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Tony Snow Subject Files
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Originally Processed With FOIA(s):
FOIA Number:
S
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the George Bush Presidential
Library Staff.
Record Group/Collection:
George H.W. Bush Presidential Records
Collection/Office of Origin:
Speechwriting, White House Office of
Series:
Snow, Tony, Files
Subseries:
Subject File, 1988-1993
OA/ID Number:
13894
Folder ID Number:
13894-013
Folder Title:
[Federal Employees Health Benefit Program, 6/90]
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Section:
Shelf:
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G
18
29
2
2
IMPORTANT: This booklet contains significant new information for you if you are or will be covered by
the health insurance program. Please read it carefully.
FEHB
1992 Enrollment
Federal Employees
Health Benefits Program
Information Guide
and
Plan Comparison Chart
(1991 Open Season)
For Federal Civilian Employees
This booklet contains information about enrollment in the Federal Employees Health Benefits Program during the Open
Season that begins on November 12 and continues through December 9, 1991. It will help you select the health care
protection best suited to your needs. However, before you make a final choice, you should review carefully the official
brochures for those plans that interest you. While this booklet provides a general overview of the health benefits offered
by each plan, the official brochures provide the contractual description of coverage that determines how claims for
payment or for service are paid or provided.
ATTENTION ALL
SPECIAL NOTICE
ENROLLEES
All fee-for-service plans in the FEHB
Important information on how plans pay for or
Program require precertification of each
provide services is on pages 4, 5, 6 and 8.
hospital admission and reduce benefits by
$500 if you fail to obtain it. See page 2 for
details.
Published and Distributed by the
United States Office of
Personnel Management
Retirement and Insurance Group
1900 E Street, NW.
RI 70-1
Washington, DC 20415
Rev. November 1991
Table of Contents
You Can Help
2
Introduction
3
How To Be a Good Health Benefits Consumer
3
About Open Season
3
Your Health Insurance Premium
4
Who Is Covered Under Your Enrollment
4
Using Your Health Plan Comparison Chart and Picking a Health Plan
4
How Fee-for-Service Plans Determine Their Claims Payments
5
General Information About Enrollment and Coverage
6
Definitions
7
Plan Comparison Chart
10
You Can Help
You know that health care costs are increasing each year because those increases are reflected in your premiums.
The Federal Employees Health Benefits (FEHB) Program, like the majority of employer provided health insurance
programs throughout the country, asks members to make special efforts to be responsible consumers of health care
services.
All FEHB plans have cost containment measures in place. All fee-for-service plans include two specific provisions in
their benefits packages, preadmission certification and large case management. Preadmission certification ensures
that a proposed hospitalization is medically necessary and that you are admitted only for the number of hospital days
required to treat your condition. Large case management gives your plan the flexibility to determine, in consultation
with you and your physician, the most cost effective way to provide services.
The preadmission certification provision makes you responsible for ensuring that the requirement is met. You must
check, or confirm that your doctor has checked, with your plan before being admitted to the hospital. If that
doesn't happen, your plan will reduce benefits by $500. Be a responsible consumer. Be aware of your plan's cost
containment provisions. Avoid penalties and help keep premiums under control by following the procedures specified
in your plan's brochure. This requirement does not apply if Medicare is the primary payer for the hospital confinement
or if you are confined in a hospital in certain overseas locations (see the Plan's FEHB brochure).
If you believe that a provider of medical services has filed a fraudulent claim, please call OPM at (703) 908-8662.
An example would be when services have been billed but not rendered.
2
Introduction
providers of service. Remember that in most instances you
must pay any amounts charged by a provider that your plan
does not pay. For instance, you are responsible for deduct-
The Federal Employees Health Benefits Program offers you a
ibles, coinsurance and copayments, as well as the amount a
practical way to help meet the costs of health care. The
provider may charge above the reasonable and customary
Program provides:
charge or scheduled allowance for a particular service (see
"Definitions" in this booklet for an explanation of these terms).
a choice of plans and options;
(Sometimes provider charges are limited by law; if you are
a Government contribution up to 75% toward the cost
enrolled in a fee-for-service plan, see your brochure for
of your premium;
details.) Also, keep in mind that approximately one-third of the
payments for your share of the premium through payroll
claim disputes in the FEHB Program concern the amount paid
deductions;
by the plans. You can avoid this type of claim dispute by (1)
immediate coverage from the date of enrollment without
checking with the provider of service to be sure the plan was
a medical examination or restrictions because of your
billed correctly, e.g., that the proper procedure code(s) was
age or physical condition;
used, complications were correctly indicated on the billing or
operative report, etc.; and (2) being mindful that the plan
under certain circumstances, the opportunity for
determines the reasonable and customary charges based on
temporary continuation of group coverage or conver-
available information.
sion to nongroup coverage if your enrollment ends or a
covered family member loses eligibility for coverage;
Another very Important thing you can do to assure quality
and
care at the right price for you and your family is to observe
if certain conditions are met, continued protection for
the cost containment provisions your plan has estab-
you and eligible family members after your retirement
lished. These provisions are explained in the plan brochure
and for eligible family members after your death.
and two of them preadmission certification and large case
management -- are highlighted in this booklet (see "You Can
Help" on page 2). Be sure to note that if you fail to obtain
How To Be a Good
preadmission certification your benefits will be reduced by
Health Benefits Consumer
$500.
With the introduction of utilization control features in all of the
There are some things you can do to help assure that you and
your family receive the right kind and quality of care at the right
fee-for-service plans and the continued implementation of
price.
controls in the prepaid plans, we expect positive results in our
cooperative effort with you to control premium increases.
The first thing you can do is to choose the health benefits
plan that best meets your needs. The Federal Employees
About Open Season
Health Benefits Program includes a variety of health benefits
November 12 - December 9, 1991
plans that take very different approaches to health care
coverage. You may choose one of the fee-for-service health
Each year, the Office of Personnel Management reviews the
benefits plans. In these plans, you are free to go to virtually any
benefits and premiums of the plans in the Federal Employees
doctor or hospital of your choice and the provider will either bill
Health Benefits Program and negotiates adjustments in
the plan directly or give you the bill to forward to the plan for
benefits and premiums to be effective the following January.
payment of covered services. Or you may choose one of the
Also, some new plans are accepted for participation in the
prepaid plans that operate through affiliated doctors and
Program and some plans cease to participate.
hospitals in designated locations. In these plans, most of your
covered services are prepaid by your premium and are
Open Season is your annual opportunity to join the Federal
available only from the affiliated providers.
Employees Health Benefits Program if you are not already
enrolled. If you are enrolled, it is your opportunity to change
In deciding which type of plan to choose, you should consider
your health plan coverage to become effective the following
the following:
January.
the coverage offered by each type of plan;
If you are already enrolled and do not wish to make a change,
the cost of each plan, i.e., your premium and out-of-
your current enrollment will continue without any additional
pocket costs for services covered only in part or not at
action on your part. However, you should check the
all; and
Comparison Chart beginning on page 10 to be sure that
the accessibility of health care services.
your current plan (and option) will be participating in the
Federal Employees Health Benefits Program in 1992.
Before you make a final decision, be sure to review the official
brochures for those plans that interest you.
If you want to enroll in the Federal Employees Health Benefits
Program or change your current health plan enrollment during
The next thing you can do is to see that you and your
Open Season, you must file a Health Benefits Registration
covered family members use health care services wisely.
Form (Standard Form [SF] 2809) in time for it to be received by
Always include the subject of costs in any discussion with the
your employing office by December 9, 1991. Your employing
3
office can give you the specific day in January 1992 on which
benefits, premiums, and other factors that may influence your
your enrollment or enrollment change will take effect. Your
decision about which plan to select for the coming year. For
certified copy of the SF 2809 may be used as proof of
example, you can determine each plan's relative cost by
coverage until your new plan sends you an identification card.
comparing your premium and your out-of-pocket expenses as
reflected by deductibles, copayments, coinsurance, and
Your Health Insurance Premium
catastrophic limits.
You and the Government share the cost of your premium. For
You should not rely on the Chart alone. Detailed informa-
1992, the maximum biweekly Government contribution is
tion about plan benefits and the contractual features appear
$60.50 for a self only enrollment and $130.58 for a family
only in the individual plan brochures. All benefits are subject to
enrollment. The maximum monthly Government contribution is
the definitions, limitations and exclusions set forth there. You
$131.08 for self only and $282.92 for family. The exact amount
should review carefully the official brochure for each plan that
of the Government contribution for your plan is shown on the
interests you before you pick your health plan.
plan's brochure cover.
Picking your health plan. To assist you in making the best
You pay the remainder of premium costs. The premium costs
possible choice of health plans we expanded and clarified the
on the Comparison Chart in this booklet show your share only
description of plans available to you under the FEHB Program.
-- the amount you must pay, that will be withheld from your
We hope this information will help you this Open Season.
salary. (If you are not a full-time employee, your share of the
premium may be different. Your employing office can tell you
There are two basic types of health benefits plans available to
the specific amount.)
you under the FEHB Program, prepaid plans and fee-for-
service (FFS) plans. Many people decide on the type of plan
they want before selecting the specific plan and option that
Who Is Covered Under
best suits their medical needs and their budget.
Your Enrollment
In prepaid plans, your covered health services are prefunded
Self only enrollment -- A self only enrollment provides
by your premium and the Government's contribution toward the
benefits just for you the enrolled employee.
cost of your health insurance. Prepaid plans, also called
Comprehensive Medical Plans or Health Maintenance
Self and family enrollment A self and family enrollment
Organizations (CMPs or HMOs), meet your health care needs
provides benefits for you, your spouse, and your unmarried
through specified plan physicians, hospitals and other
dependent children under 22 years old. In some cases, a
providers at designated locations. Prepaid plans pay providers
disabled child who is 22 years old or older is eligible for
for most of your health care services through salaries or other
coverage if you have adequate medical certification of a
arrangements. Your premiums cover most of the cost of
mental or physical handicap that existed before his or her
services. Every prepaid plan has some form of cost sharing
22nd birthday. In such cases, you should ask your
through copayments for certain services, such as doctors'
employing office about the documentation required.
office visits, hospital admissions and prescription drugs. You
can read about these details in each brochure. Because
Children covered by your enrollment include your legally
prepaid plans provide services through specified providers you
adopted children and recognized children born out of
must live within that plan's service/enrollment area to join. The
wedlock; and stepchildren or foster children, if they live with
first thing you should do when you are interested in a prepaid
you in a regular parent-child relationship and you meet
plan is to make sure you live within the service/enrollment
certain other requirements. Ask your employing office for
area. Prepaid plans provide many routine medical services
details about these requirements. Children whose marriage
that are not always provided by FFS plans; but the prepaid
ends before they reach age 22 again become eligible for
plans differ as to the exact services provided and the providers
coverage from the date the marriage ends until they reach
you can use. Therefore, you should consult both the plan
age 22.
brochure and plan provider directory before selecting a prepaid
plan.
Other relatives for example, your grandchildren (unless
the foster parent-child relationship described above exists)
Your decision may also be affected by the way the prepaid
or your parents are not eligible for coverage even though
plan operates. Group practice plans provide care through a
they live with you and are dependent upon you.
group of doctors who practice at medical centers operated by
or under contract to the plans. Individual practice plans
To provide coverage for a new eligible family member, you
provide care through participating doctors who practice in their
must have, elect or change to a self and family enrollment.
own offices. Mixed model plans include doctors who practice
in their own offices as well as doctors in medical groups.
Using Your Health Plan
Prepaid plans arrange hospital and other care not available in
Comparison Chart and Picking
plan centers and offices when necessary.
a Health Plan
This year some prepaid plans are offering "opt-out" benefits
which allow you to obtain certain non-emergency benefits
The Plan Comparison Chart beginning on page 10 provides
outside the prepaid plan provider system on a fee-for-service
general information about many of the major features of each
basis.
plan in the FEHB Program. It can help you to compare
4
Fee-for-service (FFS) plans reimburse you or your provider
and customary reimbursements you can compare directly
for covered services rather than provide or arrange for services
what your out-of-pocket expenses will be. When you take
as prepaid plans do. FFS plans allow you to choose your own
advantage of a plan's preferred provider arrangement you
physicians, hospitals, and other health care providers.
can effectively limit your out-of-pocket expenses for covered
However, the amount of reimbursement paid by each FFS plan
services to deductibles and coinsurance. If you do not take
varies, as do their deductibles, methods for applying deduct-
advantage of a preferred provider arrangement (or if one is
ibles to families and the amount of coinsurance you are
not offered in your area), your plan's reimbursement
required to pay for any given covered service. The type and
probably will not cover all of your provider's bill. In those
extent of covered services also vary.
cases you will be responsible for any amount applied toward
a deductible, your coinsurance, and any charges due above
Many FFS plans use "preferred provider organization" (PPO)
your plan's reasonable and customary limit.
arrangements to improve your fee-for-service benefits. These
arrangements with health care providers allow FFS plans to
One FFS plan, the Mail Handlers Benefit Plan, reimburses
provide enhanced benefits or to limit the out-of-pocket-
its members for covered services in two ways. Payments
expenses usually associated with fee-for-service reimburse-
for outpatient diagnostic services are made under a
ment arrangements. Each brochure specifies how the plan's
reasonable and customary charge system. All other
arrangements with providers work. If you choose a FFS plan
provider services are reimbursed on a fee schedule basis
which includes a PPO, it will be to your advantage to learn
where the plan pays a fixed amount for each service.
about and use the plan's provider arrangements to limit your
These payments probably will not cover your medical bills
expenses and to maximize your benefits.
and you are responsible for the balance of your provider's
charges.
There are several types of FFS plans:
As noted above, if you choose a FFS plan it will be to your
The Government-wide Service Benefit Plan is administered
advantage to use affiliated providers whenever possible. This
by the Blue Cross and Blue Shield Association through 69
is especially true if your plan makes a preferred provider
local plans and is open to all Federal employees. The
organization available to you. The Service Benefit Plan and
Service Benefit Plan provides reimbursement for covered
most of the employee organization plans have made arrange-
services in two ways. First, benefits may be paid to
ments with certain providers to reduce your out-of-pocket
physicians who participate with the local plans and generally
expenses and in some cases to provide enhanced benefits. By
agree to accept the local plan's determination of reasonable
using preferred providers or participating providers you will be
and customary charges, less any coinsurance or deduct-
sure that the plan's determination of reasonable and customary
ibles you are responsible for, as payment in full. Similarly,
charges will be accepted as the basis for your out-of-pocket
local plans have member hospital agreements which require
expenses. Therefore, you should consider the availability of
the hospitals to accept as payment in full the Service Benefit
affiliated providers when choosing a FFS plan.
Plan's payment, less the deductible that you are responsible
for. In most areas of the country, local plans have preferred
providers. In most cases, by using participating or preferred
How Fee-for-Service Plans
physicians and member or preferred hospitals you can limit
your costs for covered expenses to your deductibles and
Determine Their Claims Payments
coinsurance. Second, if you do not use a participating
physician the local plan will limit its reimbursement to a set
As noted above, the basis for many plans' claim payments,
percentage of the locally determined reasonable and
subject to deductibles and coinsurance, begins with determin-
customary calculation. Generally, the plan's reimbursement
ing the reasonable and customary charge appropriate for the
to the nonparticipating physician will not limit your out-of-
procedure covered by your claim. Claims data is gathered for
pocket expenses to the brochure deductible and coin-
a given period by the plan and/or an independent organization
surance and you will be responsible for any portion of the
and updated periodically. By analyzing the claims data, your
bill above the plan's allowance. If you use a nonmember
plan knows how much other providers in your area charge for
hospital your reimbursement will be significantly less than
the procedure. Some charges may be higher than your
the hospital charge. Therefore, if you enroll in the Service
provider's and some may be lower. The plan then sets a
Benefit Plan it will be to your advantage to receive your care
benchmark or "percentile" at the highest dollar amount it
from preferred providers or participating physicians and
considers reasonable and customary for the procedure. A 90th
from member hospitals.
percentile factor means that 90 percent of the claims that your
plan analyzed were at or below the benchmark charge. (For
The remaining FFS plans are sponsored by unions and
example, if there were 20 charges for the procedure, when the
20 are listed in numeric order the dollar amount of the 18th
other employee organizations. Some plans open their
membership to all Federal employees and may charge a
charge becomes the benchmark -- 20 X 90 percent equals 18.)
membership fee or annual dues while some plans limit their
membership to certain groups of Federal employees.
Once the plan establishes its benchmark or percentile, it
applies its coinsurance percentage to that amount or an
Most of these FFS plans base their payments for covered
amount adjusted for unusual circumstances, such as the
services on reasonable and customary charges as deter-
complexity of a surgical procedure. For example, if the plan
mined by the plans. There are several methods these plans
pays 80 percent of reasonable and customary charges, it will
use to determine their reasonable and customary charges;
pay the lower of 80 percent of your claim or 80 percent of the
the details are discussed in the next section. In cases
benchmark amount. If your physician or other health care
where plans use the same basis to determine, reasonable
provider charges more than the reasonable and customary
5
amount, you will be responsible for paying any balance due in
Check the comparison chart on page 10 and the brochures for
addition to the coinsurance.
more information about how plans pay claims.
Some other systems, such as fee schedules, are sometimes
used to determine what your claim payment will be. The fee
General Information About
schedule approach sets a specific dollar allowance for any
given procedure and pays your claim up to that amount.
Enrollment and Coverage
All fee-for-service plans pay at least some types of claims
Dual Enrollment
according to a reasonable and customary allowance. Many of
Normally, you may not enroll or be enrolled as an employee if
them use health care charge data collected by commercial
you are covered as a family member under someone else's
industry sources. Among these are HIAA (Health Insurance
enrollment in the Federal Employees Health Benefits Program.
Association of America), MDR (Medical Data Research) and
However, such dual enrollments may be permitted under
the Prudential Insurance Company. HIAA and MDR charge
certain circumstances in order to:
data are updated twice a year and Prudential charge data are
Protect the interests of employees' children who
updated annually. Other plans use claims information
otherwise would lose coverage as family members, or
compiled locally. In either case, the charge data allows a plan
to establish a reasonable and customary charge for a given
Enable an employee who is under age 22 and covered
procedure or service by geographic area. Regardless of the
under a parent's enrollment and becomes the parent
source of the charge data, the plan is solely responsible for its
of a child to enroll for self and family coverage.
interpretation and use. It is also responsible for determining
specific allowances where sufficient data is not available or in
No person (employee or family member) is entitled to receive
unusual circumstances.
benefits under more than one enrollment in the Program.
Alliance, BACE, NAPUS, NTEU and Secret Service Plans are
Continuation of Enrollment After Retirement
underwritten by Blue Cross and Blue Shield of the National
To continue your enrollment after you retire, you must retire:
Capital Area which has established its reasonable and
customary allowances in the Washington, DC, area on its data
Under a retirement system specifically for Federal
base, updated annually, of all physician claims paid in the prior
civilian employees, and
year. Outside the Washington Metropolitan area the allow-
ances are adjusted upward or downward based on local
On an immediate annuity.
conditions. The allowances also vary by procedure but
generally exceed the 90th percentile.
In addition, you must be currently enrolled in a plan under the
Federal Employees Health Benefits Program and must have
APWU, Foreign Service, GEHA and Rural Carriers have
been enrolled (or covered as a family member) in a plan under
established their reasonable and customary allowances at the
the Program for:
90th percentile-ar use charge data collected by HIAA.
The five years of service Immediately before retire-
The Blue Cross and Blue Shield Service Benefit Plan bases its
ment, or
reasonable and customary allowances on claims information
compiled locally and usually updated annually. The local plan
If fewer than five years, all service since your first
allowances are generally based on the 80th percentile.
opportunity to enroll. (Generally, your first opportunity
to enroll is within 31 days after your first appointment [in
Mail Handlers has established its allowances for outpatient
your Federal career] to a position under which you are
diagnostic services at the 90th percentile and uses charge data
eligible to enroll under conditions that permit a
collected by HIAA. The plan uses nationwide scheduled
Government contribution toward the enrollment.)
allowances for all other claims.
Temporary Continuation of Coverage
NALC has established its allowances for surgical care at the
If you are an employee whose enrollment is terminated
90th percentile and uses charge data collected by HIAA. The
because you separate from service, you may be eligible for
plan uses MDR charge data at the 90th percentile for other
temporary continuation of your health benefits coverage under
claims.
the Federal Employees Health Benefits Program after
separation. Ask your employing office for RI 70-5, Enrollment
Postmasters uses MDR charge data at the 90th percentile for
Information Guide and Plan Comparison Chart for individuals
surgical care and other charges at actual costs unless the plan
eligible for Temporary Continuation of Coverage (TCC). TCC
determines that the charge is unreasonable and limits the
is available to you whether your separation is voluntary or
charge to the 90th percentile.
involuntary (unless it is for gross misconduct), and you would
not otherwise be eligible for continued coverage under the
SAMBA uses the 80th percentile of the Prudential Insurance
Program. (An example is separation for retirement when you
Company charge data base for surgical procedures and
do not meet the five-year enrollment requirement for continua-
anesthesia and actual charges for all other care.
tion of enrollment into retirement described above).
Panama Canal in the U.S. bases allowances on charge data
Your TCC begins after your coverage as an employee
collected by HIAA at the 85th percentile for surgical care; a fee
(including any extension of coverage for conversion period)
schedule for other inpatient doctor services; and actual
ends and continues for up to 18 months after your separation
charges for other charges.
from service. You must pay the total premium (both the
6
Government and employee shares) plus a charge for ad-
you will not be eligible to continue your enrollment after you
ministrative expenses of 2 percent of the total premium. When
retire unless you reenroll before you retire and meet all the
your TCC ends (except by cancellation or nonpayment of
requirements for continuation of enrollment after retirement,
premiums), you are entitled to a 31-day extension of coverage
including the five-year enrollment requirement (see page 6).
for conversion to nongroup coverage.
