MHBP Standard Option Summary of Benefits

Standard Option Benefits Summary

This is a summary of the Mail Handlers Benefit Plan Standard Option. Before making a final decision, please read the official Plan brochure. 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 Standard Option available to you.

Medical Coverage

Topic	You Pay
Topic	PPO	Non-PPO
Calendar Year Deductible	$350 per person Limited to $700 per family	$500 per person Limited to $1,250 per family
Annual Physical Exam For Adults Age 18 and over	$10 copayment (no deductible)	Not covered
Well-Child Care	Nothing (No deductible)	All charges after the Plan has paid $75 per child per calendar year (No deductible)
Preventive Screenings Includes cholesterol screenings, mammograms, PAP tests, PSA tests, urinalysis, bone density screenings, colon cancer screenings, and more	Nothing (no deductible)	30% fo the plan's allowance and any difference between our allowance and the billed amount
Maternity Care	Nothing (no deductible)	30% of the plan's allowance and any difference between our allowance and the biled amount
Doctor's Office Visits	$20 copayment per office visit for adults, $10 copayment for dependent children under age 22 (no deductible)	30% of the plan's allowance and any difference between our allowance and the billed amount (no deductible)
Convenient Care Center (such as MinuteClinics in CVS drugstores and Take Care Health centers at Walgreens)	$10 copayment per visit (no deductible)	30% of the Plan's allowance and any difference between our allowance and the billed amount
Lab, X-Ray and Diagnostic Tests	10% of the plan's allowance	30% of the plan's allowance and any difference between our allowance and the billed amount
Lab Savings Program	Nothing for covered lab tests with the Lab Savings Program with Quest Diagnostics (No deductible)	Nothing for covered lab tests with the Lab Savings Program with Quest Diagnostics (No deductible)
Chiropractic Care	$15 copayment per office visit, and all charges after the Plan has paid the $2,500 combined alternative, chiropractic and rehabilitative therapies maximum (No deductible)	30% of the Plan's allowance and any difference between our allowance and the billed amount, and all charges after the Plan has paid the $2,500 combined alternative, chiropractic and rehabilitative therapies maximum (No deductible)
Hospitalization	$200 per-admission copayment, nothing for covered room & board and 15% of the Plan's allowance for hospital ancillary services (No deductible)	$500 per-admission copayment, 30% of the Plan's allowance and any difference between our allowance and the billed amount (No deductible)
Hospitalization—Maternity	Nothing (No deductible)	$500 per-admission copayment, 30% of the Plan's allowance and any difference between our allowance and the billed amount (No deductible)
Surgery and Anesthesia	10% of the plan's allowance	30% of the plan's allowance and any difference between our allowance and the billed amount
Emergency Treatment	$50 copayment at an urgent care center, $150 copayment at a hospital emergency room. Hospital ER copayment waived if admitted. No deductible for accidental injury.	30% of the Pan'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 $4,500 per calendar year	Nothing after your out-of-pocket expenses for covered services from PPO providers and non-PPO providers combined totals $9,000 per calendar year

Prescription Drug Coverage—Retail Pharmacy (up to a 30-Day Supply)

No deductible applies to prescription drugs.

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

Retail Pharmacy

Topic	You Pay
Topic	Network Pharmacy And Electronic Claims	Non-Network Pharmacies and Paper Claims
Generic	$10 copayment	50% of the Plan's allowance and any difference between our allowance and the billed amount
Preferred brand name	$40 copayment	50% of the Plan's allowance and any difference between our allowance and the billed amount
Non-Preferred brand name	$60 copayment	50% of the Plan's allowance and any difference between our allowance and the billed amount
Specialty*	$100 copayment	50% of the Plan's allowance and any difference between our allowance and the billed amount

Prescription Drug Coverage—Mail Order Pharmacy (up to a 90-Day Supply)

No deductible applies to prescription drugs.

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

Mail Order Pharmacy

Topic	You Pay
Topic	Network Pharmacy And Electronic Claims	Non-Network Pharmacy And Paper Claims
Generic	$15 copayment	Not covered
Preferred brand name	$65 copayment	Not covered
Non-Preferred Brand name	$90 copayment	Not covered
Specialty*	$300 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 all 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 FEHBP deductibles or out-of-pocket maximums.

2010 Standard Option Rates

Topic	Federal Employees (Biweekly)	Postal Employees (Biweekly)	Annuitants (Monthly)
Standard OptionSelf Only (454)	$76.62	$53.34	$166.01
Standard OptionSelf & Family (455)	$182.90	$130.67	$396.29

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

Non-postal rates apply to most non-postal enrollees. If you are in a special enrollment category, refer to the FEHB guide for that category or contact the agency that maintains your health benefits enrollment.

Postal rates apply to career Postal Service employees. Most employees should refer to the FEHB Guide for United States Postal Service Employees, RI 70-2. Different postal rates apply and a special FEHB guide is published for Postal Service Inspectors and Office of Inspector General (OIG) employees (see RI 70-2IN).

* Postal rates do not apply to non-career postal employees, postal retirees, or associate members of any postal employee organization who are not career postal employees. Refer to the applicable FEHB Guide.