Consumer Option Summary of Benefits
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- Consumer Option Summary of Benefits
MHBP Consumer Option 2010 Summary of Benefits
This is a summary of the Mail Handlers Benefit Plan Consumer Option. Before making a final decision, please read the official Plan brochure (RI 71-007). All benefits are subject to the definitions, limitations and exclusions set forth in the official Plan brochure. A single annual $42 Mail Handlers Benefit Plan associate membership fee makes MHBP Consumer Option available to you.
Health Savings Account / Health Reimbursement Account
| Topic | You Pay | |
|---|---|---|
| Topic | HSA | HRA |
| MHBP: (up to) |
$845 (Self Only) $1,690 (Self & Family) |
$845 (Self Only) $1,690 (Self & Family) |
| Member, Optional: (up to) |
$2,205 (Self Only) $4,460 (Self & Family) |
Not applicable |
Calendar Year Deductible
| Topic | You Pay | |
|---|---|---|
| Topic | Self Only | Self And Family |
| Calendar-Year Deductible | $2,000 | $4,000 |
PPO Preventive Care
The calendar year deductible applies to most benefits. We added "No Deductible" to show when the calendar year deductible does not apply.
| Topic | You Pay | |
|---|---|---|
| Topic | PPO | Non-PPO |
| Routine Physical Exam & Immunizations | Nothing (no deductible) | Not covered |
| Routine Preventive Screenings | Nothing (no deductible) | Not covered |
Traditional Medical Coverage
Deductible must be met before benefits begin.
| Topic | You Pay | |
|---|---|---|
| Topic | PPO | Non-PPO |
| Doctor's Office Visits | $15 copayment per office visits including associated testing | 40% of the Plan's allowance and any difference between our allowance and the billed amount |
| Convenient Care Center (such as MinuteClinics in CVS drugstores and Take Care Centers at Walgreens) | $10 copayment per visit |
40% of the Plan's allowance and any difference between our allowance and the billed amount |
| Lab, X-Ray and Diagnostic Tests | $15 copayment per office visits, including associated testing | 40% of the Plan's allowance and any difference between our allowance and the billed amount |
| Lab Savings Program | Nothing for covered lab tests with the Lab Savings Program with Quest Diagnostics | Nothing for covered lab tests with the Lab Savings Program with Quest Diagnostics |
| Chiropractic Care | $15 copayment per office visit, and all charges after the Plan has paid the $2,500 combined alternative, chiropractic and rehabilitative therapies maximum. | 40% of the Plan's allowance and any difference between our allowance and the billed amount, and all charges after the Plan has paid the $2,500 combined alternative, chiropractic and rehabilitative therapies maximum. |
| Hospitalization | Nothing for covered room & board and $75 per day up to $750 for hospital ancillary services | 40% of the Plan's allowance and any difference between our allowance and the billed amount |
| Outpatient Surgical Facility | $150 copayment per occurrence | 40% of the Plan's allowance and any difference between our allowance and the billed amount |
| Surgery and Anesthesia |
Nothing in hospital $15 copayment in doctor's office |
40% of the Plan's allowance and any difference between our allowance and the billed amount |
| Emergency Treatment | $50 copayment per occurrence | 40% of the Plan's allowance and any difference between our allowance and the billed amount |
| Overseas Medical Expenses | PPO-level benefits for covered care received outside of the United States | PPO-level benefits for covered care received outside of the United States |
|
Catastrophic Protection (Some costs do not count toward this protection) |
Nothing after your out-of-pocket expenses for covered services from PPO providers totals $5,000, per calendar year for Self Only enrollment ($10,000 for Self & Family enrollment) | Nothing after your out-of-pocket expenses for covered services from PPO providers and non-PPO providers combined totals $7,500 per calendar year for Self Only enrollment ($15,000 for Self & Family enrollment) |
Prescription Drug Coverage—Retail Pharmacy
(Up to a 30-Day supply)
Deductible must be met before benefits begin
| Topic | You Pay | |
|---|---|---|
| Topic | Network Pharmacy and Electronic Claims | Non-Network Pharmacy and Paper Claims |
| Generic | $10 copayment | Not covered |
| Preferred brand name | $25 copayment | Not covered |
| Non-preferred brand name | $40 copayment | Not covered |
Prescription Drug Coverage—Mail Order Pharmacy
(Up to a 90-day supply)
Deductible must be met before benefits begin
| Topic | You Pay | |
|---|---|---|
| Topic | Network Pharmacy and Electronic Claims | Non-Network Pharmacies and Paper Claims |
| Generic | $20 copayment | Not covered |
| Preferred Brand Name | $50 copayment | Not covered |
| Non-preferred brand name | $80 copayment | Not covered |
Special Member Benefits
Vision care discounts and savings from EyeMed Vision Care providers, laser vision correction savings from the U.S. Laser Network and QualSight, a hearing aid discount program from HearPO, healthy living and fitness benefits from GlobalFit and savings on everyday health-related items through the CVS Caremark ExtraCare Health Card program*.
*These benefits are neither offered nor guaranteed under contract with the FEHBP, but are made available to MHBP enrollees and their covered family members. You cannot file a FEHBP disputed claim about them.
The fees you pay for these services do not count toward the FEHBP deductibles or out-of-pocket maximums.
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