Your employing office can give you details about the above
In certain cases, a child who loses eligibility for coverage (such
enrollment and coverage information.
as when the child reaches age 22 or marries) and a former
spouse who loses eligibility for coverage (and who is not
eligible to enroll or continue enrollment in the FEHB Program
Definitions
under the Spouse Equity law or similar statutes) also may
qualify for TCC. They also must pay the total premium plus the
Insurance is a fairly complex subject and the technical terms
2 percent administrative charge. TCC in these cases generally
and details about benefits may be difficult to understand. The
continues for up to 36 months after the qualifying event occurs,
following terms, which have special meaning in the health. care
e.g., the date a child reaches age 22 or the date of the divorce.
field, have been defined, as much as possible, in everyday
When their TCC ends (except by cancellation or nonpayment
English to help you understand the benefits coverage and
of premiums), child and former spouse enrollees are entitled to
limitations of the various plans in the Federal Employees
a 31-day extension of coverage for conversion to nongroup
Health Benefits Program:
coverage.
Brochure the booklet showing the complete details of a
Notification and Election Requirements under TCC:
plan's benefits, limitations (or limited benefits), exclusions, and
definitions. The brochure is a plan's contractual statement of
benefits.
Separating Employees -- Within 61 days after an employ-
ee's enrollment terminates because of separation from service,
Case Management (or Large Case Management) the
his or her employing office will notify the employee of his or her
monitoring of a patient with a major illness to assure that the
opportunity to elect TCC. The employee has 60 days after
type of services provided is appropriate and cost effective.
separation (or after receiving the notice from the employing
office, if later) to elect TCC.
Catastrophic Limit -- a benefit feature to limit the amount you
have to pay in a calendar year if you or your family incur large
Children and Former Spouses -- When a child or former
and unusual medical bills. The catastrophic limit is the
spouse becomes eligible for TCC, the employing office or
maximum amount of covered expenses you have to pay out of
retirement system must be notified. For a child, the employing
your own pocket during the year for yourself and your family.
office must be notified within 60 days after the qualifying event
Generally, there are separate catastrophic limits for medical-
occurs. For a former spouse, the employee or annuitant or
surgical expenses and mental conditions expenses. The limits
former spouse must notify the employing office within 60 days
apply to your coinsurance payments. Depending on the plan,
these limits may also include any copayments and the calendar
after the former spouse's change in status, e.g., former spouse
year, inpatient and mental health deductibles you pay. Please
remarries before reaching age 55. The employing office or
refer to the brochures for the plans that Interest you.
retirement system then notifies the child or the former spouse
of his or her rights under TCC. If a child wants continued
Coinsurance -- the stated percentage of covered charges you
coverage, he or she must elect it within 60 days after the date
must pay after you have met any applicable deductible. For
of the qualifying event (or after receiving the notice, if later). If a
example, if a plan pays 80 percent of covered charges (after
former spouse wants TCC, he or she must make the election
applying any deductible), you would be responsible for the
within 60 days after any of the following events, whichever is
deductible and the 20 percent balance.
later:
Copayment -- a fixed dollar amount you must pay for a service
The date of the qualifying event;
or benefit provided by a plan.
The date he or she loses coverage as an enrolled former
Covered Charges -- those amounts of your expenses for
medical care that are covered by a plan. An expense that is
spouse because of remarriage or loss of qualifying court
not a covered charge cannot be used to satisfy the plan's
order; or
deductible or catastrophic limit. Often a plan includes as
covered charges only an amount specified in a scheduled
The date he or she receives the notice.
allowance or based on a reasonable and customary profile.
See the plan brochures to find out how covered charges are
Important: If the employing office or retirement system is not
determined. Covered charges do not include expenses for
notified of a child or former spouse's eligibility for TCC within
nonmedical items related to an illness or injury or for specific
the 60-day time limit, the opportunity to elect TCC ends. The
items excluded by the plan.
time limit is 60 days after the qualifying event, in the case of a
child; and 60 days after the change in status, in the case of a
Deductible -- the amount of covered charges you must pay
former spouse.
before the plan pays benefits, e.g., calendar year deductible
and inpatient hospital deductible. Generally, no more than two
Cancellation of Enrollment
or three family members must meet the calendar year
You may voluntarily cancel your enrollment at any time.
deductible. However, some plans have a family calendar year
deductible which can be met by any or all of those covered.
However, once your cancellation takes effect, you may not
enroll again until an event occurs that permits enrollment, e.g.,
Dental Care -- any type of dental care beyond accidental
change in marital status or the next Open Season. In addition,
dental injury benefits. The level of benefits may range from
7
diagnostic and preventive care for children to include for all
Opt-out -- benefits offered for non-emergency care provided
family members restorative, endodontic and periodontal
outside a prepaid plan's (CMP/HMO) regular health care
services.
delivery system, generally at a higher out-of-pocket expense to
you than for care inside the plan's delivery system. If your plan
Enrollment Area -- the geographic area within which a prepaid
has the Opt-out feature, it will be described in the plan
plan (CMP/HMO) enrolls members. To be eligible to enroll in a
brochure.
prepaid plan, you must live within this area. The plant brochure
identifies the enrollment area.
Outpatient Services -- the care provided to you in the
outpatient department of a hospital, in a clinic or other medical
Exclusions -- charges, services, or supplies that are not
facility, or in a doctor's office.
covered. A plan does not provide or pay benefits for excluded
items, and charges for them do not count towards deductibles
Preadmission Certification -- a procedure whereby (1) you or
or catastrophic limits.
your doctor is required to contact your plan before your
admission to a hospital and (2) your plan determines the
Extended Care Facility -- an institution that furnishes, in lieu
appropriateness of the admission and the length of stay.
of hospitalization, room and board and medically prescribed
skilled nursing care 24 hours a day by an organized medical
Preferred Provider Organization (PPO) Arrangement --
staff; and is not, other than incidentally, a place for rest, the
agreements between a fee-for-service plan and physicians,
aged, drug addicts, alcoholics or domiciliary care.
hospitals, health care institutions, or other providers to provide
services to you at a reduced cost.
Home Health Care -- medically supervised care and treatment
in the home of a patient whose physician certifies that without
Premium -- the biweekly or monthly fee you must pay for your
such care confinement in a hospital or extended care facility
enrollment in an FEHB plan, as shown on the Comparison
would be required. Typically, care and treatment are provided
Chart beginning on page 10 of this booklet.
in accordance with an approved home health care plan and
must begin within a specified period of time after discharge
Prescription Drugs -- outpatient drugs and medicines that, by
from a hospital.
United States law, cannot be obtained without a doctor's
prescription.
Home Nursing Care -- skilled care in the home provided by a
registered nurse (R.N.), licensed practical nurse (L.P.N.), or
Reasonable and Customary Charge -- one of two benefit
licensed vocational nurse (L.V.N.). The care generally must be
maximums plans use as the amount of your medical or dental
ordered by a physician; is usually limited to a specified number
care expenses they will cover for a particular service. (The
of hours per day and visits per year; and does not include
other is the Scheduled Allowance.) A Reasonable and
homemaking services of any kind.
Customary Charge is the amount a plan considers appropriate
for the service or procedure in the geographic area. Health
Hospice Care -- a coordinated program of home and/or
insurance industry-accepted methods are used by the plans to
inpatient palliative and supportive care for a terminally ill
establish and periodically update reasonable and customary
patient and the patient's family provided by a medically
charges. The actual amount a provider charges for a particular
supervised specialized team under the direction of a licensed
service may be more than the reasonable and customary
or certified hospice care facility or agency.
charge set by the plan for that service. You must pay any
amount charged above the reasonable and customary charge
Inpatient Services the care provided to you while you are a
unless the provider accepts a lesser amount because of
bedpatient in a covered facility.
plan-provider agreements or statutory limitations. See page 5
for more information.
Limitations (or Limited Benefits) -- statements in the
brochure showing services or supplies that are not fully
Scheduled Allowance or Fee Schedule -- one of two benefit
covered; only partially paid for by a plan; or covered only if the
maximums plans use as the amount of your medical or dental
service or supply provided meets certain specified criteria, e.g.,
care expenses they will cover for a particular service. (The
preadmission testing within 72 hours of surgery.
other is the Reasonable and Customary Charge.) A, Scheduled
Allowance is the fixed dollar amount that has been assigned to
Maternity Care -- prenatal and postnatal care and delivery by
a covered medical or dental service. You must pay any
a covered hospital, physician, or other covered practitioner,
amount the provider charges above it. (Because a plan's
including nurse midwives. Plans generally pay for maternity
Scheduled Allowance for a particular service applies nation-
care the same as for other covered inpatient and outpatient
wide and the amount providers charge for that service varies
services.
geographically, the Scheduled Allowance is likely to defray
more of the provider's charge in some areas than in others.)
Mental Conditions/Substance Abuse -- conditions and
See page 5 for more information.
diseases listed in the most recent edition of International
Classification of Diseases (ICD) as-psychoses, neurotic
Service Area -- the geographic area where prepaid plan
disorders and personality disorders; other non-psychotic
providers and facilities are available to you. This area is the
mental disorders listed in the ICD, to be determined by the
same as, or within, the plan's enrollment area.
Plan; also disorders listed in the ICD requiring treatment for
abuse of or dependence upon substances, such as alcohol,
narcotics, or hallucinogens.
8
1992
Plan Comparison Chart
(1991 Open Season)
9
FEHB Plan Comparison Chart - For Benefits Beginning in January 1992
Fee-for-Service Plans
The calendar year deductible shown is the per person amount.
These plans require you to share costs for covered charges. In
The calendar year deductible may not apply to every covered
addition to the calendar year and inpatient hospital deductibles,
charge.
other cost-sharing amounts you pay may include coinsurance
and/or copayments.
The inpatient hospital deductible shown is a per person amount.
It typically is a per admission or per confinement deductible.
The amounts of covered charges that plans pay for medical-
However, for certain plans, it is a deductible that applies just to
surgical primary care shown on the next page are maximum
the first admission in a calendar year or a separate calendar
amounts. Payments may be affected, however, by certain limi-
year deductible that applies only to inpatient hospital expenses.
tations and conditions, which are described in the plan bro-
chures. The provider's total charge may not be paid because it
exceeds the maximums used by the plan. See "Using Your
Health Plan Comparison Chart and Picking a Health Plan" on
page 4.
Enrollment
1992
1992
Medical-Surgical
Code
Monthly Premium
Biweekly Premium
Primary Care
Fee-for-Service Plan
Plan
Your Share
Your Share
You Pay
Name and Option
Telephone
Catastrophic
Plan
Self
Self &
Number
Self
Self &
Self
Self &
Calendar
Inpatient
Limit (max.
Code
Only
Family
Only
Family
Year
Only
Family
Hospital
covered
Deductible
Deductible
out of pocket)
person/family
Government-wide Plan
Blue Cross and Blue Shield
High
10
1
2
See Local
176.48
366.37
81.45
169.09
$200
$50
$2,000/$2,000
Service Benefit Plan
Stnd
10
4
5
Phone Book
41.06
86.28
18.95
39.82
$250
$100
$3,000/$3,000
Open Plans
Alliance
YA
1
2
(202) 939-6325
46.52
145.54
21.47
67.17
$300
$150
$2,500/$2,500
APWU
47
1
2
(800) 222-2798
43.73
92.56
20.18
42.72
$175
None
$2,000/$2,000
GEHA
31
1
2
1-800-821-6136
51.22
100.84
23.64
46.54
$250
None
$2,500/$3,000
High
45
1
2
1-800-468-2958
34.94
77.87
Mail Handlers
16.12
35.94
NA
$125
$2,500/$3,500
Stnd
45
4
5
1-800-468-2958
26.67
57.89
12.31
26.72
NA
$250
$2,500/$3,500
NALC
32
1
2
(703) 729-4677
57.85
113.26
26.70
52.27
$200
$100
$1,750/$3,500
NTEU
YY
1
2
(202) 783-4444
92.48
222.13
42.68
102.52
$275
$225
$2,250/$2,250
High
36
1
2
(703) 683-5585
188.03
405.56
Postmasters
86.78
187.18
$250
$150
$2,000/$2,500
Stnd
36
4
5
(703) 683-5585
43.42
93.88
20.04
43.33
$300
$200
$2,500/$2,500
Restricted Plans (open ONLY to specific groups)
BACE
Y2
1
2
(301) 881-0510
38.50
91.12
17.77
42.05
$150
$150
$1,500/$1,500
Foreign Service
40
1
2
(202) 833-4910
47.09
150.28
21.73
69.36
$200
$175
$2,000/$2,000
NAPUS
YP
1
2
(800) 451-4479
63.90
128.38
29.49
59.25
$200
None
$700/$1,400
Panama Canal Area
43
1
2
(504) 566-1300
34.46
74.73
15.90
34.49
NA
$125
$1,000+
Rural Carriers
38
1
2
(800) 638-8432
48.19
88.43
22.24
40.81
$250
$200
$1,500/$3,000
SAMBA
44
1
2
(301) 984-1440
41.95
144.11
19.36
66.51
$200
None
$1,000/$2,000
Secret Service
Y7
1
2
(800) 424-7474
41.87
125.43
19.32
57.89
$200
$100
$1,000/$2,000
# Per person
ABBREVIATIONS: ECF - Extended Care Facility
PPO Preferred Provider
HHC - Home Health Care
Organization Arrangement
NA - Not Applicable
R & C- Reasonable & Customary
SA - Scheduled Allowance
10
Do Not Rely on This Chart Alone - See Plan Brochures for Details
Most plans require that accidental injury care must be received
While not shown on the Chart and you should see plan
within a specified number of hours of the injury for the amounts
brochures for details, all or virtually all plans provide:
shown to apply.
-Prescription drug benefits, which may include a mail order
program and you share costs.
The mental conditions inpatient catastrophic limit is the maxi-
-Mental conditions outpatient care benefits, which usually have
mum amount of covered out-of-pocket expenses you pay per
dollar and/or visit limits, and you share costs to these limits.
person per year until the plan pays up to the lifetime maximum;
-Inpatient and outpatient care benefits for alcoholism and drug
you pay any expenses that exceed it. The lifetime maximum is
abuse, which usually have dollar, day and/or visit limits, and
the amount up to which plans pay per person for covered mental
you share costs to these limits.
conditions inpatient services.
-Inpatient and outpatient hospice care benefits, which have a
dollar maximum that varies by plan.
A PPO may be available in your area. Please see plan
brochures for details.
Medical - Surgical Primary Care
Mental Conditions
Plan Pays
Other Benefit Features
Brochure
Inpatient Care
Outpatient Care
Inpatient Care
Number
RI
Hospital Charges
Physician Charges
Physician Charges
Diagnostic
Accidental
You Pay
Plan Pays
ECF
Dental
Tests
Other
Injury Care
Catastrophic
and/or
PPO
Room &
Surgeons
Other Drs
Surgeons
Other Drs
Lifetime
Care
Board
Hosp. Exp.
(R & C)
(R & C)
(R & C)
(R & C)
(R & C)
(R & C)
Limit #
Maximum #
HHC
Government-wide Plan
100%
100%
80%
80%
80%
80%
80%
100%
$4,000
$75,000
HHC
No
Yes
71-5
71-5
100%
100%
75%
75%
75%
75%
75%
100%
$8,000
$50,000
No
Yes
Yes
Open Plans
100%
100%
75%
75%
90%
75%
75%
100%
$8,000
$50,000
Both
Yes
No
71-3
80%
85%
85%
100%
85%
85%
85%
$8,000
$50,000
HHC
Yes
Yes
71-4
100%
100%
80%
80%
80%
80%
80%
80%
100%
$8,000
$50,000
HHC
Yes
Yes
71-6
100%
100%
SA
SA
SA
SA
75%
75%
$5,000
$50,000
No
Yes
Yes
71-7
SA
SA
SA
SA
70%
75%
$5,000
$50,000
No
No
Yes
71-7
100%
100%
100%
80%
85%
75%
85%
75%
75%
SA
$8,000
$50,000
HHC
Yes
Yes
71-9
100%
100%
75%
75%
100%
75%
75%
100%
None
None
Both
Yes
No
71-11
80%
100%
80%
80%
80%
$8,000
$50,000
Both
Yes
Yes
71-13
100%
85%
85%
100%
80%
75%
75%
75%
75%
75%
75%
$8,000
$50,000
Both
Yes
Yes
71-13
Restricted Plans (open ONLY to specific groups)
100%
100%
80%
80%
100%
80%
80%
100%
$8,000
$50,000
Both
Yes
Yes
72-8
100%
80%
90%
80%
100%
80%
80%
100%
$8,000
$75,000
Both
Yes
No
72-1
100%
100%
75%
75%
100%
75%
75%
100%
$4,200
$50,000
Both
Yes
No
72-3
100%
80%
100%
SA
100%
SA
SA
100%
None
None
No
Yes
Yes
72-4
100%
80%
90%
75%
90%
75%
75%
SA
$8,000
None
Both
Yes
No
72-5
100%
90%
100%
80%
100%
80%
80%
100%
$6,500
$50,000
Both
No
Yes
72-6
100%
100%
80%
80%
80%
80%
80%
100%
$4,000
$50,000
Both
Yes
No
72-11
The above benefits may be subject to dollar, day and/or visit limits; as well as preadmission approval, precertification,
second opinion and/or other requirements. Read the plan brochures carefully.
11
FEHB Plan Comparison Chart - For Benefits Beginning in January 1992
Prepaid Plans (Commonly referred to as CMP/HMOs)
A Prepaid plan's general location is the approximate area served by the plan. To
Every Prepaid plan provides physicals, immunizations, and prescription drug benefits
enroll in a Prepaid plan, you MUST live within the plan's exact enrollment area shown
and all Prepaid plan benefit packages include catastrophic coverage, since these
in the plan's brochure.
plans provide for necessary care during a year.
Some Prepaid plans require you to share costs for certain services.
Every Prepaid plan provides benefits for mental conditions/substance abuse inpa-
Many Prepaid plans provide chiropractic care benefits and most provide hospice care
tient and outpatient services. However, benefits are limited to short-term care,
benefits.
generally 30 to 45 days of inpatient care and 20 to 35 outpatient visits per calendar
year. You typically share costs to benefit limits.
Many Prepaid plans provide "Opt-Out" benefits (see definition).
Enrollment
1992
1992
Code
Monthly Premium
Biweekly Premium
Other Benefit
Prepaid Plan
Name and Option
General Location
Plan Telephone
Plan
Your Share
Your Share
Features
Brochure
Plan
Number
Self &
Type
Number
Self
Self
Self &
Self
Self &
ECF
Dental
RI
Code
Only
Family
Only
Family
Only
and/or
Family
HHC
Care
Alabama
Complete Health of Alabama
NJ
1
2
Anniston, Huntsville & Montgomery areas
(800) 654-5507
MMP
60.82
183.98
28.07
84.91
Both
Yes
73-532
Complete Health of Alabama
NL
1
2
Mobile, Ozark & Other areas
(800) 654-5507
MMP
67.45
185.73
31.13
85.72
Both
Yes
73-532
Complete Health of Alabama
NY
1
2
Birmingham area
(800) 654-5507
MMP
66.35
183.13
30.62
84.52
Both
Yes
73-532
Humana Alabama
NS
1
2
Huntsville area
(205) 532-2050
IPP
50.57
177.54
23.34
81.94
Both
No
73-529
Humana Alabama
PY
1
2
Montgomery area
(205) 270-5544
IPP
41.70
184.13
19.24
84.98
Both
No
73-529
PARTNERS Health Plan of Alabama
DF
1
2
Birmingham area
(205) 942-5787
IPP
42.14
148.62
19.45
68.59
Both
No
73-349
Prime Health
AA
1
2
Mobile area
(205) 342-0022
GPP
81.10
132.21
37.43
61.02
Both
Yes
73-280
Principal Health Care of Florida
C2
1
2
Southwestern Alabama
(904) 484-4080
MMP
39.13
139.69
18.06
64.47
Both
No
73-355
Arizona
CIGNA Phoenix
16
1
2
Phoenix area
(602) 371-2300
GPP
34.31
108.27
15.84
49.97
Both
Yes
73-28
CIGNA Tucson
B1
1
2
Tucson area
(602) 571-6596
MMP
36.88
109.51
17.02
50.54
Both
No
73-95
FHP/Arizona
A3
1
2
Phoenix and Tucson areas
(602) 966-6773
MMP
36.50
125.30
16.85
57.83
Both
Yes
73-18
Humana Phoenix
DY
1
2
Maricopa County
(602) 381-4300
IPP
39.35
167.01
18.16
77.08
Both
No
73-401
Intergroup of Arizona, Inc.
A7
1
2
Cochise/Phoenix/Santa Cruz/Tucson areas
(602) 326-4357
MMP
32.68
96.46
15.08
44.52
Both
No
73-283
PARTNERS Health Plan of Arizona
A1
1
2
Graham/Greenlee/SE Pinal/Yuma Cos.
(602) 750-8151
IPP
41.20
165.67
19.01
76.46
Both
No
73-556
PARTNERS Health Plan of Arizona
TD
1
2
Cochise/Pima/Santa Cruz Cos.
(602) 750-8151
IPP
34.04
92.67
15.71
42.77
Both
No
73-556
Arkansas
American HMO - Arkansas
RB
1
2
Little Rock and Ft. Smith areas
1-800-333-3534
MMP
36.23
122.79
16.72
56.67
Both
No
73-565
California
AETNA Health Plan of San Diego, Inc.
