatment

$50 copayment at an urgent care center, $150 copayment at a hospital emergency room. Hospital ER copayment waived if admitted. No deductible for accidental injury.

30% of the Plan’s allowance and any difference between our allowance and the billed amount

Overseas Medical Expenses

PPO-level benefits for covered care received outside of the United States

Catastrophic protection
(Some costs do not count toward this protection)

Nothing after your out-of-pocket expenses for covered services from PPO providers totals $4,500 per calendar year

Nothing after your out-of-pocket expenses for covered services from PPO providers and non-PPO providers combined totals $9,000 per calendar year

Prescription Drug Coverage  
You Pay

 

Network Pharmacy and Electronic Claims

Non-Network Pharmacies and Paper Claims
Retail Pharmacy - Up to a 30-day supply  
No deductible

Generic

$10 copayment

50% of the Plan's allowance and any difference between our allowance and the billed amount

Preferred brand name

$40 copayment

Non-Preferred brand name

$60 copayment

Specialty†

$100 copayment
Mail Order Pharmacy - Up to a 90-day supply  
No deductible

Generic

$15 copayment

Not Covered

Preferred brand name

$65 copayment

Non-Preferred brand name

$90 copayment

Specialty†

$300 copayment

Special Member Benefits*

Vision care discounts and savings from EyeMed Vision Care providers, laser vision correction savings from the U.S. Laser Network and QualSight, and a hearing aid discount program from HearPO.

*These benefits are neither offered nor guaranteed under contract with the FEHBP, but are made available to all FEHBP participants and their covered family members. You cannot file a FEHBP disputed claim about them.

The fees you pay for these services do not count toward the FEHBP deductibles or out-of-pocket maximums.

The Mail Handlers Benefit Plan 2008 Standard Option Rates

   

Federal Employees
(Biweekly)

Postal Employees
(Category 1 Biweekly)

Postal Employees
(Category 2 Biweekly)

Annuitants
(Monthly)

Self Only: 454

$52.23

$28.05

$26.04

$113.17

Self & Family :455

$111.17

$56.29

$51.71

$240.87

These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to your FEHBP Guide or contact the agency that maintains your health benefits enrollment.

† Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring.

This is a summary of the Mail Handlers Benefit Plan Standard Option. Before making a final decision, please read the 2008 Official Plan brochure (RI71-007). All benefits are subject to the definitions, limitations and exclusions set forth in the 2008 Official Plan brochure. A single annual $42 Mail Handlers Benefit Plan associate membership fee makes MHBP Standard Option available to you.