NI
1
2
San Diego County
(619) 497-0244
MMP
39.86
145.58
18.40
67.19
Both
No
73-569
AETNA Health Plans of So. CA
RG
1
2
Southern California
1-800-347-4343
IPP
37.86
121.40
17.47
56.03
Both
No
73-538
Bay Pacific Health Plan
BU
1
2
Greater San Francisco Bay area
(415) 952-2005
IPP
41.31
106.78
19.07
49.28
Both
No
73-111
Blue Cross CaliforniaCare
M5
1
2
Most of California
(800) 825-1030
MMP
37.46
99.24
17.29
45.80
Both
No
73-517
Blue Shield of California HMO
SJ
1
2
Most of California
1-800-541-6652
IPP
40.60
154.92
18.74
71.50
Both
No
73-574
Bridgeway Plan for Health
CC
1
2
San Francisco Bay area
(800) 554-3110
MMP
38.90
106.08
17.95
48.96
Both
No
73-115
CareAmerica-Southem CA
BG
1
2
Los Angeles area
1-800-827-2273
IPP
35.67
109.79
16.46
50.67
Both
No
73-290
CIGNA Healthplan of San Diego
SK
1
2
San Diego County
1-800-368-2471
IPP
65.50
200.64
30.23
92.60
Both
No
73-402
CIGNA Medical Group Healthplan
61
1
2
Los Angeles/Orange Counties
(800) 344-0557
GPP
51.22
165.73
23.64
76.49
Both
No
73-14.
FHP/California
66
1
2
Southern California
(213) 809-5399
MMP
39.09
176.15
18.04
81.30
Both
Yes
73-18
Foundation Health of CA
C6
1
2
Northern/Central California
(800) 621-PLAN
IPP
49.86
159.82
23.01
73.76
Both
No
73-74
1992
1992
Enrollment
Other Benefit
Monthly Premium
Biweekly Premium
Code
Features
Plan Telephone
Plan
Your Share
Your Share
Brochure
Prepaid Plan
General Location
Number
Name and Option
Number
Type
ECF
Plan
Self
Self &
Self
Self &
Self
Self &
Dental
RI
and/or
Code
Only
Family
Only
Family
Only
Family
Care
HHC
California (cont.)
Health Net.
LB
1
2
Most of California
1-800-640-2004
MMP
38.64
110.96
17.83
51.21
Both
No
73-159
(800) 427-2669
IPP
36.41
103.03
16.80
47.55
Both
No
73-220
Health Plan of America
BH
1
2
Most of California
Health Plan of the Redwoods
CW
1
2
Sonoma/Marin/Part of Mendocino/Lake Cos.
(707) 544-2273
MMP
53.35
178.15
24.62
82.22
Both
No
73-221
Kaiser (Northern CA)
59
1
2
Northern California
(415) 987-3190
GPP
39.37
91.63
18.17
42.29
Both
No
73-3
Kaiser (Southern CA)
62
1
2
Southern California
(213) 667-4102
GPP
42.03
134.25
19.40
61.96
Both
No
73-2
Kaiser (Southern CA)
RC
1
2
Bakersfield area
(805) 836-0123
GPP
40.27
116.44
18.58
53.74
Both
No
73-2
No
73-188
Lifeguard Health Plan
CD
1
2
Northern California/Bay area
(408) 943-9400
IPP
41.72
140.04
19.25
64.63
Both
Lincoln National. Health Plan of CA
CY
1
2
Portions of California
1-800-999-8033
MMP
40.61
139.45
18.74
64.36
Both
Yes
73-260
Maxicare (Northern CA)
CX
1
2
Northern California
(415) 375-8600
MMP
32.28
77.66
14.90
35.84
Both
No
73-246
Maxicare (Southern CA)
CM
1
2
Southern California
(213) 765-2000
MMP
37.83
120.10
17.46
55.43
Both
No
73-43
1-800-468-8600
IPP
37.64
93.62
17.37
43.21
Both
No
73-512
National Med
MN
1
2
Stan./San Joaq./Merced/Tuolum. Cos.
PacifiCare of California
CQ
1
2
Northern and Southern California
(800) 624-8822
MMP
36.17
106.28
16.69
49.05
Both
No
73-105
PCA Health Plans of California
CL
1
2
Sacramento area
(916) 921-0996
MMP
41.10
130.61
18.97
60.28
Both
No
73-561
Qual-Med California
CF
1
2
Northern California
(415) 465-1400
IPP
53.11
177.50
24.51
81.92
Both
No
73-176
St. Joseph's Omni Health Plan
HN
1
2
San Joaquin, Stanislaus and Tuolumne Cos.
(209) 466-6664
IPP
35.56
93.19
16.41
43.01
Both
No
73-406
No
73-144
Takecare
LC
1
2
Northern California/Los Angeles areas
1-800-635-2273
MMP
38.31
109.31
17.68
50.45
Both
United Health Plan
C4
1
2
Los Angeles/Orange Counties
(213) 671-3465
MMP
43.14
167.92
19.91
77.50
Both
No
73-269
ValuCare/Central Valley Health Plan
BE
1
2
Central Valley area
(209) 435-8366
IPP
41.53
145.21
19.17
67.02
Both
No
73-403
Colorado
COMPRECARE (High)
D6
1
2
Denver/Col Springs/No. Colorado
(303) 750-6200
MMP
38.35
110.72
17.70
51.10
Both
Yes
73-49
MMP
31.11
80.25
14.36
37.04
Both
Yes
73-49
COMPRECARE (Stnd)
D6
4
5
Denver/Col Springs/No. Colorado
(303) 750-6200
HMO Colorado
L2
1
2
Front Range and San Luis Valley
(303) 831-4114
MMP
39.02
116.12
18.01
53.59
Both
Yes
73-147
Kaiser Colorado
65
1
2
Denver area
(303) 344-7500
GPP
32.34
82.13
14.92
37.90
Both
Yes
73-19
Lincoln National Health Plan of CO, Inc.
DD
1
2
Denver/Col Springs/No. CO/So. CO
1-800-255-1139
MMP
36.32
90.80
16.76
41.91
Both
Yes
73-78
Qual-Med Colorado
MT
1
2
Col Springs/Denver/South Central CO
(719) 598-0553
MMP
35.04
91.79
16.17
42.36
Both
No
73-514
73-27
Rocky Mountain HMO
88
1
2
Western Colorado
(303) 243-7050
IPP
46.26
138.28
21.35
63.82
Both
Yes
Connecticut
CIGNA Healthplan of Connecticut
AL
1
2
Northern, Central and Southern CT
(203) 745-2288
IPP
116.31
311.83
53.68
143.92
Both
No
73-410
Community Health Care Plan
71
1
2
New Hvn/Mddisex/Htfd/Ffd/Ltchfd Cos.
1-800-237-2427
MMP
90.38
248.48
41.71
114.68
Both
No
73-24
Health New England
DJ
1
2
Northern Connecticut
(413) 787-4000
IPP
55.34
128.99
25.54
59.53
Both
No
73-437
HMO IPA Network
KH
1
2
Portions of Connecticut
(413) 499-4009
IPP
42.90
163.26
19.80
75.35
Both
No
73-194
Kaiser Connecticut
DM
1
2
Hartford and Stamford areas
(203) 678-6100
GPP
40.22
109.68
18.56
50.62
Both
No
73-114
Physicians Health Services/CT
DP
1
2
Eastern, Southern & Western CT
(800) 848-4747
IPP
60.43
217.41
27.89
100.34
Both
No
73-140
U.S. Healthcare Connecticut
H1
1
2
Frfld/Hrtfrd/Ltchfld/New Hvn Cos.
1-800-537-9384
IPP
47.52
202.37
21.93
93.40
Both
Yes
73-412
ABBREVIATIONS:
ECF - Extended Care Facility
IPP - Individual Practice Plan
GPP Group Practice Plan
MMP- Mixed Model Plan
HHC- Home Health Care
13
FEHB Plan Comparison Chart - For Benefits Beginning in January 1992
Prepaid Plans (Commonly referred to as CMP/HMOs)
A Prepaid plan's general location is the approximate area served by the plan. To
Every Prepaid plan provides physicals, immunizations, and prescription drug benefits
enroll in a Prepaid plan, you MUST live within the plan's exact enrollment area shown
and all Prepaid plan benefit packages include catastrophic coverage, since these
in the plan's brochure.
plans provide for necessary care during a year.
Some Prepaid plans require you to share costs for certain services.
Every Prepaid plan provides benefits for mental conditions/substance abuse inpa-
Many Prepaid plans provide chiropractic care benefits and most provide hospice care
tient and outpatient services. However, benefits are limited to short-term care,
benefits.
generally 30 to 45 days of inpatient care and 20 to 35 outpatient visits per calendar
year. You typically share costs to benefit limits.
Many Prepaid plans provide "Opt-Out" benefits (see definition).
Enrollment
1992
1992
Code
Monthly Premium
Biweekly Premium
Other Benefit
Prepaid Plan
General Location
Plan Telephone
Plan
Your Share
Your Share
Features
Brochure
Name and Option
Plan
Number
Self &
Type
Number
Self
Self
Self &
Self
Self &
ECF
Dental
RI
Code
Only
Family
Only
Family
Only
and/or
Family
HHC
Care
Delaware
Delaware Valley HMO
SP
1
2
State of Delaware
(302) 571-0822
IPP
45.50
175.03
21.00
80.78
Both
Yes
73-65
Healthcare Delaware
MR
1
2
New Castle County
(302) 421-4141
IPP
76.31
243.10
35.22
112.20
Both
No
73-513
Principal Health Care of Delaware
RV
1
2
State of Delaware
(302) 322-4700
IPP
72.28
266.18
33.36
122.85
Both
No
73-544
US Healthcare Delaware
NK
1
2
State of Delaware
1-800-537-9384
IPP
43.65
205.79
20.15
94.98
Both
Yes
73-527
District of Columbia
AETNA HEALTH PLAN
V8
1
2
Washington, DC
1-800-537-5096
IPP
37.50
104.46
17.31
48.21
Both
Yes
73-250
CareFirst
JQ
1
2
Washington, DC
(301) 528-7000
MMP
35.09
93.00
16.19
42.92
Both
Yes
73-268
George Washington Univ HP (High)
E5
1.
2
Washington, DC
(202) 416-0400
MMP
60.91
128.79
28.11
59.44
Both
Yes
73-46
George Washington Univ HP (Stnd)
E5
4
5
Washington, DC
(202) 416-0400
MMP
35.84
76.88
16.54
35.48
Both
Yes
73-46
Group Health Association (High)
50
1
2
Washington, DC
(202) 966-4357
GPP
56.51
165.41
26.08
76.34
Both
Yes
73-8
Group Health Association (Stnd)
50
4
5
Washington, DC
(202) 966-4357
GPP
28.97
73.80
13.37
34.06
Both
Yes
73-8
HealthPlus (High)
JN
1
2
Washington, DC
(301) 441-1600
IPP
40.13
94.34
18.52
43.54
Both
Yes
73-67
HealthPlus (Stnd)
JN
4
5
Washington, DC
(301) 441-1600
IPP
29.68
68.25
13.70
31.50
Both
Yes
73-67
Kaiser/Mid-Atlantic
E3
1
2
Washington; DC
(202) 364-3400
GPP
35.67
96.25
16.46
44.42
Both
Yes
73-47
Lincoln National Health Plan
DS
1
2
Washington, DC
1-800-782-0622
IPP
43.38
142.20
20.02
65.63
Both
Yes
73-442
M.D. IPA
JP
1
2
Washington, DC
(301) 294-5100
IPP
31.03
87.66
14.32
40.46
Both
Yes
73-100
Physicians Care
X9
1
2
Washington, DC
1-800-542-7258
IPP
52.03
229.50
24.01
105.92
Both
Yes
73-331
Prudential Health Plan/Mid-Atlantic
HD
1
2
Washington, DC
1-800-888-5447
MMP
41.43
165.65
19.12
76.45
Both
Yes
73-413
Florida
AV-MED/Gainesville
JF
1
2
Gainesville area
1-800-237-1255
IPP
39.16
150.26
18.07
69.35
Both
Yes
73-126
AV-MED/Jacksonville
HW
1
2
Jacksonville area
1-800-227-4184
IPP
43.61
199.29
20.13
91.98
Both
Yes
73-126
AV-MED/Orlando
GP
1
2
Orlando area
1-800-227-4848
IPP
41.00
170.56
18.92
78.72
Both
Yes
73-126
AV-MED/South Florida
EM
1
2
South Florida
1-800-432-6676
IPP
46.96
208.96
21.67
96.44
Both
Yes
73-126
AV-MED/Tampa
H5
1
2
Tampa area
1-800-257-2273
IPP
39.88
158.17
18.41
73.00
Both
Yes
73-126
Capital Health of Tallahassee
EA
1
2
Tallahassee area
(904) 386-3161
MMP
33.93
90.60
15.66
41.81
Both
No
73-197
CIGNA Healthplan of Florida
EJ
1
2
Tampa area
(813) 281-1000
GPP
42.05
182.57
19.41
84.26
Both
Yes
73-170
CIGNA Healthplan of Florida
EN
1
2
Orlando area
(407) 660-1344
MMP
48.86
215.52
22.55
99.47
Both
Yes
73-170
Family Health Plan, Inc.
FQ
1
2
Dade and Broward Counties
1-800-772-4347
IPP
32.31
83.39
14.91
38.49
Both
No
73-551
Health Options-Jacksonville/Gainesile
E8
1
2
Jacksonville and Gainesville areas
(904) 731-7967
MMP
39.90
148.10
18.41
68.35
Both
No
73-219
Health Options-Pensacola
D5
1
2
Escambia & Santa Rosa Counties
(904) 484-7550
IPP
39.93
151.84
18.43
70.08
Both
No
73-385
1992
1992
Enrollment
Other Benefit
Monthly Premium
Biweekly Premium
Code
Features
Plan Telephone
Plan
Your Share
Your Share
Brochure
Prepaid Plan
General Location
Number
Name and Option
Number
Type
ECF
Plan
Self
Self &
Self
Self &
Self
Self &
Dental
RI
and/or
Code
Only
Family
Only
Family
Only
Family
Care
HHC
Florida (cont.)
Health Options-South FL/Palm Beach
FN
1
2
Palm Beach area
1-800-955-3589
IPP
35.73
98.80
16.49
45.60
Both
No
73-82
122.49
17.38
56.53
Both
No
73-82
Health Options-South Florida/Miami
FR
1
2
Dade and Broward Counties
1-800-955-3589
IPP
37.66
Health Options-Tampa Bay
D7
1
2
Tampa Bay area
(813) 882-0632
MMP
46.89
184.99
21.64
85.38
Both
No
73-384
HIP Network of Florida
K7
1
2
Broward/Dade/Palm Beach
(305) 491-9055
IPP
47.52
222.00
21.93
102.46
Both
No
73-421
Humana Medical Plan-Daytona
P7
1
2
Daytona area
(904) 676-1850
MMP
35.58
115.57
16.42
53.34
Both
No
73-278
Orlando area
(407) 661-6001
MMP
34.52
103.61
15.93
47.82
Both
No
73-278
Humana Medical Plan-Orlando
P5
1
2
Humana Medical Plan-South Florida
EE
1
2
South Florida
(800) 531-4773
MMP
33.16
96.20
15.30
44.40
Both
No
73-278
Humana Medical Plan-Tampa
JH
1
2
Tampa area
(800) 544-7541
MMP
29.67
84.79
13.69
39.13
Both
No
73-278
PCA Health Plans of Florida
PJ
1
2
Broward, Dade, Palm Beach Cos.
(305) 267-6633
IPP
38.42
116.72
17.73
53.87
Both
No
73-573
Principal Health Care of Florida
C2
1
2
Northwest Florida
(904) 484-4080
MMP
39.13
139.69
18.06
64.47
Both
No
73-355
PruCare of Jacksonville
EC
1
2
Jacksonville area
(904) 396-5401
MMP
36.01
113.23
16.62
52.26
Both
No
73-261
PruCare of South Florida
HE
1
2
South Florida
1-800-457-3885
IPP
38.70
150.46
17.86
69.44
Both
No
73-422
PruCare Orlando
EH
1
2
Orlando area
(407) 875-2171
GPP
30.18
84.52
13.93
39.01
Both
No
73-164
PruCare-Tampa Bay
FH
1
2
Tampa Bay area
1-800-284-4302
IPP
35.81
118.22
16.53
54.56
Both
No
73-343
Georgia
Both
No
73-424
HMO Georgia, Inc.
CR
1
2
Atlanta, Augusta & Macon areas
(404) 365-9673
IPP
43.33
156.48
20.00
72.22
Kaiser-Georgia
F8
1
2
Atlanta area
(404) 261-2825
GPP
39.06
141.18
18.03
65.16
Both
Yes
73-321
Partners Health Plan of Georgia, Inc.
F3
1
2
Atlanta area
(404) 951-1255
MMP
55.25
182.91
25.50
84.42
Both
Yes
73-304
PruCare of Atlanta
EZ
1
2
Atlanta area
(404) 955-7735
MMP
35.01
109.16
16.16
50.38
Both
No
73-107
Guam
110.53
15.30
51.01
Both
Yes
73-18
FHP/Guam
JK
1
2
Guam
646-1984
GPP
33.15
Guam Memorial Health Plan (High)
ZA
1
2
Guam and Belau (Palau)
(671) 472-4647
IPP
38.33
109.88
17.69
50.71
Both
Yes
73-213
Guam Memorial Health Plan (Stnd)
ZA
4
5
Guam and Belau (Palau)
(671) 472-4647
IPP
28.11
75.11
12.97
34.67
Both
No
73-213
Health Maintenance Life
28
1
2
Guam
646-7826
IPP
23.40
70.23
10.80
32.41
Both
Yes
73-36
Hawaii
(808) 944-2498
IPP
33.56
88.95
15.49
41.05
Both
Yes
73-10
HMSA
87
1
2
Hawaii
HMSA's Community Health Program
F6
1
2
Hawaii
(808) 944-2372
GPP
34.75
94.08
16.04
43.42
Both
Yes
73-60
Island Care
F9
1
2
Hawaii
(808) 523-8686
IPP
42.42
140.58
19.58
64.88
Both
Yes
73-319
Kaiser Hawaii (High)
63
1
2
Hawaii
(808) 521-0803
GPP
39.56
98.46
18.26
45.44
Both
Yes
73-5
Kaiser Hawaii (Stnd)
63
5
Hawaii
(808) 521-0803
GPP
31.35
72.73
14.47
33.57
Both
Yes
73-5
4
Idaho
Group Health Northwest
VR
1
2
Kootenai and Bonner Counties
(208) 664-5174
MMP
39.55
120.41
18.25
55.57
Both
Yes
73-96
Lincoln National Health Plan
GM
1
2
Ada and Canyon Counties
1-800-255-1139
GPP
39.69
150.46
18.32
69.44
Both
No
73-426
Qual-Med Washington
TM
1
2
Northern Idaho
1-800-845-7881
IPP
39.18
127.64
18.08
58.91
Both
No
73-287
ABBREVIATIONS:
ECF
Extended
Care
Facility
IPP
Individual
Practice
Plan
GPP- Group Practice Plan
MMP- Mixed Model Plan
HHC----- Home Health Care
FEHB Plan Comparison Chart - For Benefits Beginning in January 1992
Prepaid Plans (Commonly referred to as CMP/HMOs)
A Prepaid plan's general location is the approximate area served by the plan. To
Every Prepaid plan provides physicals, immunizations, and prescription drug benefits
enroll in a Prepaid plan, you MUST live within the plan's exact enrollment area shown
and all Prepaid plan benefit packages include catastrophic coverage, since these
in the plan's brochure.
plans provide for necessary care during a year.
Some Prepaid plans require you to share costs for certain services.
Every Prepaid plan provides benefits for mental conditions/substance abuse inpa-
tient and outpatient services. However, benefits are limited to short-term care,
Many Prepaid plans provide chiropractic care benefits and most provide hospice care
generally 30 to 45 days of inpatient care and 20 to 35 outpatient visits per calendar
benefits.
year. You typically share costs to benefit limits.
Many Prepaid plans provide "Opt-Out" benefits (see definition).
Enrollment
1992
1992
Code
Monthly Premium
Biweekly Premium
Other Benefit
Prepaid Plan
Plan Telephone
Plan
Your Share
Your Share
Features
Brochure
Name and Option
General Location
Number
Self
Self &
Type
Number
Plan
Self
Self &
Self
Self &
ECF
Dental
RI
Code
Only
Family
Only
Family
Only
and/or
Family
HHC
Care
Illinois
American HMO Illinois
AC
1
2
Metro Chicago area
1-800-367-9597
MMP
38.04
143.18
17.56
66.08
Both
No
73-427
BCI HMO, Inc./Chicago Metro Area
LF
1
2
Chicago area
(708) 620-0176
MMP
37.51
103.55
17.31
47.79
Both
No
73-152
BCI HMO, Inc./Downstate Area
JL
1
2
Downstate counties
(618) 632-1900
MMP
51.25
212.34
23.65
98.00
Both
No
73-152
Blackhawk Health, Assurance Plan
LH
1
2
Rockford area
(815) 965-6755
IPP
31.10
79.69
14.35
36.78
Both
No
73-149
BlueChoice
M4
1
2
St. Clair and Madison Counties
(800) 634-4395
IPP
41.34
132.95
19.08
61.36
Both
Yes
73-516
CarleCare
FX
1
2
East Central Illinois
(217) 337-8100
MMP
36.01
86.57
16.62
39.95
Both
No
73-168
Chicago HMO Ltd
FJ
1
2
Chicago area
(312) 751-4460
MMP
36.38
124.46
16.79
57.44
Both
Yes
73-199
Dreyer HMO
EU,
1
2
Greater Fox Valley and Dekalb areas
(708) 859-0400
GPP
33.07
92.62
15.26
42.75
Both
No
73-300
Foundation Program
LG
1
2
Springfield area
(217) 753-5280
IPP
64.79
245.16
29.90
113.15
Both
No
73-151
Great Lakes Health Plan, Inc.
FY.,
1
2
Chicago area
1-800-325-7498
IPP
40.19
110.87
18.55
51.17
Both
No
73-231
Group Health Plan St. Louis
MM
1
2
St. Louis area
(314) 453-1700
MMP
42.98
146.88
19.84
67.79
Both
Yes
73-104
HealthChicago, Inc.
GQ
1
2
Chicago Metro area
(708) 964-2700
MMP
44.70
179.79
20.63
82.98
Both
No
73-310
Humana Michael Reese HMO
75
1
2
Chicago Metro area
(312) 808-3801
GPP
31.87
89.25
14.71
41.19
Both
No
73-25
Maxicare Illinois
FV
1
2
Chicago/Champaign areas
(312) 220-9830
MMP
30.66
85.07
14.15
39.26
Both
No
73-58
MetLife HCN of St. Louis
12
1
2
St. Louis area
(800) 552-4679
MMP
64.74
143.46
29.88
66.21
Both
Yes
73-32
PARTNERS HMO
RN
1
2
Madison and St. Clair Counties
1-800-338-4123
IPP
43.58
134.73
20.11
62.18
Both
No
73-541
PersonalCare's HMO
GE
1
2
East Central, Northeast IL
(800) 431-1211
MMP
33.37
92.84
15.40
42.85
Both
No
73-257
RUSH-ANCHOR HMO
17
1
2
Chicago Metro area
(312) 347-0163
MMP
38.64
140.04
17.83
64.63
Both
No
73-29
SANUS Health Plan
H8
1
2
St. Louis Metro area
(314) 434-6010
IPP
53.48
141.60
24.68
65.35
Both
Yes
73-345
Share Health Plan of Illinois
FP
1
2
Chicago area
800-MD-SHARE
MMP
41.39
93.13
19.10
42.98
Both
Yes
73-187
Union Health Service, Inc.
76
1
2
Chicago Metropolitan area
(312) 829-4224
GPP
30.43
86.43
14.04
39.89
Both
No
73-26
Indiana
American HMO - Illinois
AC
1
2
Northwest Indiana
1-800-367-9597
MMP
38.04
143.18
17.56
66.08
Both
No
73-427
Arnett HMO
G2
1
2
Greater Lafayette area
(317) 448-8200
GPP
38.25
114.82
17.65
52.99
Both
No
73-288
BCI HMO, Inc.
LF
1
2
Lake and Porter Counties
(708) 620-0176
MMP
37.51
103.55
17.31
47.79
Both
No
73-152
Great Lakes Health Plan, Inc.
FY
1
2
Lake County
1-800-325-7498
IPP
40.19
110.87
18.55
51.17
Both
No
73-231
HealthChicago, Inc.
GQ
1
2
Lake, LaPorte and Porter Counties
(708) 964-2700
MMP
44.70
179.79
20.63
82.98
Both
No
73-310
Humana Care Plan
18
1
2
Southern Indiana
(800) 448-0222
MMP
34.36
107.47
15.86
49.60
Both
No
73-238
Humana Health Plan
D2
1
2
Clark, Floyd and Harrison Counties
(800) 448-0222
IPP
34.31
108.14
15.83
49.91
Both
No
73-434
Humana Michael Reese HMO
75
1
2
Lake County
(312) 808-3801
GPP
31.87
89.25
14.71
41.19
Both
No
73-25
1992
1992
Other Benefit
Enrollment
Monthly Premium
Biweekly Premium
Features
Code
Plan Telephone
Plan
Your Share
Your Share
Brochure
Prepaid Plan
Number
General Location
Name and Option
Number
Type
ECF
Plan
Self
Self &
Self
Self &
Self
Self &
Dental
RI
and/or
Code
Only
Family
Only
Family
Only
Family
Care
HHC
Indiana (cont.)
Key Health Plan
GH
1
2
North and Central Indiana
1-800-321-8961
IPP
40.88
174.83
18.87
80.69
Both
Yes
73-163
30.66
85.07
14.15
39.26
Both
No
73-58
Maxicare Illinois
FV
1
2
Lake and Porter Counties
(312) 220-9830
MMP
Maxicare Indiana
GK
1
2
Indianapolis area
(317) 843-9989
MMP
36.78
139.84
16.97
64.54
Both
No
73-183
PARTNERS National Health of Indiana
MC
1
2
Elkhart/South Bend
(219) 233-4677
IPP
38.39
134.81
17.72
62.22
Both
No
73-506
RUSH-ANCHOR HMO
17
1
2
Lake and Porter Counties
(312) 347-0163
MMP
38.64
140.04
17.83
64.63
Both
No
73-29
IN
2
Indianapolis Metro area
(317) 571-5300
MMP
33.35
102.29
15.39
47.21
Both
No
73-578
The M Plan
1
Welborn HMO
H3
1
2
Evansville area
(812) 425-3939
GPP
36.46
113.99
16.83
52.61
Both
No
73-430
lowa
Care Choices
FA
1
2
Sioux City area
1-712-252-2344
IPP
40.22
149.87
18.56
69.17
Both
No
73-444
HMO lowa
56
1
2
Des Moines area
(515) 282-2000
IPP
41.17
194.22
19.00
89.64
Both
No
73-554
Principal Health Care of Nebraska
GU
1
2
Council Bluffs
(402) 333-1720
IPP
31.30
84.51
14.45
39.00
Both
Yes
73-453
Yes
73-186
Share Health Plan of lowa
GS
1
2
Central lowa
(515) 225-1234
IPP
42.41
98.76
19.57
45.58
Both
Share Health Plan of Nebraska
NF
1
2
Omaha/Council Bluffs area
(402) 345-5500
IPP
41.54
107.49
19.17
49.61
Both
Yes
73-265
Kansas
CIGNA Healthplan of Kansas
HC
1.
2
Wichita area
(316) 636-1152
GPP
39.62
138.41
18.29
63.88
Both
No
73-175
HMO Kansas
HM
1
2
Capitol area/Wichita area/Central Kansas
(800) 332-0028
MMP
28.63
77.35
13.21
35.70
Both
Yes
73-232
104.76
16.26
48.35
Both
Yes
73-128
Kaiser-Kansas City
HA
1
2
Kansas City area
(913) 469-5607
GPP
35.24
Prime Health (High)
MS
1
2
Kansas City area
(816) 941-8003
MMP
38.99
135.25
17.99
62.42
Both
No
73-54
Prime Health (Stnd)
MS
4
5
Kansas City area
(816) 941-8003
MMP
35.62
100.56
16.44
46.41
Both
No
73-54
Principal Health Care of Kansas City
N3
1
2
Kansas City area
(816) 941-3030
IPP
36.24
110.05
16.73
50.79
Both
No
73-275
2
Kansas City area
(816) 395-2323
IPP
72.20
211.06
33.32
97.41
Both
No
73-142
Total Health Care
LZ
1
Kentucky
HealthWise of Kentucky
DU
1
2
28 counties in Central Kentucky
(800) 543-8339
IPP
33.71
117.31
15.56
54.14
Both
No
73-433
Humana Care Plan
18
1
2
Louisville area
(800) 448-0222
MMP
34.36
107.47
15.86
49.60
Both
No
73-238
Humana Care Plan
HR
1
2
Lexington area
(800) 221-8390
MMP
30.34
84.35
14.00
38.93
Both
No
73-238
Humana Health Plan
D2
1
2
Louisville and Lexington areas
(800) 448-0222
IPP
34.31
108.14
15.83
49.91
Both
No
73-434
73-254
Lincoln National Health Plan
R8
1
2
Northern Kentucky
1-800-999-6019
MMP
40.75
116.55
18.81
53.79
Both
Yes
Louisiana
Community Health Network of LA
RY
1
2
Baton Rouge area
1-800-349-1000
IPP
37.75
106.30
17.42
49.06
Both
No
73-575
Community Health Network of LA
S6
1
2
New Orleans area
1-800-349-1000
IPP
37.69
105.72
17.40
48.79
Both
No
73-575
Community Health Network of LA
S8
1
2
Shreveport area
1-800-349-1000
IPP
39.19
121.23
18.09
55.95
Both
No
73-575
16.54
48.77
Both
No
73-576
Gulf South Health Plans, Inc.
LY
1
2
Baton Rouge area
(504) 927-7212
IPP
35.85
105.67
Maxicare Louisiana
JA
1
2
New Orleans area
(504) 836-2022
MMP
38.60
110.24
17.82
50.88
Both
No
73-244
PARTNERS Health Plan of Louisiana
NG
1
2
New Orleans area
1-800-877-7997
IPP
36.53
118.93
16.86
54.89
Both
No
73-570
Principal Health Care of Louisiana
RP
1
2
New Orleans and River Region
(504) 834-0840
IPP
32.27
87.14
14.89
40.22
Both
No
73-542
ABBREVIATIONS:
ECF - - Extended Care Facility
IPP - Individual Practice Plan
GPP- Group Practice Plan
MMP- Mixed Model Plan
HHC- Home Health Care
FEHB Plan Comparison Chart - For Benefits Beginning in January 1992
Prepaid Plans (Commonly referred to as CMP/HMOs)
A Prepaid plan's general location is the approximate area served by the plan. To
Every Prepaid plan provides physicals, immunizations, and prescription drug benefits
enroll in a Prepaid plan, you MUST live within the plan's exact enrollment area shown
and all Prepaid plan benefit packages include catastrophic coverage, since these
in the plan's brochure.
plans provide for necessary care during a year.
Some Prepaid plans require you to share costs for certain services.
Every Prepaid plan provides benefits for mental conditions/substance abuse inpa-
tient and outpatient services. However, benefits are limited to short-term care,
Many Prepaid plans provide chiropractic care benefits and most provide hospice care
generally 30 to 45 days of inpatient care and 20 to 35 outpatient visits per calendar
benefits.
year. You typically share costs to benefit limits.
Many Prepaid plans provide "Opt-Out" benefits (see definition).
Enrollment
1992
1992
Code
Monthly Premium
Biweekly Premium
Other Benefit
Prepaid Plan
Plan Telephone
Plan
Your Share
Your Share
Features
Brochure
Name and Option
General Location
Number
Self
Self &
Type
Number
Plan
Self
Self &
Self
Self &
ECF
Dental
RI
Code
Only
Family
Only
Family
Only
and/or
Family
HHC
Care
Maine
Healthsource Maine
MY
1
2
North, Central and Southern Maine
(800) 642-5551
IPP
71.18
194.35
32.85
89.70
Both
No
73-515
HMO Maine
CU
1
2
Southern and Central Maine
1-800-527-7706
IPP
54.17
181.51
25.00
83.77
Both
No
73-443
Maryland
AETNA HEALTH PLAN
V8
1
2
DC and Baltimore Metro areas
1-800-537-5096
IPP
37.50
104.46
17.31
48.21
Both
Yes
73-250
CareFirst
JQ
1
2
DC area/Most of Maryland
(301) 528-7000
MMP
35.09
93.00
16.19
42.92
Both
Yes
73-268
Chesapeake Health Plan
BL
1
2
Baltimore City & Co./Harford/Anne Arundel
(301) 539-8622
MMP
34.55
92.81
15.95
42.84
Both
Yes
73-441
Columbia Medical Plan
67
1
2
Central Maryland
(301) 997-8500
GPP
39.50
143.65
18.23
66.30
Both
Yes
73-20
Free State Health Plan
LD
1
2
Central Maryland
(301) 964-8168
MMP
39.11
139.56
18.05
64.41
Both
Yes
73-146
George Washington Univ HP (High)
E5
1
2
Washington, DC area
(202) 416-0400
MMP
60.91
128.79
28.11
59.44
Both
Yes
73-46
George Washington Univ HP (Stnd)
E5
4
5
Washington, DC area
(202) 416-0400
MMP
35.84
76.88
16.54
35.48
Both
Yes
73-46
Group Health Association (High)
50
1
2
Mntgmry/P.G./ Hwrd/Part of Chrls Cos.
(202) 966-4357
GPP
56.51
165.41
26.08
76.34
Both
Yes
73-8
Group Health Association (Stnd)
50
4
5
Mntgmry/P.G./ Hwrd/Part of Chrls Cos.
(202) 966-4357
GPP
28.97
73.80
13.37
34.06
Both
Yes
73-8
HealthPlus (High)
JN
1
2
DC Metro area
(301) 441-1600
IPP
40.13
94.34
18.52
43.54
Both
Yes
73-67
HealthPlus (Stnd)
JN
4
5
DC Metro area
(301) 441-1600
IPP
29.68
68.25
13.70
31.50
Both
Yes
73-67
HealthPlus (High)
JW
1
2
Baltimore Metro Area
(301) 441-1600
IPP
36.59
85.98
16.89
39.68
Both
Yes
73-67
HealthPlus (Stnd)
JW
4
5
Baltimore Metro Area
(301) 441-1600
IPP
27.01
62.13
12.47
28.67
Both
Yes
73-67
Kaiser/Mid-Atlantic
E3
1
2
Washington, DC area
(202) 364-3400
GPP
35.67
96.25
16.46
44.42
Both
Yes
73-47
Kaiser/Mid-Atlantic
E7
1
2
Baltimore area
(301) 281-6123
GPP
32.52
88.10
15.01
40.66
Both
Yes
73-47
Lincoln National Health Plan
DS
1
2
Prince George's and Montgomery Cos.
1-800-782-0622
IPP
43.38
142.20
20.02
65.63
Both
Yes
73-442
M.D. IPA
JP
1
2
Most of Maryland
(301) 294-5100
IPP
31.03
87.66
14.32
40.46
Both
Yes
73-100
Physicians Care
X9
1
2
DC Metro area
1-800-542-7258
IPP
52.03
229.50
24.01
105.92
Both
Yes
73-331
Potomac Health
JM
1
2
Most of Maryland
(301) 528-7000
MMP
38.79
120.56
17.90
55.64
Both
Yes
73-225
Prudential Health Plan/Mid-Atlantic
HD
1
2
Montgomery and Prince George's Cos.
1-800-888-5447
MMP
41.43
165.65
19.12
76.45
Both
Yes
73-413
Prudential Health Plan/Mid-Atlantic
JB
1
2
Central Maryland
1-800-888-5447
MMP
37.02
117.94
17.08
54.43
Both
Yes
73-413
Massachusetts
Bay State Health Care
KW
1
2
Eastern Massachusetts
1-800-525-5151
IPP
67.86
254.31
31.32
117.37
Both
Yes
73-193
Central Massachusetts Health Care
J1
1
2
Worcester County
(508) 754-1870
IPP
77.94
260.00
35.97
120.00
Both
Yes
73-291
CIGNA Healthplan of Massachusetts
G6
1
2
Gtr Springfield and Worcester areas
(800) 345-9458
IPP
57.46
159.51
26.52
73.62
Both
No
73-295
CIGNA Healthplan of Massachusetts
TR
1
2
Eastern Massachusetts
(800) 345-9458
IPP
67.02
222.20
30.93
102.55
Both
No
73-295
Community Health Plan
SM
1
2
Berkshire/Franklin/Hampshire Cos.
(413) 584-0600
MMP
45.05
169.07
20.79
78.03
Both
No
73-53
1992
1992
Other Benefit
Enrollment
Monthly Premium
Biweekly Premium
Features
Brochure
Code
Plan Telephone
Plan
Your Share
Your Share
Prepaid Plan
Number
General Location
Name and Option
Number
Type
ECF
Plan
Self
Self &
Self
Self &
Self
Self &
Dental
RI
and/or
Code
Only
Family
Only
Family
Only
Family
Care
HHC
Massachusetts (cont.)
Fallon Community Health Plan
JV
1
2
Central Massachusetts
(800) 635-1221
GPP
38.83
122.12
17.92
56.36
Both
Yes
73-90
Eastern and Western Massachusetts
(617) 739-6161
GPP
61.62
239.49
28.44
110.53
Both
Yes
73-21
Harvard Community Health Plan, Inc.
68
1
2
Harvard Health New England
70
1
2
Southeastern Massachusetts
(401) 331-4034
GPP
33.85
81.63
15.62
37.67
Both
Yes
73-23
DJ
1
2
Hampden and Hampshire Cos.
(413) 787-4000
IPP
55.34
128.99
25.54
59.53
Both
No
73-437
Health New England
HMO Blue
JT
1
2
Eastern/Central Massachusetts
(617) 246-8140
MMP
50.62
189.48
23.36
87.45
Both
Yes
73-112
KH
1
2
Portions of Massachusetts
(413) 499-4009
IPP
42.90
163.26
19.80
75.35
Both
No
73-194
HMO IPA Network
69.10
Both
No
73-489
HMO Rhode Island
DA
1
2
Portions of Southeastern MA
(401) 274-6674
MMP
49.19
149.72
22.70
Kaiser Massachusetts
K1
1
2
Parts of Western Massachusetts
(413) 256-0151
GPP
49.66
114.71
22.92
52.94
Both
Yes
73-86
Lahey Clinic-BCBS HMP
JX
1
2
Greater Burlington area
(617) 246-8140
GPP
54.47
218.14
25.14
100.68
Both
No
73-106
Matthew Thornton Health Plan
NX
1
2
Northern Massachusetts
1-800-544-8333
GPP
43.00
179.95
19.84
83.05
Both
No
73-76
1
2
Springfield area
(413) 781-7320
GPP
43.60
111.18
20.12
51.31
Both
Yes
73-97
Medical West CHP
JZ
JU
1
2
Eastern Massachusetts
(617) 871-3950
IPP
62.01
257.73
28.62
118.95
Both
Yes
73-139
Pilgrim Health Care
K2
1
2
Eastern and Central Massachusetts
(617) 466-1000
IPP
74.65
293.13
34.45
135.29
Both
No
73-134
Tufts Associated Health Plan
U.S. Healthcare-Massachusets
NE
1
2
Boston Metropolitan area
1-800-537-9384
IPP
43.54
182.18
20.09
84.08
Both
Yes
73-526
Michigan
G7
1
2
North Michigan
(616) 941-7823
IPP
40.33
126.95
18.61
58.59
Both
No
73-272
Blue Care Network Great Lakes
17.19
60.11
Both
No
73-272
Blue Care Network Great Lakes
KF
1
2
Southwest Michigan
(616) 388-9500
IPP
37.25
130.24
Blue Care Network Great Lakes
KR
1
2
West Michigan
(616) 957-5057
IPP
29.41
85.46
13.57
39.44
Both
No
73-272
Blue Care Network of East MI/Flint
KN
1
2
Greater Flint area
(313) 733-9593
MMP
35.89
148.36
16.56
68.47
Both
No
73-88
Blue Care Network of East MI/Saginaw
K5
2
Saginaw, Bay City, Midland
(517) 791-3222
MMP
34.96
87.33
16.14
40.30
Both
No
73-88
1
LX
1
2
Detroit area
(800) 662-6667
MMP
29.71
112.91
13.71
52.11
Both
No
73-153
Blue Care Network of SE Michigan
(517) 322-8022
MMP
34.24
148.53
15.80
68.55
Both
No
73-154
Blue Care Network-Health Central
LN
1
2
Lansing area
BQ
1
2
Grand Rapids Metro area
(616) 942-1221
IPP
34.66
105.26
16.00
48.58
Both
No
73-550
Butterworth HMO
Care Choices/Ann Arbor
KZ
1
2
Ann Arbor area
1-800-852-9780
IPP
49.66
186.58
22.92
86.11
Both
No
73-444
BA
1
2
Grand Rapids/Muskegon areas
(616) 957-1100
IPP
34.14
92.78
15.76
42.82
Both
No
73-444
Care Choices/Grand Rapids & Muskegon
40.57
153.06
18.72
70.64
Both
No
73-444
Care Choices/Lansing
FE
1
2
Lansing area
1-800-642-0119
IPP
Comprehensive Health Services, Inc.
K3
1
2
Southeastern Michigan
(313) 875-5222
MMP
35.59
88.96
16.42
41.06
Both
No
73-75
RL
1
2
Grand Rapids area
(616) 949-2410
GPP
32.66
90.59
15.07
41.81
Both
No
73-567
Grand Valley Health Plan
Health Alliance Plan of Michigan
52
1
Southeastern Michigan
(313) 872-8100
MMP
38.21
114.64
17.64
52.91
HHC
No
73-15
2
EG
1
2
Southeastern Michigan
(313) 747-8700
MMP
42.71
146.86
19.71
67.78
Both
No
73-445
M-Care
73-473
Medical Value Plan
EV
1
2
Monroe and Lenawee Counties
(419) 244-2902
MMP
40.14
198.58
18.53
91.65
Both
No
OmniCare Health Plan
KA
1
2
Southeastern Michigan
(313) 873-2813
MMP
37.83
93.44
17.46
43.12
Both
No
73-62
SelectCare HMO
K6
1
2
Detroit Metro area
(313) 680-1100
MMP
35.62
94.64
16.44
43.68
Both
No
73-69
Total Health Care
1
2
Detroit Metro area
(313) 871-2000
GPP
36.85
89.96
17.01
41.52
Both
No
73-534
N2
ABBREVIATIONS: ECF - Extended Care Facility
IPP - Individual Practice Plan
GPP- Group Practice Plan
MMP- Mixed Model Plan
HHC- Home Health Care
20
FEHB Plan Comparison Chart - For Benefits Beginning in January 1992
Prepaid Plans (Commonly referred to as CMP/HMOs)
A Prepaid plan's general location is the approximate area served by the plan. To
Every Prepaid plan provides physicals, immunizations, and prescription drug benefits
enroll in a Prepaid plan, you MUST live within the plan's exact enrollment area shown
and all Prepaid plan benefit packages include catastrophic coverage, since these
in the plan's brochure.
plans provide for necessary care during a year.
Some Prepaid plans require you to share costs for certain services.
Every Prepaid plan provides benefits for mental conditions/substance abuse inpa-
tient and outpatient services. However, benefits are limited to short-term care,
Many Prepaid plans provide chiropractic care benefits and most provide hospice care
generally 30 to 45 days of inpatient care and 20 to 35 outpatient visits per calendar
benefits.
year. You typically share costs to benefit limits.
Many Prepaid plans provide "Opt-Out" benefits (see definition).
Enrollment
1992
1992
Other Benefit
Code
Monthly Premium
Biweekly Premium
Prepaid Plan
Plan Telephone
Plan
Your Share
Your Share
Features
Brochure
General Location
Name and Option
Number
Type
Number
Plan
Self
Self &
Self
Self &
Self
Self &
ECF
Dental
RI
Code
and/or
Only
Family
Only
Family
Only
Family
HHC
Care
Minnesota
Group Health (High)
53
1
2
Minneapolis and St. Paul
(612) 623-8400
GPP
29.14
83.98
13.45
38.76
Both
Yes
73-9
Group Health (Stnd)
53
4
5
Minneapolis and St. Paul
(612) 623-8400
GPP
23.82
68.63
10.99
31.68
Both
No
73-9
Medica Choice
DR
1
2
Minnesota
(612) 936-1821
IPP
37.27
121.94
17.20
56.28
Both
Yes
73-169
Medica Primary
11
1
2
Minneapolis and St. Paul
(612) 936-6000
MMP
31.58
88.93
14.57
41.04
Both
Yes
73-30
Mississippi
CIGNA Healthplan of Tennessee
SR
1
2
Memphis area
(915) 683-3311
IPP
49.77
172.86
22.97
79.78
Both
No
73-356
Missouri
BlueChoice
M4
1
2
St. Louis area
(800) 634-4395
IPP
41.34
132.95
19.08
61.36
Both
Yes
73-516
Group Health Plan St. Louis
MM
1
2
St. Louis area.
(314) 453-1700
MMP
42.98
146.88
19.84
67.79
Both
Yes
73-104
Kaiser Kansas City
HA
1
2
Kansas City area
(913) 469-5607
GPP
35.24
104.76
16.26
48.35
Both
Yes
73-128
MetLife HCN of St. Louis
12
1
2
St. Louis area
(800) 552-4679
MMP
64.74
143.46
29.88
66.21
Both
Yes
73-32
PARTNERS HMO
RN
1
2
St. Louis Metro area
1-800-338-4123
IPP
43.58
134.73
20.11
62.18
Both
No
73-541
Prime Health (High)
MS
1
2
Kansas City area
(816) 941-8003
MMP
38.99
135.25
17.99
62.42
Both
No
73-54
Prime Health (Stnd)
MS
4
5
Kansas City area
(816) 941-8003
MMP
35.62
100.56
16.44
46.41
Both
No
73-54
Principal Health Care of Kansas City
N3
1
2
Kansas City area
(816) 941-3030
IPP
36.24
110.05
16.73
50.79
Both
No
73-275
SANUS Health Plan
H8
1
2
St. Louis Metro area
(314) 434-6010
IPP
53.48
141.60
24.68
65.35
Both
Yes
73-345
Total Health Care
LZ
1
2
Kansas City area
(816) 395-2323
IPP
72.20
211.06
33.32
97.41
Both
No
73-142
Nebraska
Care Choices
FA
1
2
Dakota/Dixon/Thurston Cos.
1-712-252-2344
IPP
40.22
149.87
18.56
69.17
Both
No
73-444
Principal Health Care of Nebraska
GU
1
2
Omaha and Lincoln areas
(402) 333-1720
IPP
31.30
84.51
14.45
39.00
Both
Yes
73-453
Share Health Plan of Nebraska
NF
1
2
Omaha/Council Bluffs area
(402) 345-5500
IPP
41.54
107.49
19.17
49.61
Both
Yes
73-265
Nevada
Health Plan of Nevada
NM
1
2
Las Vegas area
(702) 646-8350
MMP
42.02
112.11
19.39
51.74
Both
Yes
73-129
Humana Health Plan (Las Vegas)
TL
1
2
Las Vegas area
(702) 737-7211
IPP
32.14
89.99
14.83
41.53
Both
No
73-580
New Hampshire
Harvard Community Health Plan, Inc.
68
1
2
Southern New Hampshire
(617) 739-6161
GPP
61.62
239.49
28.44
110.53
Both
Yes
73-21
Healthsource New Hampshire
J2
1
2
New Hampshire
(800) 531-3121
IPP
41.81
180.77
19.30
83.43
Both
No
73-312
HMO Blue
JT
1
2
Southeast New Hampshire Towns
(617) 246-8140
MMP
50.62
189.48
23.36
87.45
Both
Yes
73-112
Kaiser Massachusetts
K1
1
2
Southwestern New Hampshire
(413) 256-0151
GPP
49.66
114.71
22.92
52.94
Both
Yes
73-86
Matthew Thornton Health Plan
NX
1
2
South Central New Hampshire
1-800-544-8333
GPP
43.00
179.95
19.84
83.05
Both
No
73-76
1992
1992
Enrollment
Other Benefit
Code
Monthly Premium
Blweekly Premium
Features
Prepaid Plan
Plan Telephone
Plan
Your Share
Your Share
Brochure
General Location
Number
Name and Option
Number
Type
ECF
Plan
Self
Self &
Self
Self &
Self
Self &
Dental
RI
and/or
Code
Only
Family
Only
Family
Only
Family
HHC
Care
New Hampshire (cont.)
U.S. Healthcare-Massachusetts
QN
1
2
Salem, New Hampshire area
1-800-537-9384
IPP
55.38
205.38
25.56
94.79
Both
Yes
73-526
New Jersey
Aetna Health Plans
PC
1
2
New Jersey
(800) 223-0812
IPP
58.61
227.70
27.05
105.09
Both
No
73-127
CoMED HMO
P4
1
2
New Jersey
(201) 361-8808
IPP
44.46
176.05
20.52
81.25
Both
No
73-87
GHI Health Plan
80
1
2
Northern New Jersey
(201) 623-6000
IPP
41.03
170.69
18.94
78.78
HHC
Yes
73-7
Greater Atlantic Health Service
27
1
2
Camden/Burl/Glou Cos.
(215) 823-8610
MMP
35.15
92.06
16.22
42.49
Both
No
73-40
HIP of New Jersey
P9
1
2
Northern and Southern New Jersey
(609) 654-9424
GPP
42.86
153.79
19.78
70.98
Both
Yes
73-84
Medigroup HMO
E4
1
2
New Jersey
(201) 593-4481
MMP
89.31
268.06
41.22
123.72
Both
No
73-393
Oxford Health Plans/New Jersey
GD
1
2
Northern New Jersey
(800) 444-6222
IPP
51.64
178.13
23.83
82.21
Both
Yes
73-466
PruCare New Jersey
PB
1
2
New Jersey
(800) 422-7399
IPP
71.94
296.84
33.20
137.00
Both
No
73-73
Rutgers Community Health Plan
PA
1
2
Central and Northern New Jersey
(908) 560-9898
GPP
42.86
153.79
19.78
70.98
Both
Yes
73-57
Sanus Health Plan
HK
1
2
New York Metro area
(800) 338-8113
IPP
31.54
85.15
14.56
39.30
Both
Yes
73-468
US Healthcare/NJ (High)
P3
1
2
New Jersey
1-800-537-9384
IPP
59.20
224.49
27.32
103.61
Both
Yes
73-116
US Healthcare/NJ (Stnd)
P3
4
5
New Jersey
1-800-537-9384
IPP
43.13
175.72
19.91
81.10
Both
No
73-116
New Mexico
FHP/New Mexico
P2
1
2
Albuquerque/Santa Fe areas
(505) 881-7900
MMP
36.53
95.34
16.86
44.00
Both
Yes
73-563
Lovelace Health Plan
Q1
1
2
Albuquerque/Santa Fe
(505) 262-7363
GPP
32.28
83.92
14.90
38.73
Both
No
73-79
Qual-Med New Mexico
PX
1.
2
Greater Albuquerque/Santa Fe areas
(505) 889-8800
IPP
31.81
83.31
14.68
38.45
Both
Yes
73-251
New York
Aetna Health Plans
PC
1
2
Metropolitan New York
(800) 223-0812
IPP
58.61
227.70
27.05
105.09
Both
No
73-127
Blue Choice of New York
MK
1
2
Rochester area
(716) 454-4810
IPP
29.10
74.29
13.43
34.29
Both
No
73-510
BlueCare Plus
AH
1
2
Greater Utica/Rome & So. Tier areas
(315) 798-4395
IPP
42.89
146.21
19.79
67.48
Both
No
73-460
Capital District Physicians HP
SG
1
2
Capital District area
(518) 452-1941
IPP
40.28
147.88
18.59
68.25
Both
No
73-549
ChoiceCare
J6
1
2
Queens/Nassau/Suffolk Counties
(516) 694-4000
IPP
42.59
165.39
19.66
76.33
Both
No
73-294
CHP/Hudson Valley Region
QB
1
2
Dutchess/Orange/Ulster/Putnam Cos.
(914) 471-2368
MMP
38.82
126.69
17.92
58.47
Both
No
73-136
Community Blue
J7
1
2
Western New York
(716) 884-2800
IPP
32.17
87.58
14.85
40.42
Both
No
73-298
Community Health Plan
PW
1
2
Capital Area/Central Clinton Co.
(518) 783-1864
MMP
37.64
105.20
17.37
48.55
Both
No
73-53
Empire BC/BS HEALTHNET/Cap/AD
S1
1
2
Catskills/NE NY Adirondacks
(800) 453-0113
MMP
40.95
149.55
18.90
69.02
Both
No
73-33
Empire BC/BS HEALTHNET/Subrb
S7
1
2
Suburban/Metro
(800) 453-0113
MMP
53.80
191.06
24.83
88.18
Both
No
73-33
Empire BC/BS HLTHNET/Cap/MHu
S2
1
2
Capitol Dist./Mid-Hudson
(800) 453-0113
MMP
42.68
159.49
19.70
73.61
Both
No
73-33
Empire BC/BS HLTHNET/Manhattan
15
1
2
Manhattan
(800) 453-0113
MMP
73.39
242.15
33.87
111.76
Both
No
73-33
Foundation Health Plan
CE
1
2
Southern Tier
(607) 754-3380
IPP
40.84
130.39
18.85
60.18
Both
No
73-461
GHI Health Plan
80
1
2
New York State
(212) 721-2020
IPP
41.03
170.69
18.94
78.78
HHC
Yes
73-7
Group Health of New York
21
1
2
Rochester area
(716) 325-3630
GPP
27.60
71.07
12.74
32.80
Both
No
73-35
Health Care Plan
Q8
1
2
Buffalo area
(716) 847-1480
GPP
31.74
84.70
14.65
39.09
Both
No
73-71
ABBREVIATIONS:
ECF - Extended Care Facility
IPP - Individual Practice Plan
GPP- Group Practice Plan
MMP- Mixed Model Plan
HHC- Home Health Care
FEHB Plan Comparison Chart
-
For
Benefits
Beginning
in
January
1992
Prepaid Plans (Commonly referred to as CMP/HMOs)
A Prepaid plan's generalt location is the approximate area served by the plan. To
Every Prepaid plan provides physicals, immunizations, and prescription drug benefits
enroll in a Prepaid plan, you MUST live within the plan's exact enrollment area shown
and all Prepaid plan benefit packages include catastrophic coverage, since these
in the plan's brochure.
plans provide for necessary care during a year.
Some Prepaid plans require you to share costs for certain services.
Every Prepaid plan provides benefits for mental conditions/substance abuse inpa-
tient and outpatient services. However, benefits are limited to short-term care,
Many Prepaid plans provide chiropractic care benefits and most provide hospice care
generally 30 to 45 days of inpatient care and 20 to 35 outpatient visits per calendar
benefits.
year. You typically share costs to benefit limits.
Many Prepaid plans provide "Opt-Out" benefits (see definition).
1992
1992
Enrollment
Other Benefit
Code
Monthly Premium
Biweekly Premium
Prepaid Plan
Plan Telephone
Plan
Your Share
Your Share
Features
Brochure
General Location
Name and Option
Number
Type
Number
Plan
Self
Self &
Self
Self &
Self
Self &
ECF
Dental
RI
and/or
Code
Only
Family
Only
Family
Only
Family
Care
HHC
New York (cont.)
HIP of New York
51
1
2
Greater New York area
1-800-HIP-TALK
GPP
40.53
132.21
18.70
61.02
Both
No
73-1
Independent Health Association
C1
1
2
Hudson Valley area
(914) 631-0939
IPP
41.66
158.58
19.23
73.19
Both
No
73-103
Independent Health Association
QA
1
2
Western New York
(716) 631-5392
IPP
26.70
74.74
12.32
34.50
Both
No
73-103
Independent Prepaid Health Plan
EB
1
2
Syracuse area
(315) 638-4900
IPP
40.70
132.37
18.78
61.09
Both
No
73-462
Kaiser New York
QH
1
2
Westchester County
(914) 682-0025
GPP
43.68
103.22
20.16
47.64
Both
Yes
73-55
Mid-Hudson Health Plan
F4
1
2
Hudson Valley area
(914) 338-0202
IPP
36.63
98.22
16.91.
45.33
Both
No
73-464
Mohawk Valley Health Plan
GA
1.
2
Eastern Region
(518) 370-4793
IPP
43.57
162.57.
20.11
75.03
Both
No.
73-465
Mohawk Valley Health Plan
M9
1
2
Central and Northern Region
(800) 777-4793
IPP
37.26
94.64
17.20
43.68
Both
No
73-465
Mohawk Valley Health Plan.
MX
1
2
Mid-Hudson Region
(914) 473-1762
IPP
81.64
258.86
37.68
119.47
Both
No
73-465
Oxford Health Plans/New York
GC
1
2
Metropolitan New York
(800) 444-6222
IPP
62.53
204.02
28.86
94.16
Both
Yes
73-466
PHP/Slocum Dickson Medical Network
SH
1
2
Utica area
(315) 797-7019
GPP
37.94
101.10
17.51
46.66
Both
No
73-560
Physicians Health Services/NY
PD
1
2
Westchester County
(800) 732-5357
IPP
82.25
275.37
37.96
127.09
Both
No
73-531
Preferred Care
GV
1
2
Rochester area
(716) 325-3113
IPP
31.17
79.14
14.39
36.53
Both
No
73-467
Prepaid Health Plan
QE
1
2
Syracuse area
(315) 638-2133
GPP
37.86
110.83
17.47
51.15
Both
Yes
73-98
Sanus Health Plan
HK
1
2
New York Metro area
(718) 899-3600
IPP
31.54
85.15
14.56
39.30
Both
Yes
73-468
TOTAL HEALTH
HU
1.
2
Metropolitan New York
(516) 466-1000
IPP
33.89
92.35
15.64
42.62
Both
No
73-469
US Healthcare-New York
JC
1
2
Metropolitan and Greater New York
1-800-537-9384
IPP
37.66
94.71
17.38
43.71
Both
Yes
73-365
North Carolina
Carolina Physicians' Health Plan
RQ
1
2
Central and Eastern North Carolina
(919) 833-8000
IPP
41.29
144.52
19.06
66.70
Both
No
73-566
Kaiser North Carolina
QT
1
2
Triangle area/Charlotte
(919) 981-6000
GPP
37.10
99.09
17.12
45.73
Both
No
73-240
Maxicare North Carolina
Q5
1
2
Charlotte, Greensboro and Raleigh
(800) 822-0012
MMP
40.10
138.69
18.51
64.01
Both
No
73-227
PruCare of Charlotte
Q4
1
2
Portions of North Carolina
(704) 365-6070
GPP
31.86
89.21
14.70
41.17
Both
No
73-340
North Dakota
Heart of America HMO
RU
1
2
Northcentral North Dakota
(701) 776-5848
GPP
31.65
82.16
14.61
37.92
Both
No
73-543
Medica Choice
DR
1
2
Fargo/Moorehead area
1-800-642-0477
IPP
37.27
121.94
17.20
56.28
Both
Yes
73-169
Ohio
AETNA Health Plan
RD
1
2
Northern Ohio
(216) 486-8979
IPP
41.06
94.82
18.95
43.76
Both
No
73-273
CIGNA Healthplan of Ohio
AT
1
2
Central Ohio
(800) 541-7526
IPP
53.95
173.01
24.90
79.85
Both
No
73-471
Health Guard
MA
1
2
Portions of Ohio
(614) 676-4623
MMP
32.23
82.93
14.87
38.28
Both
No
73-504
Health Plan of the Upper Ohio Valley
U4
1
2
Eastern Ohio
(614) 695-3585
IPP
32.72
81.89
15.10
37.79
Both
No
73-553
1992
1992
Enrollment
Other Benefit
Code
Monthly Premium
Biweekly Premium
Features
Prepaid Plan
Plan Telephone
Plan
Your Share
Your Share
Brochure
General Location
Number
Name and Option
Number
Type
ECF
Plan
Self
Self &
Self
Self &
Self
Self &
Dental
RI
and/or
Code
Only
Family
Only
Family
Only
Family
Care
HHC
Ohio (cont.)
HealthOhio, Inc.
RF
1
2
Marion area
(614) 387-6355
IPP
34.45
87.74
15.90
40.50
Both
Yes
73-56
HHP/Licking Memorial
MG
1
2
Central Ohio
(614) 366-0533
IPP
36.33
93.80
16.77
43.29
Both
No
73-508
HMO Health Ohio
L4
1
2
Northeast Ohio
(800) 634-0977
MMP
44.66
166.58
20.61
76.88
Both
No
73-157
HMO Health Ohio
MD
1
2
Northwest Ohio
(800) 634-0977
MMP
37.37
112.80
17.25
52.06
Both
No
73-157
HMO Health Ohio
OH
1
2
Central Ohio
(800) 634-0977
MMP
44.23
158.08
20.41
72.96
Both
No
73-157
HMP/OHIO
R5
1
2
Portions of Ohio
1-800-342-5467
MMP
47.91
177.80
22.11
82.06
Both
Yes
73-31
Humana Health Plan/Ohio
SQ
1
2
SW Ohio
(800) 521-3508
MMP
42.40
151.74
19.57
70.03
Both
No
73-579
Kaiser Ohio
64
1
2
Cleveland and Akron areas
(216) 621-5600
GPP
43.10
120.25
19.89
55.50
Both
No
73-17
Lincoln National Health Plan
R8
1
2
Cincinnati/Dayton areas
1-800-999-6019
MMP
40.75
116.55
18.81
53.79
Both
Yes
73-254
Medical Value Plan
EV
1
2
Greater Toledo area
(419) 244-2902
MMP
40.14
198.58
18.53
91.65
Both
No
73-473
Personal Physician Care
PL
1
2
Cleveland Metro area
(216) 687-0015
IPP
39.99
120.25
18.46
55.50
Both
No
73-557
Principal Health Care of Ohio
R4
1
2
Columbus area
(614) 841-1237
GPP
36.35
90.88
16.78
41.94
Both
No
73-99
PruCare-Central Ohio
AY
1
2
Columbus area
(614) 761-0244
GPP
40.00
123.20
18.46
56.86
Both
No
73-339
Western Ohio Health Care Plan
RH
1
2
Dayton/Springfield area
(513) 439-8903
IPP
44.70
169.35
20.63
78.16
Both
Yes
73-539
Oklahoma
BlueLincs HMO-Oklahoma City
N5
1
2
Oklahoma City area
(405) 841-9777
IPP
37.03
102.99
17.09
47.53
Both
No
73-267
BlueLincs HMO-Tulsa
RX
1
2
Greater Tulsa area
(918) 561-9933
IPP
61.02
164.17
28.16
75.77
Both
No
73-267
CIGNA Healthplan of Oklahoma
RT
1
2
Oklahoma City area
(405) 943-7711
MMP
36.52
107.64
16.86
49.68
Both
No
73-216
PacifiCare
PE
1
2
Oklahoma City area
(800) 545-0389
GPP
38.29
112.80
17.67
52.06
Both
Yes
73-530
PacifiCare of Oklahoma
N1
1
2
Tulsa area
(918) 496-8181
GPP
41.74
134.51
19.26
62.08
Both
Yes
73-396
PruCare of Oklahoma City
RR
1
2
Oklahoma City area
(405) 942-6687
GPP
34.03
83.25
15.70
38.42
Both
No
73-108
PruCare of Tulsa
RS
1
2
Tulsa area
(918) 624-4733
GPP
35.04
95.49
16.17
44.07
Both
No
73-118
Oregon
Kaiser Northwest (High)
57
1
2
Portland/Salem
(503) 721-2000
GPP
41.40
124.31
19.11
57.37
Both
Yes
73-4
Kaiser Northwest (Stnd)
57
4
5
Portland/Salem
(503) 721-2000
GPP
35.06
89.34
16.18
41.23
Both
No
73-4
PacifiCare of Oregon
SS
1
2
Portland/Salem/Corvallis
(503) 620-9324
GPP
39.05
121.34
18.02
56.00
Both
No
73-362
Qual-Med Oregon
AF
1
2
Portland Metro area
(503) 222-6691
IPP
38.56
121:01
17.80
55.85
Both
No
73-327
SelectCare
SD
1
2
Eugene/Springfield/Albany
(800) 248-2330
IPP
41.22
88.94
19.02
41.05
Both
No
73-83
Pennsylvania
AETNA Health Plans of Eastern PA
GL
1
2
Phila/Mont/Bucks/Dela/Chester Cos.
1-800-876-5000
IPP
42.53
156.00
19.63
72.00
Both
Yes
73-485
Central Medical Health Plan
24
1
2
Pittsburgh area
(412) 471-6877
MMP
38.41
131.93
17.73
60.89
Both
Yes
73-42
Foundation Health Plan
CE
1
2
NY Southern Tier
(607) 754-3380
IPP
40.84
130.39
18.85
60.18
Both
No
73-461
Free State Health Plan
LD
1
2
Portions of Southern PA
(301) 964-8168
MMP
39.11
139.56
18.05
64.41
Both
Yes
73-146
Freedom Health Care
CT
1
2
Harrisburg area
(800) 247-8452
MMP
37.18
93.61
17.16
43.20
Both
No
73-478
ABBREVIATIONS: ECF - Extended Care Facility IPP - Individual Practice Plan
GPP- Group Practice Plan
MMP- Mixed Model Plan
HHC- Home Health Care
23
FEHB Plan Comparison Chart - For Benefits Beginning in January 1992
Prepaid Plans (Commonly referred to as CMP/HMOs)
A Prepaid plan's general location is the approximate area served by the plan. To
Every Prepaid plan provides physicals, immunizations, and prescription drug benefits
enroll in a Prepaid plan, you MUST live within the plan's exact enrollment area shown
and all Prepaid plan benefit packages include catastrophic coverage, since these
in the plan's brochure.
plans provide for necessary care during a year.
Some Prepaid plans require you to share costs for certain services.
Every Prepaid plan provides benefits for mental conditions/substance abuse inpa-
tient and outpatient services. However, benefits are limited to short-term care,
Many Prepaid plans provide chiropractic care benefits and most provide hospice care
generally 30 to 45 days of inpatient care and 20 to 35 outpatient visits per calendar
benefits.
year. You typically share costs to benefit limits.
Many Prepaid plans provide "Opt-Out" benefits (see definition).
1992
1992
Enrollment
Other Benefit
Code
Monthly Premium
Biweekly Premium
Features
Prepaid Plan
Plan Telephone
Plan
Your Share
Your Share
Brochure
General Location
Number
Name and Option
Number
Type
ECF
Plan
Self
Self &
Self
Self &
Self
Self &
Dental
RI
and/or
Code
Only
Family
Only
Family
Only
Family
HHC
Care
Pennsylvania (cont.)
Freedom Health Care
KJ
1
2
Philadelphia and Reading area
(800) 822-0505
MMP
38.04
121.01
17.56
55.85
Both
No
73-478
Geisinger Health Plan
N9
1
2
Central, Northeast Pennsylvania
(717) 271-8760
MMP
22.92
73.19
10.58
33.78
Both
No
73-303
Greater Atlantic Health Service
27
1
2
Southeast Pennsylvania
(215) 823-8610
MMP
35.15
92.06
16.22
42.49
Both
No
73-40
HealthAmerica Pennsylvania
26
1
2
Pittsburgh area
(412) 553-7300
MMP
33.23
93.03
15.34
42.94
Both
Yes
73-255
HealthAmerica Pennsylvania
SW
1
2
Central Pennsylvania
(717) 763-9313
MMP
33.18
86.53
15.31
39.94
Both
Yes
73-255
HealthGuard of Lancaster
NQ
1
2
Lancaster County
(717) 560-9049
IPP
30.57
83.50
14.11
38.54
Both
No
73-311
HMO of Northeastern Pennsylvania
C8
1
2
Northeastern Pennsylvania
(717) 821-1241
IPP
30.86
79.37
14.24
36.63
Both
Yes
73-480
Keystone Health Plan Central
S4
1
2
Harrisburg area
1-800-622-2843
IPP
33.19
81.90
15.32
37.80
Both
No
73-241
Keystone Health Plan Central
ST
1
2
Lehigh Valley area
1-800-622-2843
IPP
34.46
91.57
15.90
42.26
Both
No
73-241
Keystone Health Plan East
ED
1
2.
Greater Philadelphia area
(215) 558-3337
IPP
37.70
108.38
17.40
50.02
Both
Yes
73-483
Keystone Health Plan West
EF
1
2
Pittsburgh area
(412) 937-4330
IPP
34.80
122.68
16.06
56.62
Both
No
73-484
Medigroup HMO
E4
1
2
Portion of Lower Bucks County
(609) 259-5965
MMP
89.31
268.06
41.22
123.72
Both
No
73-393
Riverside Health Plan
HG
1
2
Beaver Valley area in Southwest PA
(412) 775-4404
IPP
33.66
88.33
15.53
40.77
Both
No
73-487
US Healthcare/PA (High)
SU
1
2
Southeastern PA
1-800-537-9384
IPP
39.97
131.89
18.45
60.87
Both
Yes
73-52
US Healthcare/PA (Stnd)
SU
4
5
Southeastern PA
1-800-537-9384
IPP
32.94
85.85
15.20
39.62
Both
No
73-52
US Healthcare/PA (Pitt.) (High)
KL
1
2
Pittsburgh area
1-800-537-9384
IPP
37.48
132.65
17.30
61.22
Both
Yes
73-52
US Healthcare/PA (Pitt.) (Stnd)
KL
4
5
Pittsburgh area
1-800-537-9384
IPP
32.49
89.44
15.00
41.28
Both
No
73-52
Puerto Rico
Health Plus, Inc.
ME
1
2
Puerto Rico
(809) 782-7900
IPP
24.35
59.27
11.24
27.36
Both
No
73-507
SSS Plan
89
1
2
Puerto Rico
(809) 749-4777
IPP
32.87
73.00
15.17
33.69
Both
Yes
73-16
Rhode Island
Harvard Community Health Plan, Inc.
68
1
2
Northern Rhode Island
(617) 739-6161
GPP
61.62
239.49
28.44
110.53
Both
Yes
73-21
Harvard Health - New England
70
1
2
Rhode Island
(401) 331-4034
GPP
33.85
81.63
15.62
37.67
Both
Yes
73-23
HMO Rhode Island
DA
1
2
Rhode Island
(401) 274-6674
MMP
49.19
149.72
22.70
69.10
Both
No
73-489
Pilgrim Health Care
PZ
1
2
Rhode Island
(617) 871-3950
IPP
50.34
225.03
23.23
103.86
Both
Yes
73-139
South Carolina
Companion Health Care
SE
1
2
Portions of South Carolina
1-800-868-2528
IPP
36.71
113.58
16.94
52.42
Both
Yes
73-548
Healthsource South Carolina
M3
1
2
Charleston area
(803) 723-5520
IPP
39.21
109.20
18.10
50.40
Both
No
73-536
Maxicare North Carolina
Q5
1
2
Chester and York Counties
(800) 822-0012
MMP
40.10
138.69
18.51
64.01
Both
No
73-227
Maxicare South Carolina
TA
1
2
Columbia/Greenville/Spartanburg
(800) 334-6294
MMP
69.47
197.13
32.06
90.98
Both
No
73-180
Enrollment
1992
1992
Other Benefit
Code
Monthly Premium
Biweekly Premium
Features
Prepaid Plan
Plan Telephone
Plan
Your Share
Your Share
Brochure
General Location
Number
Name and Option
Number
Type
ECF
Plan
Self
Self &
Self
Self &
Self
Self &
Dental
RI
and/or
Code
Only
Family
Only
Family
Only
Family
HHC
Care
South Carolina (cont.)
PruCare-Charlotte
Q4
1
2
York County
(704) 365-6070
GPP
31.86
89.21
14.70
41.17
Both
No
73-340
Tennessee
AETNA Health Plans of Tennessee
TN
1
2
Nashville and Central Tennessee
1-800-537-5097
IPP
40.74
165.08
18.80
76.19
Both
No
73-571
CIGNA Healthplan of Tennessee
SR
1
2
Memphis area
(915) 683-3311
IPP
49.77
172.86
22.97
79.78
Both
No
73-356
PruCare of Memphis
UB
1
2
Shelby County
(901) 766-7908
GPP
32.59
93.84
15.04
43.31
Both
No
73-122
PruCare of Nashville
UA
1
2
Nashville area
(615) 248-7156
GPP
37.76
109.83
17.43
50.69
Both
No
73-92
Tennessee First Health Plan
HT
1
2
Knoxville area
(800) 634-1454
IPP
32.47
112.65
14.98
51.99
Both
No
73-491
Texas
CIGNA Healthplan of Texas-Dallas
UG
1
2
Dallas/Ft. Worth area
(214) 401-5310
MMP
55.21
164.84
25.48
76.08
Both
Yes
73-119
CIGNA Healthplan of Texas-Houston
UH
1
2
Houston area
(713) 552-7600
MMP
43.97
207.20
20.29
95.63
Both
No
73-124
Coastal Bend Health Plan
T5
1
2
Corpus Christi area
(512) 887-0101
IPP
39.66
172.10
18.30
79.43
Both
No
73-299
EQUICOR Healthplan of Houston
V1
1
2
Houston area
(713) 552-7600
IPP
43.97
207.20
20.29
95.63
Both
No
73-271
FIRSTCARE
CK
1
2
Potter/Randall/Carson/Armstrng Cos.
(806) 358-5151
IPP
91.26
195.37
42.12
90.17
Both
No
73-496
Harris Methodist Health Plan
SC
1.
2
Ft. Worth/Dallas Metroplex
(817) 878-5880
IPP
82.27
175.85
37.97
81.16
Both
No
73-547
Humana Care Plan
UR
1
2
San Antonio area
(512) 617-1010
MMP
37.89
106.52
17.49
49.16
Both
Yes
73-70
Humana of Corpus Christi
TX
1
2
Corpus Christi area
(512) 994-2020
IPP
33.19
118.00
15.32
54.46
Both
No
73-237
Kaiser Texas
UK
1
2
Dallas/Ft. Worth area
(214) 458-8645
GPP
38.00
121.19
17.54
55.93
Both
No
73-63
PacifiCare of Texas
GF
1
2
San Antonio area
(512) 641-7838
MMP
33.64
94.19
15.52
43.47
Both
No
73-498
PCA Health Plans of Texas
TW
1
2
Austin/Waco/Temple/Bryan/Collge Station
1-800-234-7912
IPP
37.20
124.85
17.17
57.62
Both
No
73-198
PruCare Austin
UN
1
2
Austin area
(512) 465-6661
GPP
31.48
84.92
14.53
39.19
Both
No
73-91
PruCare Houston
UP
1
2
Houston Metro area
(713) 993-3801
GPP
28.63
83.25
13.21
38.42
Both
Yes
73-48
SANUS/New York Life Health Plan
UM
1
2
Houston Metro area
(713) 993-9982
MMP
43.51
172.45
20.08
79.59
Both
No
73-120
SANUS Texas Health Plan
V2
1-
2
Dallas/Ft. Worth Metroplex
(214) 929-0376
IPP
40.62
125.89
18.75
58.10
Both
Yes
73-264
Scott and White Health Plan
UF
1
2
Bryan/College Station/Temple/Killeen/Waco
(817) 774-4000
GPP
41.04
141.81
18.94
65.45
Both
No
73-102
Southwest, an AETNA Health Plan
TS
1
2
Dallas/Ft. Worth area
1-800-992-7947
IPP
42.08
179.99
19.42
83.07
Both
No
73-572
Utah
FHP/Utah
KU
1
2
Ogden/Salt Lake areas
(801) 355-1234
GPP
33.48
107.58
15.45
49.65
Both
Yes
73-564
PHP/UT
UT
1
2
Salt Lake City area (6 counties)
(801) 942-6967
IPP
43.36
93.23
20.01
43.03
Both
No
73-581
Vermont
Community Health Plan
PW
1
2
Most of Vermont (7 Counties)
(802) 878-1008
MMP
37.64
105.20
17.37
48.55
Both
No
73-53
Harvard Community Health Plan, Inc.
68
1
2
Southern Vermont
(617) 739-6161
GPP
61.62
239.49
28.44
110.53
Both
Yes
73-21
Kaiser Massachusetts
K1
1
2
Southeastern Vermont
(413) 256-0151
GPP
49.66
114.71
22.92
52.94
Both
Yes
73-86
Virginia
AETNA HEALTH PLAN
V8
1
2
Northern Virginia
1-800-537-5096
IPP
37.50
104.46
17.31
48.21
Both
Yes
73-250
CIGNA Healthplan of Virginia/Central VA
W3
1
2
Central Virginia
(804) 273-1150
IPP
38.28
126.84
17.67
58.54
Both
No
73-270
ABBREVIATIONS: ECF - Extended Care Facility IPP - Individual Practice Plan
GPP- Group Practice Plan
MMP- Mixed Model Plan
HHC- Home Health Care
25
26
FEHB Plan Comparison Chart - For Benefits Beginning in January 1992
Prepaid Plans (Commonly referred to as CMP/HMOs)
A Prepaid plan's general location is the approximate area served by the plan. To
Every Prepaid plan provides physicals, immunizations, and prescription drug benefits
enroll in a Prepaid plan, you MUST live within the plan's exact enrollment area shown
and all Prepaid plan benefit packages include catastrophic coverage, since these
in the plan's brochure.
plans provide for necessary care during a year.
Some Prepaid plans require you to share costs for certain services.
Every Prepaid plan provides benefits for mental conditions/substance abuse inpa-
tient and outpatient services. However, benefits are limited to short-term care,
Many Prepaid plans provide chiropractic care benefits and most provide hospice care
generally 30 to 45 days of inpatient care and 20 to 35 outpatient visits per calendar
benefits.
year. You typically share costs to benefit limits.
Many Prepaid plans provide "Opt-Out" benefits (see definition).
1992
1992
Enrollment
Other Benefit
Monthly Premium
Biweekly Premium
Code
Features
Prepaid Plan
Plan Telephone
Plan
Your Share
Your Share
Brochure
General Location
Number
Name and Option
Number
Type
ECF
Plan
Self
Self &
Self
Self &
Self
Self &
Dental
RI
and/or
Code
Only
Family
Only
Family
Only
Family
Care
HHC
Virginia (cont.)
CIGNA Healthplan of Virginia/Southeast VA
W2
1
2
Southeastern Virginia
(804) 498-1555
IPP
39.48
139.73
18.22
64.49
Both
No
73-270
George Washington Univ HP (High)
E5
1
2
Washington, DC area
(202) 416-0400
MMP
60.91
128.79
28.11
59.44
Both
Yes
73-46
George Washington Univ HP (Stnd)
E5
4
5
Washington, DC area
(202) 416-0400
MMP
35.84
76.88
16.54
35.48
Both
Yes
73-46
Group Health Association (High)
50
1
2
Northern Virginia
(202) 966-4357
GPP
56.51
165.41
26.08
76.34
Both
Yes
73-8
Group Health Association (Stnd)
50
4
5
Northern Virginia
(202) 966-4357
GPP
28.97
73.80
13.37
34.06
Both
Yes
73-8
HealthPlus (High)
JN
1
2
DC Metro area
(301) 441-1600
IPP
40.13
94.34
18.52
43.54
Both
Yes
73-67
HealthPlus (Stnd)
JN
4
5
DC Metro area
(301) 441-1600
IPP
29.68
68.25
13.70
31.50
Both
Yes
73-67
HMO Virginia
V7
1
2
Hampton Roads area
(800) 421-1880
MMP
37.89
147.51
17.49
68.08
Both
No
73-235
HMO Virginia
X8
1
2
Richmond area
(804) 358-7390
MMP
39.70
160.16
18.32
73.92
Both
No
73-235
Kaiser/Mid-Atlantic
E3
1
2
Washington, DC area
(202) 364-3400
GPP
35.67
96.25
16.46
44.42
Both
Yes
73-47
Lincoln National Health Plan
DS
1
2
Northern Virginia
1-800-782-0622
IPP
43.38
142.20
20.02
65.63
Both
Yes
73-442
M.D. IPA
JP
1
2
Northern Virginia, Richmond and Tidewater
(301) 294-5100
IPP
31.03
87.66
14.32
40.46
Both
Yes
73-100
OPTIMA (High)
V9
1
2
Peninsula/Southside Hampton Roads
(804) 552-7410
IPP
66.98
150.91
30.91
69.65
Both
Yes
73-253
OPTIMA (Stnd)
V9
4
5
Peninsula/Southside Hampton Roads
(804) 552-7410
IPP
23.62
89.79
10.90
41.44
Both
Yes
73-253
Physicians Care
X9
1
2
DC Metro area
1-800-542-7258
IPP
52.03
229.50
24.01
105.92
Both
Yes
73-331
PruCare of Richmond
V6
1
2
Richmond area
(804) 323-0900
MMP
31.42
85.78
14.50.
39.59
Both
No
73-132
Prudential Health Plan/Mid-Atlantic
HD
1
2
Northern Virginia
1-800-888-5447
MMP
41.43
165.65
19.12
76.45
Both
Yes
73-413
Sentara Health Plan
V5
1
2
Peninsula/Southside Hampton Roads
(804) 552-7110
MMP
55.73
118.87
25.72
54.86
Both
Yes
73-228
Washington
Group Health Cooperative (High)
54
1
2
Puget Sound area
(206) 448-4140
MMP
55.15
164.00
25.45
75.69
HHC
Yes
73-12
Group Health Cooperative (Stnd)
54
4
5
Puget Sound area
(206) 448-4140
MMP
36.79
85.18
16.98
39.31
HHC
No
73-12
Group Health Northwest
VR
1
2
Spokane/Tri Cit./Yak./Ellens./Walla W.
(509) 783-3484
MMP
39.55
120.41
18.25
55.57
Both
Yes
73-96
Kaiser Northwest (High)
57
1
2
Vancouver/Longview
(503) 721-2000
GPP
41.40
124.31
19.11
57.37
Both
Yes
73-4
Kaiser Northwest (Stnd)
57
4
5
Vancouver/Longview
(503) 721-2000
GPP
35.06
89.34
16.18
41.23
Both
No
73-4
Kitsap Physicians Service (High)
VT
1
2
Kitsap, Mason, Jefferson Counties
1-800 552-7114
IPP
101.60
213.92
46.89
98.73
Both
No
73-51
Kitsap Physicians Service (Stnd)
VT
4
5
Kitsap, Mason, Jefferson Counties
1-800 552-7114
IPP
38.41
82.03
17.73
37.86
Both
Yes
73-51
Pacific Health Plans
WB
1
2
King/Snohomish/Kitsap/Pierce/Thurstor
1-800-722-4666
MMP
32.87
89.71
15.17
41.40
Both
No
73-329
PacifiCare of Oregon
SS
1
2
Clark County
1-800-922-1444
GPP
39.05
121.34
18.02
56.00
Both
No
73-362
Qual-Med Oregon
AF
1
2
Clark County
1-800-388-8335
IPP
38.56
121.01
17.80
55.85
Both
No
73-327
Qual-Med Washington
TM
1
2
Most of Washington
1-800-869-7165
IPP
39.18
127.64
18.08
58.91
Both
No
73-287
1992
1992
Enrollment
Other Benefit
Code
Monthly Premium
Biweekly Premium
Features
Prepaid Plan
Plan Telephone
Plan
Your Share
Your Share
Brochure
*U.S. G.P.0.:1991-299-607S
General Location
Number
Name and Option
Number
Type
ECF
Plan
Self
Self &
Self
Self &
Self
Self &
Dental
RI
and/or
Code
Only
Family
Only
Family
Only
Family
HHC
Care
Washington (cont.)
SelectCare
SD
1
2
Cowlitz & Wahkiakum Counties
(206) 577-4419
IPP
41.22
88.94
19.02
41.05
Both
No
73-83
West Virginia
Free State Health Plan
LD
1
2
Portions of Northeastern WV
(301) 964-8168
MMP
39.11
139.56
18.05
64.41
Both
Yes
73-146
Health Guard
MA
1
2
Portions of West Virginia
(614) 676-4623
MMP
32.23
82.93
14.87
38.28
Both
No
73-504
Health Plan of the Upper Ohio Valley
U4
1
2
Northern West Virginia
(614) 695-3585
IPP
32.72
81.89
15.10
37.79
Both
No
73-553
Wisconsin
Chicago HMO Ltd
FJ
1
2
Kenosha area
(312) 751-4460
MMP
36.38
124.46
16.79
57.44
Both
Yes
73-199
Compcare Health Services
69
1
2
Southeastern Wisconsin
(414) 226-6744
MMP
38.26
112.74
17.66
52.03
Both
Yes
73-22
DeanCare HMO
WD
1
2
South Central Wisconsin
(608) 828-1301
GPP
32.69
88.27
15.09
40.74
Both
No
73-189
Family Health Plan
WH
1
2
Metropolitan Milwaukee
(414) 256-0040
GPP
34.56
89.75
15.95
41.42
Both
Yes
73-81
Greater Marshfield Health Plan
WY
1
2
Marshfield and surrounding counties
(800) 472-2363
MMP
181.31
416.72
83.68
192.33
Both
Yes
73-38
Group Health Coop of Eau Claire
WT
1
2
West Central Wisconsin
(715) 836-8552
GPP
40.87
142.33
18.86
65.69
Both
No
73-552
Group Health Coop/South Central WI
WJ
1
2
Madison and adjacent areas
(608) 251-3356
GPP
31.79
84.82
14.67
39.15
Both
Yes
73-61
HMO Midwest
CV
1
2
West Central & Northwestern Wisconsin
(800) 535-4041
MMP
30.45
90.02
14.05
41.55
Both
No
73-454
HMO of Wisconsin
W4
1
2
Southern/Central Wisconsin
(800) 362-3308
IPP
37.55
115.01
17.33
53.08
Both
No
73-317
Maxicare Wisconsin
WG
1
2
Milwaukee area
(414) 271-6865
MMP
33.38
86.15
15.41
39.76
Both
Yes
73-179
Physicians Plus HMO
29
1
2
South Central Wisconsin
(608) 282-8505
MMP
38.45
116.96
17.74
53.98
Both
No
73-559
PrimeCare Health Plan, Inc.
WK
1
2
Milwaukee area
(414) 453-9070
IPP
41.20
129.59
19.01
59.81
Both
Yes
73-172
U-Care HMO
WC
1
2
Dane County area
(608) 833-6666
MMP
33.12
88.25
15.28
40.73
Both
Yes
73-562
Wisconsin Health Organization
X1
1
2
Southeastern Wisconsin
(414) 223-3300
IPP
36.36
95.25
16.78
43.96
Both
No
73-367
ABBREVIATIONS: ECF - Extended Care Facility IPP - Individual Practice Plan
GPP- Group Practice Plan. MMP- Mixed Model Plan
HHC- Home Health Care
27
FEHB
FEDERAL EMPLOYEES
HEALTH BENEFITS PROGRAM
INFORMATION FOR FEDERAL CIVILIAN EMPLOYEES
AND U.S. POSTAL SERVICE EMPLOYEES
United States
FPM Supplement 890-1
Office of
GSA Control No. 2809-219
Personnel
NSN 7540-00-130-8501
Management
SF 2809-A
Rev. June 1990
TO EMPLOYEES:
One of the benefits of working for the Government is the protection against the cost of medical care available to you through the
Federal Employees Health Benefits (FEHB) Program. This pamphlet contains information about your rights and obligations under
the Program and describes its major features. The information may be subject to change because of statutory or regulatory
revisions that take effect after publication. Your employing office can give you the most up-to-date information.
To aid you in selecting the health care protection best suited to your needs, you should review the most current FEHB Enrollment
Information Guide and Plan Comparison Chart applicable to you (see below) and the official brochure for the health benefits plan
or plans in which you are interested. These may be obtained from your employing office.
UNITED STATES
OFFICE OF PERSONNEL MANAGEMENT
FEHB Enrollment Information Guide and Plan Comparison Chart Booklets for Employees
RI 70-1 Federal Employees (Non-Postal)
RI 70-2 Postal Employees
RI 70-5 Individuals Eligible for Temporary Continuation of FEHB Coverage
RI 70-6 Individuals Receiving Compensation from the Office of Workers' Compensation Programs
(OWCP)
RI 70-7 Employees in Positions Outside the Continental U.S. (including Alaska, Hawaii, Guam and
Puerto Rico)
RI 70-8 Temporary Employees Eligible for FEHB under 5 U.S.C. 8906a
RI 70-10 Visually Impaired Employees
2
TABLE OF CONTENTS
Participation is Voluntary
4
Who is Eligible to Enroll
4
What the Program Offers You
4
Cost of Enrollment
4
Types of Plans Available
4
Types of Enrollment
5
Enrollment of Former Spouses
6
Dual Enrollment
6
Opportunities to Enroll or Change Enrollment
6
Effective Dates
7
Identification Cards
7
Coordination of Benefits
7
Circumstances Permitting Continuation of Enrollment
8
Cancellation of Enrollment
9
Termination of Enrollment
9
31-Day Extension of Coverage
10
Conversion Rights
10
Temporary Continuation of Coverage
10
Cost Containment
11
Review of Claims
12
Table of Permissible Changes in Enrollment
13
3
PARTICIPATION IS VOLUNTARY
A Government contribution toward the cost of your plan
(unless you are a temporary employee required to pay
The Federal Employees Health Benefits Program helps
both the Government and employee shares of the cost).
protect you and your eligible family members from the
expenses of illness and accident. It is a voluntary program.
The payroll deduction method of making premium
Whether you enroll or not is entirely up to you; but, if you are
payments.
eligible, you are encouraged to enroll for this protection. If
you do enroll, you may cancel your enrollment at any time. If
Extended protection for 31 days without cost to you after
you don't enroll at your first opportunity, you won't be able to
your enrollment or coverage of a family member ends
enroll until Open Season or until another event permitting
(unless you voluntarily cancel).
enrollment occurs (see the table on page 13).
Under certain circumstances, an opportunity for
temporary continuation of group coverage or conversion
IMPORTANT
to nongroup coverage if your enrollment ends or a
covered family member loses eligibility for coverage.
You will not be eligible for health benefits coverage
after retirement unless you are enrolled before you
If you meet certain requirements, continued protection
retire and meet all the requirements for continuation
for you and eligible family members after your retirement
of enrollment after retirement (see page 8).
or while you are receiving compensation from the Office
of Workers' Compensation Programs for a work-related
injury.
If certain conditions are met, confinued protection for
WHO IS ELIGIBLE TO ENROLL
your eligible family members after your death.
All permanent employees with regularly scheduled tours of
duty and temporary employees whose appointments are for
COST OF ENROLLMENT
longer than one year are eligible to enroll in the FEHB
Program. Also eligible to enroll are temporary employees
Unless you are a temporary employee who is required to pay
with an appointment for one year or less who have com-
the total cost, you and the Government share the cost of your
pleted one year of current, continuous employment, exclud-
enrollment. Under current law, the Government pays 60
ing any break in service of five days or less. Employees
percent of the average high option premium of six of the
whose appointments are intermittent (without a prearranged
largest health benefits plans in the Program, but not more
regular tour of duty), or short-term (limited to one year or
than 75 percent of the total premium for any plan. (For
less) are not eligible to enroll.
Postal employees, the Postal Service pays 75 percent of the
average of the "Big 6," but not more than 93.75 percent of
the total premium.) After the Government contribution is
WHAT THE PROGRAM OFFERS YOU
deducted from the total cost, you pay the remainder of the
premium through salary withholdings. Premiums are
An opportunity, within 31 days from the date of your
adjusted annually; the amount you would currently pay under
appointment (or from the date you become eligible), to
any plan in the Program is shown in the most recent
enroll in a health benefits plan with group-rated
Enrollment Information Guide and Plan Comparison
premiums and benefits.
Chart applicable to you (see page 2).
An annual opportunity, during Open Season, to enroll in
a health benefits plan if you are not already enrolled or, if
Note 1: The formula utilized to compute the
you are enrolled, to change to another plan or option.
Government contribution has been modified for
1990 (and 1991), because of the departure from the
A choice of plans and options so that you can get the
FEHB Program of the Aetna Indemnity Plan, whose
kind and amount of protection best suited to your
high option premium had been used in computing
personal and family health needs and finances.
the Government's share prior to 1990.
Guaranteed protection that can't be canceled by the
Note 2: If you are a part-time employee appointed
plan.
under the Federal Employees Part-Time Career
Employment Act of 1978, you should contact your
Coverage without medical examination or restrictions
employing office for information about the cost of
because of age, current health or pre-existing medical
enrollment. Only a portion of the Government
conditions. (Plans may limit benefits for dentistry or
contribution is paid toward your total premium.
cosmetic surgery to conditions arising after the effective
Therefore, your share of the premium will be
date of coverage.)
greater than the amount that appears in the
Enrollment Information Guide and Plan Comparison
Coverage without waiting periods after the effective date
Chart.
of enrollment.
Catastrophic protection against unusually large medical
bills. (Fee-for-service plans limit the amount of covered
TYPES OF PLANS AVAILABLE
expenses you would have to pay out-of-pocket for
yourself and your family; prepaid plans provide or
The two basic types of health benefits plans available to you
arrange for all necessary care.)
under the FEHB Program are fee-for-service plans and
prepaid plans.
4
Fee-for-Service Plans
For whom a judical determination of support has
been obtained; or
These plans reimburse you or the health care provider for
covered services. If you enroll in one of these plans, you
To whose support you make regular and substantial
may choose your own physician, hospital and other health
contributions.
care providers.
Your unmarried dependent stepchildren under age 22 if
Fee-for-service plans include the Service Benefit Plan
they live with you in a regular parent-child relationship.
administered by Blue Cross and Blue Shield and plans
sponsored by unions and other employee organizations.
Your unmarried dependent foster child (or children)
under age 22 if:
The Blue Cross and Blue Shield plan is open to all Federal
employees. Some employee organization plans are open to
The child (who may or may not be related to you)
all Federal employees who hold full or associate member-
lives with you in a regular parent-child relationship;
ships in the organizations that sponsor the plans; the other
and
employee organization plans are restricted to employees in
certain occupational groups and/or agencies. Generally, the
You are raising the child as your own, exercising full
employee organizations require you to pay a membership fee
parental responsibility and control; and
or dues in addition to your health plan premium. (Such
membership charges are paid directly to the employee
You expect to continue to raise the child indefinitely
organizations and are not part of the FEHB Program.)
into adulthood.
Prepaid Plans
A child is not a foster child for health benefits purposes
if:
These are the Comprehensive Medical Plans/Health
Maintenance Organizations (CMP/HMOs) that provide or
The child is temporarily living with you as a matter of
arrange for health care by designated plan physicians,
convenience; or
hospitals, and other providers in particular locations.
CMP/HMOs are either Group Practice Plans, Individual
A welfare or social service agency places the child in
Practice Plans or a combination of both (called Mixed Model
your home and retains control of the child; or
Plans). Group Practice Plans provide care through a group
of physicians who practice at medical centers operated by or
A natural parent of the child also lives with you and is
under contract to the plans. Individual Practice Plans provide
able to exercise or share parental responsibility and
care through participating physicians who practice in their
control.
own offices.
Your unmarried dependent children age 22 or over who
Each CMP/HMO is open to all Federal employees who live
are incapable of self-support because of physical or
within the plan's enrollment area. It is very important that you
mental incapacity that existed before their 22nd birthday;
are sure you live in the plan's enrollment area before you
the incapacity must be expected to last at least one year
enroll in one of these plans. The enrollment area is de-
from the date of medical certification of incapacity. (Ask
scribed in the plan's brochure.
your employing office about the medical certification
required for a child age 22 or over. If the child is not yet
22, you should submit the medical certificate to your
TYPES OF ENROLLMENT
employing office at least 30 days before the child's 22nd
birthday.)
Each FEHB plan has two types of enrollment: (1) self only
and (2) self and family.
All eligible family members are covered under a self and
family enrollment; you can't decide to cover some and
Self Only Enrollment
exclude others. However, other relatives -- for example, your
parents or grandchildren (unless a foster parent-child
This enrollment provides benefits only for you.
relationship exists) -- are not eligible for coverage as family
members even though they live with you and are dependent
Self and Family Enrollment
upon you.
This enrollment provides benefits for you and your eligible
family members.
Events Causing Family Members
Family Members Eligible for Coverage
to Lose Eligibility for Coverage
Your spouse.
If family member is----
Event
Your unmarried dependent children under age 22,
Your wife or husband
Divorce or annulment of
including legally adopted children.
marriage.
Your unmarried dependent recognized children under
A child under age 22
Marriage or attainment of age
age 22 born out of wedlock:
22. (A child whose marriage
ends before age 22 may again
Who live with you in a regular parent-child relation-
become eligible.)
ship; or
5
Note: You will not be notified by either your
IMPORTANT
employing office or your plan when your child loses
eligibility because of age. As indicated on page 11,
Your employing office does not monitor changes in
if your child wants to temporarily continue group
your marital or family status and will not automati-
coverage, you must notify your employing office
cally change your enrollment. If you need to
of the child's loss of eligibility for coverage as a
change your enrollment from self only to self and
family member within 60 days after his or her 22nd
family or vice versa, you must file an SF 2809 with
birthday; if he or she wants to convert to nongroup
your employing office. See the table on page 13 to
coverage, you or the child must apply to the carrier
find out when such changes may be made.
of your plan for a conversion contract within 31
days after his or her 22nd birthday.
A disabled child age 22
ENROLLMENT OF FORMER SPOUSES
or over
Marriage or recovery of ability
for self-support.
Certain former spouses of employees (and of former
employees and annuitants), whose marriage ended before
Family members lose eligibility for coverage on the day
the employee's (or former employee's or annuitant's) death,
that any of the above events occurs, subject to the
may enroll in the FEHB Program under the Spouse Equity
31-day extension of coverage for conversion to a
law or similar statutes. Once enrolled, former spouses must
nongroup health benefits contract (see page 10).
pay the total premium for the plan they select, including the
Government share. (See Cost of Enrollment on page 4). For
You do not have to notify your employing office when a
further information about the enrollment of former spouses,
family member loses eligibility for coverage if at least
contact your employing office.
one other eligible family member remains covered by
your self and family enrollment. However, if your spouse
loses eligibility because of your divorce, you should
Note: Former spouses who are not eligible to enroll
promptly notify your plan in writing. (See also Enrollment
under the Spouse Equity law (or similar statutes)
of Former Spouses below, Conversion Rights on page
may be eligible to continue FEHB coverage on a
10 and Temporary Continuation of Coverage on page
temporary basis (see page 10 ).
10.)
If you become the only person covered by your self and
family enrollment, you may immediately change to a less
expensive self only enrollment. To do this, obtain a
DUAL ENROLLMENT
Health Benefits Registration Form (Standard Form (SF)
2809) from your employing office, complete the form and
Normally, you may not enroll or be enrolled as an employee if
return it to your employing office.
you are covered as a family member under someone else's
enrollment in the FEHB Program. However, such dual
enrollments may be permitted under certain circumstances in
Coverage of New Family Members
order to
Protect the interests of children who otherwise would
Self Only Enrollment
lose coverage as family members, or
You must change to a self and family enrollment if you want
Enable an employee who is under age 22 and covered
to provide coverage for a new family member, e.g., a
under a parent's enrollment and becomes the parent of
newborn child or a new spouse. To do this, find the event
a child to enroll for self and family coverage.
that permits the change in the table on page 13 to determine
when you can change. Then complete an SF 2809 and give
No person (employee or family member) is entitled to receive
it to your employing office within 60 days after a change in
benefits under more than one enrollment in the Program.
family status or anytime between 31 days before and 60
days after a change in marital status.
Your employing office can give you details about permissible
dual enrollments.
Self and Family Enrollment
A new family member is automatically covered under your
self and family enrollment, but your plan may ask you for
OPPORTUNITIES TO ENROLL
information to verify the family member's eligibility when a
claim for benefits is filed for that person.
OR CHANGE ENROLLMENT
New or Newly Eligible Employees
You are required to complete a Health Benefits Registration
Form (Standard Form (SF) 2809) obtained from your
employing office. You must indicate on the form whether you
want to enroll or do not want to enroll in an FEHB plan.
6
You must return the completed SF 2809 to your employing
pay status requirement doesn't apply to a change from self
office:
and family to self only.)
Within 31 days after
If you are a
There are exceptions --
Your date of appointment
New employee.
Open Season. Your employing office can give you the
specific day on which your enrollment or enrollment
The date you become
change will take effect.
eligible to enroll
Newly eligible employee.
Change from Self Only to Self and Family Due to the
Birth or Addition of a Child as a New Family Member.
All Eligible Employees
This change takes effect on the first day of the pay period
in which the child is born or becomes an eligible family
If you are not enrolled, you will be able to enroll only when
member, regardless of your pay status.
an event permitting enrollment occurs. Such events, which
are listed in the table on page 13, include (but are not limited
Cancellation. See page 9.
to) --
Additional information about effective dates appears in the
Open-Season.
table on page 13.
Change in marital status.
Note: If you change plans or change options in your
Loss of coverage as a family member under FEHB.
current plan, and you or a family member covered by
your prior plan or option are confined in a hospital on
Loss of coverage under spouse's non-Federal health
the date your enrollment change takes effect,
plan if spouse involuntarily loses his or her coverage or
benefits of the prior plan or option will continue
coverage for his or her dependents.
temporarily for the confined person. Benefits will
continue (unless they are exhausted) for each
additional day of continuous confinement through the
If you are enrolled, you may change your enrollment only
91st day after the date your enrollment change takes
when an event permitting the change you want to make
effect. Benefits of the new plan or option will not
occurs (see table). However, you may change from self and
begin for the confined person until the day after his or
family to self only at any time.
her confinement ends or the 92nd day after the date
your enrollment change takes effect, whichever is
To enroll or change your enrollment, obtain an SF 2809 from
earlier.
your employing office, complete the form and return it to your
employing office within the time limit specified in the table for
the event permitting the enrollment or enrollment change.
IDENTIFICATION CARDS
IMPORTANT
Once your enrollment or enrollment change is processed, your
plan will send you an identification card. However, you should
You will not be eligible for health benefits coverage
keep the copy of the SF 2809 your employing office gives you
after retirement unless you are enrolled before you
for your records. If you need to obtain benefits before you
retire and meet all the requirements for continuation
receive your identification card, contact your plan for assis-
of enrollment after retirement (see page 8).
tance and use your copy of the SF 2809 as proof of your
enrollment or enrollment change. Do not send bills or claims
to your employing office or the Office of Personnel
Management.
Temporary Employees Eligible for FEHB Under 5
U.S.C. 8906a
COORDINATION OF BENEFITS
If you are a temporary employee with an appointment for one
year or less who has completed one year of current continu-
Double Coverage
ous employment, excluding any break in service of five days
or less, you are eligible under section 8906a of the FEHB law
Because many people covered by FEHB plans also have
to participate in the FEHB Program. All of the above
other health care protection, all FEHB plans have a coordina-
enrollment and enrollment change information applies to you
tion of benefits (COB), or double coverage, provision. The
with one exception. A decision not to enroll will not affect
provision applies when a person covered by an FEHB plan is
your future eligibility to continue FEHB enrollment after
also entitled to benefits under any other kind of group health
insurance, Medicare or no-fault or other automobile insurance
retirement (see page 8).
that pays benefits without regard to fault. The purpose of the
provision is to enable enrollees and covered family members
to recover as much of their health care expenses as their total
EFFECTIVE DATES
coverage permits, but not more than the actual charges for the
In general, enrollments and enrollment changes take effect on
care. Under COB, or double coverage, one plan normally
the first day of the pay period that begins after your employing
pays its benefits in full as the primary payer, and the other plan
office receives your completed SF 2809 and follows a pay
pays a reduced benefit as the secondary payer. The com-
period during any part of which you were in a pay status. (The
bined amount paid by both plans will usually equal 100% of
covered, or allowable, expenses.
7
Say, for example, that a person with double coverage is
You are eligible for FEHB Program coverage in your
charged $100.00 for medical services received, that the
new position.
actual charge is an allowable expense of both plans, and that
the benefit of each plan is 80% of the allowable expense.
Normally, the plan designated as the primary payer would
pay $80.00, or its benefit in full, and the plan designated as
Note: If you are not enrolled in an FEHB plan at the
the secondary payer would pay only the remaining $20.00.
time you transfer, you will have an opportunity to
enroll if you have a break in service of more than
Except for Medicare, primary and secondary payers are
three days and you are eligible for FEHB coverage
determined according to the guidelines of the National
in the new position.
Association of Insurance Commissioners. Generally, the
plan that covers you as an enrollee is the primary payer; the
plan that covers you as a family member is the secondary
Leave Without Pay (LWOP)
payer.
If you go on LWOP (or your pay isn't enough to cover your
The COB provision helps reduce the FEHB plan premium
share of the premium), your enrollment will continue for up to
that you pay.
one year, unless you cancel it (see page 9). However, you
are responsible for paying your share of the premium. Your
FEHB Plans and Medicare
employing office will tell you how to make the premium
payments.
Plans under the FEHB Program typically provide protection
against the same kinds of expenses as Medicare, which has
Military Service
two parts (Part A, hospital insurance, and Part B, medical
insurance). Under the law, if you're an employee age 65 or
Your enrollment will continue without change if you enter on
over and have Part A, your FEHB plan is the primary payer
active duty in the military service for 30 days or less.
and Medicare is the secondary payer of benefits provided
under both your plan and Medicare Part A or Part B.
If you enter on active duty for more than 30 days, your
Medicare is also the secondary payer of mutually provided
enrollment will continue for up to one year, unless you elect
benefits for your covered spouse, regardless of your age, if
to have the enrollment terminated (see page 9). You are
he or she is age 65 or over and has Part A.
responsible, however, for paying your share of the premium
(your employing office will explain how to make the premium
payments). If you elect to have your enrollment terminated, it
Note: After you retire, Medicare will become the
will be reinstated at the time you exercise your reemployment
primary payer and your FEHB plan will be the
rights and return to civilian service. (You may also change
secondary payer for you (unless you are
your enrollment, or enroll if you were not enrolled when you
reemployed by the Government), and for your
entered on active duty, within 31 days after returning to
covered spouse (unless he or she is employed by
civilian service.)
the Government).
Your decision to have your enrollment terminated will not
affect your future eligibility to continue FEHB enrollment after
In addition, your FEHB plan is the primary payer and
retirement (see below).
Medicare is the secondary payer of mutually provided
benefits for an End Stage Renal Disease (ESRD) Medicare
Retirement
beneficiary under age 65 within the first 12 months of ESRD
care. Also, your FEHB plan is the primary payer and
Your enrollment will continue without change in benefits or
Medicare is the secondary payer for a person under age 65
cost (except that Postal Service retirees will pay the same
entitled to Medicare on the basis of disability.
share of the premium as other Federal retirees) if you retire
FEHB Plans and Uniformed Services Health
Under a retirement system for Federal civilian employ-
Benefits Program
ees and
If you are eligible for health care coverage under the Civilian
On an immediate annuity.
Health and Medical Program of the Uniformed Services
(CHAMPUS), your FEHB plan is the primary payer of
In addition, you must be currently enrolled in a plan under the
benefits, and CHAMPUS is the secondary payer.
FEHB Program and must have been enrolled (or covered as
a family member) in an FEHB plan for
CIRCUMSTANCES PERMITTING
The five years of service immediately before retirement,
CONTINUATION OF ENROLLMENT
or
If fewer than five years, all service since your first
Transfer
opportunity to enroll. (Generally, your first opportunity to
Your enrollment will continue without change if --
enroll is within 31 days after your first appointment [in
your Federal career] to a position under which you are
You transfer to (or are reemployed by) another Federal
eligible to enroll under conditions that permit a Govern-
ment contribution toward the enrollment.)
agency without a break in service of more than three
calendar days, and
8
If you are on a monthly or 4-week pay period, and your
Note 1: "Service" means service in which you were
employing office receives your SF 2809 --
eligible to be enrolled in an FEHB plan under
conditions that permitted a Government contribution
More than 15 days before the end of the pay period, the
toward the enrollment. Your enrollment (or
cancellation will take effect on the last day of that pay
coverage) need not have been in the same plan,
period.
but it must have been in one or more FEHB plans.
Coverage under a non-FEHB plan is not creditable
Less than 15 days before the end of the pay period, the
toward meeting the five-year or first-opportunity
cancellation will take effect on the last day of the
requirement. (In some circumstances, if you are
following pay period.
enrolled in an FEHB plan at the time of retirement,
your past coverage under CHAMPUS may be
creditable toward meeting the five-year or first
opportunity requirement. Contact your employing
Note: If you intend to be covered by someone
office for details.)
else's enrollment at the time you cancel and wish to
avoid a gap in your coverage, you should coordi-
Note 2: While the Office of Personnel Management
nate the effective date of your cancellation with the
has the authority to waive the five-year requirement
effective date of your new coverage. (See page 7
for continuation of enrollment after retirement, this
for additional information on effective dates.)
authority is limited to extraordinary situations
only and is rarely exercised.
Once your cancellation becomes effective, you may not
enroll again until an event occurs that permits enrollment,
Workers' Compensation
such as marriage or Open Season (see the table on page
13).
Your enrollment continues while you are receiving compen-
sation from the Office of Workers' Compensation Programs if
In addition, you will not be eligible for health benefits
the Secretary of Labor determines that you are unable to
coverage after retirement unless you reenroll before you
return to duty and if you were enrolled in the FEHB Program
retire and meet all the requirements for continuation of
(or covered as a family member) for (1) the five years of
enrollment after retirement (see page 8).
service immediately before the compensation started, or (2)
all service since your first opportunity to enroll. (Notes 1 and
2 above also apply to Workers' Compensation.)
Note: Some employees who cancel their enroll-
ment may plan to reenroll in time to qualify for
Death
FEHB coverage as a retiree; however, there is
always the risk that they will have to retire earlier
If you die while you are enrolled for self and family, the
than expected (e.g., due to disability or involuntary
enrollment will continue for your eligible survivor annuitants
separation) and not be able to meet the five-year
and other eligible family members with no change in benefits
requirement for continuing FEHB coverage into
or cost. (However, survivors of deceased Postal Service
retirement. Please understand that when you
employees will pay the same share of the premium as other
cancel your enrollment you are voluntarily
Federal survivor annuitants.) If there is only one survivor
accepting this risk. An alternative would be to
annuitant, and he or she is the sole eligible family member,
change to a lower cost plan so that you meet the
the enrollment will be changed automatically to self only, with
requirements for continuation of your FEHB
a corresponding reduction in cost.
enrollment after retirement.
CANCELLATION OF ENROLLMENT
TERMINATION OF ENROLLMENT
You may voluntarily cancel your enrollment at any time by
Your enrollment will end on the last day of the pay period in
submitting a properly completed Standard Form (SF) 2809 to
which --
your employing office.
You are separated from your job, unless you are
However, if you cancel your enrollment, neither you nor any
separated under circumstances that allow you to
family member covered by your enrollment will be entitled to
continue your enrollment (see page 8).
a 31-day extension of coverage for conversion to nongroup
coverage (see page 10). Moreover, family members who
You become ineligible for coverage because of a
lose coverage because of your cancellation will not be
change in your employment status.
eligible for temporary continuation of coverage (see page
10).
You die, and there is no eligible survivor annuitant to
continue the enrollment.
Effective Date of Cancellation
Your enrollment also will end on --
If you are on a biweekly pay period --
The last day of the pay period that includes your 365th
The cancellation will take effect on the last day of the
day of continuous nonpay status.
pay period in which your employing office receives your
SF 2809.
The day you are separated, furloughed or placed on
leave of absence to enter military service for more than
9
30 days, if you elect to have your enrollment terminated
nearest office of your plan within 31 days after the family
(see page 8).
member's FEHB coverage ends. (Although you will be
notified when your enrollment ends, no one will notify you or
the family member when he or she loses coverage.)
31-DAY EXTENSION OF
The carrier will then send you or the family member an
COVERAGE
application form as well as benefit and cost information about
the nongroup coverage.
Your coverage will continue for 31 days after your enrollment
ends for any reason except voluntary cancellation in order to
Effective Date of a Conversion Contract
give you the opportunity to convert to an individual (non-
group) health benefits contract.
Nongroup coverage takes effect at the end of the 31-day
extension of coverage described above. This is true even if
If you are confined in a hospital on the 31st day, the benefits
you or a family member are confined in a hospital on the 31st
under your FEHB plan will continue for up to 60 more days of
day and continue to receive benefits for that confinement
continuous confinement.
under your FEHB plan for up to 60 more days.
These extensions of coverage are without cost to you and
Some Basic Differences Between a Conversion
also apply to your family members who lose coverage for any
Contract and an FEHB Plan
reason except your voluntary cancellation.
Nongroup benefits and premiums are not subject to
Government review and approval.
CONVERSION RIGHTS
The benefits available under a conversion contract may
If your enrollment ends for any reason except voluntary
not be the same as those under your FEHB plan. In
cancellation, you may convert to nongroup coverage
fact, many carriers provide fewer benefits under their
without giving evidence of good health.
nongroup contracts.
Any member of your family who loses coverage for any
Nongroup coverage is likely to cost you more because
reason except your voluntary cancellation may also
the Government doesn't pay part of the premium, and
convert to nongroup coverage.
you will not have the advantage of a "group rate."
Nongroup coverage under a conversion contract is
available only from the carrier of the FEHB plan you are
enrolled in when your enrollment ends.
TEMPORARY CONTINUATION OF
COVERAGE
Applying for a Conversion Contract
If your enrollment is terminated because you separate from
service on or after January 1, 1990, you may be eligible to
Within 60 days after your enrollment ends, your employing
temporarily continue your health benefits coverage under the
office must give you a notice of termination of your enroll-
FEHB Program after separation. Temporary continuation of
ment and the right to convert to an individual contract with
coverage is available to you if your separation is voluntary or
the carrier of your plan.
involuntary (unless it is for gross misconduct), and you would
not otherwise be eligible for continued coverage under the
If you want to convert to nongroup coverage, write for
Program. An example is separation for retirement when you
information to the nearest office of your plan within:
are unable to meet the requirements for continuation of
enrollment after retirement (see page 8).
91 days after your enrollment ends, or
Your temporary coverage continues for up to 18 months after
your separation from service, and you must pay the total
31 days after the date the notice was signed by an
premium (both the Government and employee shares), plus
authorized official, whichever is earlier.
a charge for administrative expenses of 2% of the total
premium. When your temporary continuation of coverage
ends (except by cancellation or nonpayment of premiums),
you will be entitled to a 31-day extension of coverage for
Note: If you don't receive the notice within 60 days
conversion to nongroup coverage (see above).
after your enrollment ends, or you can show that
you did not apply for a conversion contract in a
Electing Temporary Continuation of Coverage
timely manner for reasons beyond your control, you
may request conversion to nongroup coverage by
Your employing office will notify you of your opportunity to
writing to your plan within six months from the day
elect temporary continuation of coverage within 61 days after
on which your enrollment ends. Your request must
your enrollment terminates because of separation from
be accompanied by verification of your loss of
service. You have 60 days after separation (or after
FEHB coverage, e.g., a Standard Form 50 showing
receiving the notice, if later) to elect continued coverage.
your separation from the service.
Complete a Standard Form (SF) 2809 obtained from your
employing office. You may choose --
If a member of your family wants to convert to nongroup
The same plan, option and type of enrollment that
coverage, you or the family member should write to the
covered you at the time of separation; or
10
Any other plan (for which you are eligible), option or type
spouse because of remarriage or loss of qualifying court
of enrollment.
order; or
Return the properly completed form to the employing office
The date he or she receives the notice.
within the 60-day time limit.
Effective Date of Coverage
Note: In the case of a child who becomes eligible
for temporary continuation of coverage, if the
Your temporary continuation of coverage takes effect on the
employing office is not notified by the enrollee within
day after the 31-day extension of coverage described on
the 60-day time limit, the opportunity to elect
page 10. Coverage is retroactive if you return the SF 2809 to
continued coverage ends 60 days after the
the employing office after the 31-day extension period ends.
qualifying event; in the case of a former spouse, if
the employing office is not notified by the enrollee or
Other Individuals Eligible for Temporary
the former spouse within the 60-day time limit, the
Continuation of Coverage
opportunity to elect continued coverage ends 60
days after the change in status. If someone other
On and after January 1, 1990, children who lose FEHB
than the enrollee notifies the employing office about
coverage and former spouses who are not eligible to enroll in
a child's eligibility (or someone other than the
the FEHB Program under the Spouse Equity law or similar
enrollee or former spouse, in the case of a former
statutes (see page 6) may also be eligible for temporary
spouse's eligibility), the employing office notifies the
continuation of coverage. Their temporary coverage
child (or former spouse) of his or her temporary
continues for up to 36 months after the qualifying event
continuation of coverage rights, but no additional
occurs, e.g., child reaches age 22 or divorce.
time is given.
Child and former spouse enrollees also must pay the total
premium plus the 2% administrative charge and are entitled
to a 31-day extension of coverage for conversion to non-
For a child who elects temporary continuation of coverage,
group coverage when their temporary continuation of
the effective date of coverage is the same as described
coverage ends (except by cancellation or nonpayment of
above. For a former spouse who elects temporary continua-
premiums).
tion of coverage, the effective date of coverage is the same
as described above or the date of the qualifying event, if
If temporary continuation of coverage is desired for your child
later.
or former spouse, your employing office must be notified
when the child or former spouse becomes eligible. For a
child, you must notify the employing office within 60 days
COST CONTAINMENT
after the qualifying event occurs. For a former spouse, you
or the former spouse must notify the employing office within
To ensure that enrollees and covered family members
60 days after the former spouse's change in status. The
receive the best quality of care in an environment of
employing office then notifies the child or the former spouse
constantly rising health care costs, all FEHB plans have
of his or her temporary continuation of coverage rights. If a
instituted cost containment programs. These programs,
child wants continued coverage, he or she must elect it within
which include, for example, precertification of hospital
60 days after the date of the qualifying event (or after
admissions and case management, are designed to help
receiving the notice, if later). If a former spouse wants
make sure that services are performed at the right time, in
continued coverage, he or she must make the election within
the right place and at the right price. It is important that you
60 days after the later of:
and your covered family members be sound consumers of
health care services and adhere to the cost containment
The date of the qualifying event;
programs your plan has established.
The date he or she loses coverage as an enrolled former
11
REVIEW OF CLAIMS
Along with your request for review, you must send a
copy of the plan's reconsideration decision.
Read the plan brochure to become familiar with your plan's
benefits and claims procedures. Questions concerning
OPM review may be obtained by writing to:
benefits, claim payments and claim processing must be
addressed to your plan. The Office of Personnel Manage-
ment (OPM) does not pay or process claims.
U.S. Office of Personnel Management
Insurance Review Division
If your plan denies your claim for payment or for service, it
Retirement and Insurance Group
will reconsider the denial upon receipt of a written request
P.O. Box 436
within one year of the denial. The written request should
Washington, D.C. 20044
state, in terms of applicable brochure provisions, the reasons
you believe the denied claim for payment or service should
OPM must receive your request for review, along with a copy
have been paid or provided. Within 30 days after receipt of
of your letter to the plan and its reply, within 90 days of the
your request for reconsideration, the plan must affirm the
plan's affirmation of the denial. You may also ask OPM for a
denial in writing to you, pay the claim, provide the service, or
review if the plan fails to respond within 30 days to your
request additional information from you or your health care
written request for reconsideration or within 30 days after you
provider reasonably necessary for making a determination.
have supplied additional information. In this case, OPM must
(Your plan must notify you if it has requested additional
receive a request for review within 120 days of your request
information from your provider.) If this information is not
to the plan for reconsideration or the date you were notified
supplied within 60 days, the plan will base its decision on the
that the plan needed additional information. In your request
information it has on hand. If the plan affirms its denial, you
for review, show (1) the date of your request to the plan or (2)
have a right to a review by OPM to determine whether the
the dates the plan requested and you provided additional
plan has acted in accordance with its contract. Before
information to the plan. OPM will notify you and the plan of
seeking OPM review of a claim, these are some of the things
its decision.
you should keep in mind:
If you decide to seek judicial review of the denial of a claim,
you must file suit no later than December 31 of the third year
Do not submit initial bills from providers for payment to
after the year in which the care or service was provided, or
the below address or any other office within OPM; send
two years after a final determination has been made on the
them to the plan along with the appropriate claim form.
claim by OPM through the disputed claims process,
whichever is later. Federal law governs claims for relief that
Providers may use this procedure only on behalf of and
relate to benefits under an FEHB plan. Damages recover-
with the specific written consent of the member, and are
able under Federal law are limited to the amount of benefits
required to demonstrate that the member has assigned
in dispute, plus simple interest and court costs. Under
all of his or her rights to the provider with regard to that
Federal regulations (5 CFR 890.107), such legal actions
particular claim.
should be brought against the carrier of your plan.
You should first check with your provider or facility to be
Privacy Act Statement -- If you request OPM to review a
sure the plan was billed correctly; for instance, was the
denial of a claim for payment or service, OPM is authorized
correct procedure code(s) used, were complications
by chapter 89 of title 5, U.S. Code, to use the information
correctly indicated on the billing or operative report, etc.
collected from you and the plan to determine if the plan has
Reasonable and customary (R&C) allowances are
acted properly in denying you the payment or service, and
determined and controlled solely by the plan based upon
the information so collected may be disclosed to you and/or
information available to it.
the plan in support of OPM's decision on the disputed claim.
12
TABLE OF PERMISSIBLE CHANGES IN ENROLLMENT
Enrollment May Be Cancelled or Changed From Family to Self Only at Any Time
Events That Permit Enrollment Change
Change Permitted
From Not
From
From
Time Limit in Which Registration Form
No.
Event
Enrolled
Self Only
One Plan
to
to
or Option
Electing Change Must Be Filed With
to
Employing Office**
Enrolled
Family
Another
1
Open Season.
Yes*t
Yes
Yes
As announced by the Office of Personnel Management.
2
Change in marital status. (Marriage, divorce, annulment,
Yes*
Yes (Except
Yes (Except
From 31 days before to 60 days after change in marital status.
death of spouse.)
former spouses)
former spouses)
3
Other change in family status. (For example, birth of a
No
Yes
No
Within 60 days after change in family status.
child, legal separation, discharge from military service of a
spouse or of a child under age 22).
4
Move from an area served by a prepaid plan (CMP/HMO)
Does not
Yes
Yes
At any time after move.
in which enrolled at time of move.
apply
5
Termination of enrollment by employee organization plan
Does not
No
Yes
Within 31 days after termination of enrollment in plan.
because of termination of membership in organization.
apply
6
Employee, annuitant or former spouse (spouse equity),
Yes*
Does not
Does not
Within 31 days after termination (except, for employees, within 60 days
covered as a family member under another's FEHB
apply
apply
after the death of the enrollee). Coverage is effective the first day of
enrollment, loses coverage other than by cancellation or
the pay period that begins after the employing office receives the SF
change to Self Only of the covering enrollment; or employee,
2809. If election is made within the time limit, but after expiration of the
covered under Retired Federal Employees Health Benefits
31-day extension of coverage (or too close to the expiration of the
Program or under another federally sponsored health benefits
31-day extension of coverage), there will be a break in coverage.
program, loses such coverage for any reason.
7
Employee, annuitant or former spouse (spouse equity),
Yes, for
Does not
Does not
Within 31 days after change of covering enrollment has been filed.
covered as a family member under another's FEHB
Self Only*
apply
apply
Coverage is effective the first day of the pay period that begins after
enrollment, loses coverage because of change of the
the employing office receives the SF 2809. If election is made within
covering enrollment from Family to Self Only.
the time limit, but during a pay period following the one in which the
change to Self Only was filed, there will be a break in coverage.
8
Employee transfers to overseas post of duty from the
Yes*
Yes
Yes
United States, or reverse.
Within 31 days before or after move.
9
Employee returns to active civilian duty or annuitant
separates from military service which was not limited to
Yes* t
Yes
Yes
Within 31 days after return to active civilian duty or separation from
30 days or less.
military service.
10
Your plan stops participating in the FEHB Program.
Does not
Yes
Yes
As set by the Office of Personnel Management.
apply
11
Self Only enrollment under this Program of employee's or
No
Yes
No
Within 31 days after termination of spouse's enrollment. Coverage is
annuitant's spouse terminates as a result of change in
effective the first day of the pay period that begins after the employing office
spouse's Federal employment status or 365 days' nonpay
receives the SF 2809. If election is made within the time limit, but after
status.
expiration of the 31-day extension of coverage (or too dose to the expiration
of the 31-day extension of coverage), there will be a break in coverage.
12
Employee who is not enrolled loses coverage under parent's
Yes*
Does not
Does not
Within 31 days after loss of coverage, except within 60 days after the death
non-Federal health plan.
apply
apply
of the parent.
13
Enrolled employee retires from overseas post of duty and
Does not
is eligible to continue enrollment as annuitant.
Yes
Yes
Within 60 days after retirement.
apply
14
Enrollee becomes eligible for Medicare.
Does not
No
Yes
At any time beginning 30 days before becoming eligible for Medicare.
apply
15
Enrollee's eligible child (or children) loses coverage under
No
Yes
No
another's FEHB enrollment.
Within 31 days after child's (children's) loss of coverage. Coverage is
effective the first day of the pay period that begins after the employing
office receives the SF 2809. If election is made within the time limit, but
after expiration of the 31-day extension of coverage (or too close to the
expiration of the 31-day extension of coverage), there will be a break in
coverage.
Individuals must be otherwise eligible to enroll.
t Employees only.
** Also selected effective date information.
13
Events That Permit Enrollment Change
Change Permitted
From Not
From
From
Time Limit In Which Registration Form
Enrolled
Self Only
One Plan
No.
Event
to
or Option
Electing Change Must Be Filed With
to
to
Enrolled
Family
Employing Office**
Another
16
Employee loses coverage under Medicaid (State program
Yes*
Does not
Does not
Within 31 days after termination of Medicaid.
of medical assistance for the needy).
apply
apply
17
Employee, annuitant or former spouse (spouse equity),
Yes*
Does not
You must enroll in the same plan and option as that from which coverage is lost, if
covered as a family member under another's FEHB
apply
eligible to enroll in that plan, within 31 days after cancellation of the covering
enrollment, loses coverage due to cancellation of the
enrollment. If not eligible to enroll in that plan, you may enroll in the same option of
covering enrollment.
any available plan within the 31-day period. Coverage is effective the first day of
the pay period that begins after the employing office receives the SF 2809. If
election is made within the time limit, but during a pay period following the one in
which the cancellation was filed, there will be a break in coverage.
18
Enrolled employee's employment status changes from
No
No
Yes
full-time to part-time career employment as defined in the
Within 31 days after the change in employment status.
Federal Employees Part-Time Career Employment Act of
1978.
19
Employee or employee's spouse loses coverage under
Yes*
Yes
No
Within 31 days before or after move.
spouse's non-Federal health plan when spouse
terminates employment to accompany employee whose
reassignment is directed out of commuting area.
20
Employee's or annuitant's spouse involuntarily loses his
Yes* t
Yes
No
Within 31 days before or after spouse's or dependent's loss of
or her non-Federal health insurance coverage, or
coverage; or within 31 days before or after child's (or children's) loss
coverage for his or her dependents; or employee's or
of coverage.
annuitant's eligible child (or children) loses non-Federal
coverage under the other parent's health plan because
the other parent involuntarily loses coverage for his or
her dependents.
21
Former spouse who is eligible to enroll under the authority
Yes*
Does not
Does not
Generally, within 60 days after divorce. If divorce occurs after Federal
of the Civil Service Retirement Spouse Equity Act of 1984
apply
apply
employee retires, within 60 days after divorce or 60 days after retiree
(P.L. 98-615), as amended, the Intelligence Authorization
election of a survivor annuity for the former spouse. Certain former
Act of 1986 (P.L. 99-569), or the Foreign Relations
spouses of employees who retired before May 7, 1985, may be
Authorization Act, Fiscal Years 1988 and 1989 (P.L.
subject to a different time limit and should contact the employee's
100-204).
retirement system for additional information.
22
Temporary employee completes one year of service
Yes*
Does not
Does not
Within 31 days after becoming eligible.
in accordance with 5 U.S.C. 8906a.
apply
apply
23
Temporary employee, eligible under 5 U.S.C. 8906a,
Yes*
Yes
Yes
Within 31 days after changing to non-temporary appointment.
changes to a nontemporary appointment.
24
Employee separated from service and eligible for
Does not
Yes
Yes
Within 60 days after the later of: separation; or receiving notice of the
temporary continuation of coverage.
apply
opportunity to elect temporary continuation of coverage. Coverage is
effective the day after other FEHB coverage ends, including the 31-day
extension of coverage. If election is made after the end of the 31-day
extension of coverage, the effective date will be retroactive.
25
Child of employee, former employee or annuitant stops
Yes*
Does not
Does not
Within 60 days after the later of: the qualifying event; or the child's
meeting the requirements for unmarried dependent
apply
apply
receiving notice of the opportunity to elect temporary continuation of
children.
coverage (based on the enrollee's notification to the employing office of
the child's eligibility). Coverage is effective the day after other FEHB
coverage ends, including the 31-day extension of coverage. If election is
made after the end of the 31-day extension of coverage, the effective date
will be retroactive.
.
Individuals must be otherwise eligible to enroll.
** Also selected effective date information.
t Employees only.
14
Events That Permit Enrollment Change
Change Permitted
From Not
From
From
Time Limit in Which Registration Form
Enrolled
Self Only
One Plan
No.
Event
to
or Option
Electing Change Must Be Filed With
to
to
Enrolled
Family
Employing Office**
Another
Former spouse meets the requirement in 5 U.S.C. 8901(10)
Yes*
Does not
Does not
26
Within 60 days after the later of: the qualifying event; the date coverage
of having been enrolled in an FEHB plan as a covered family
apply
apply
under Subpart H of 5 CFR Part 890 was lost, if the loss occurred within 36
member at some time during the 18 months before the
months of the qualifying event; or the former spouse's receiving notice of
marriage ended, but does not meet one or both of the other
the opportunity to elect temporary continuation of coverage (based on the
two requirements of 5 U.S.C. 8901(10).
enrollee's or former spouse's notification to the employing office of the
former spouse's eligibility). Coverage is effective the day after other FEHB
coverage ends, including the 31-day extension of coverage; or the date of
the qualifying event, if later. If election is made after the end of the 31-day
extension of coverage or the date of the qualifying event, the effective date
will be retroactive.
27
Former employee, former spouse or child whose temporary
Yes*
Does not
You must reenroll in the same plan and option as that in which you were
continuation of coverage under 5 CFR Part 890 Subpart K
apply
enrolled prior to obtaining the other FEHB coverage, if eligible to enroll in that
terminates due to other FEHB coverage, loses the other
plan, within 31 days after the other coverage ends, but not later than the
FEHB coverage.
expiration of the period of eligiblility for the temporary continuation of coverage.
If not eligible to enroll in that plan, you may enroll in the same option of any
available plan within the 31-day time limit.
*
Individuals must be otherwise eligible to enroll.
** Also selected effective date information.
t Employees only.
15