Value Plan Summary of Benefits
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MHBP Value Plan Summary of Benefits
This is a summary of the Mail Handlers Benefit Plan Value Plan. 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.
Medical Coverage
We added No Deductible to show when the calendar year deductible does not apply.
| Topic | You Pay | |
|---|---|---|
| Topic | PPO | Non-PPO |
| Calendar Year Deductible |
$500 per person Limited to $1,000 per family |
$800 per person Limited to $1,600 per family |
| Adult Preventive Care: Annual physical exam, screening and immunizations | Nothing (no deductible) | Not covered |
| Well-Child Care: Well-child visits, screenings and immunizations | Nothing (no deductible) | Not covered |
| Maternity Care | Nothing (no deductible) | 40% of the plan's allowance and any difference between our allowance and the billed amount |
| Primary Care Doctor's Office Visits (Family Practice, General Practice, Internal Medicine and Pediatrician) | $30 copayment per office visit (No deductible) | 40% of the Plan's allowance and any difference between our allowance and the billed amount |
| Non Primary Care Doctor's Office Visits | 20% of the plan's allowance | 40% of the plan's allowance and any difference between our allowance and the billed amount |
| Lab, X-Ray, and Diagnostic Tests | 20% of the plan's allowance | 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 (no deductible) | Nothing for covered lab tests with the Lab Savings Program with Quest Diagnostics (no deductible) |
| Chiropractic Care | 20% of the plan's allowance and all charges after the plan has paid the $2.500 combined alternative, chiropractic and rehabilitative therapies maximum | Not covered |
| Hospitalization | 20% of the plan's allowance | 40% of the plan's allowance and any difference between our allowance and the billed amount |
| Outpatient Surgical Facility | $200 copayment per occurrence (no deductible) | 40% of the plan's allowance and any difference between our allowance and the billed amount |
| Surgery (Professional Fee) | Nothing (no deductible) | 40% of the plan's allowance and any difference between our allowance and the billed amount |
| Surgery (Outpatient Hospital / ASC Inpatient) | 20% of the plan's allowance | 40% of the plan's allowance and any difference between our allowance and the billed amount |
| Anesthesia | 20% of the plan's allowance | 40% of the plan's allowance and any difference between our allowance and the billed amount |
| Emergency Treatment | 20% of the plan's allowance | 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 the United States | PPO-level benefits for covered care received outside 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 $4,000 per calendar year | Nothing after your out-of-pocket expenses for covered services from PPO providers and non-PPO providers combined totals $6,000 per calendar year |
Prescription Drug Coverage—Retail Pharmacy
Up to a 30-day supply. No deductible.
| Topic | You Pay | |
|---|---|---|
| Topic | Network Pharmacy And Electronic Claims | Non-Network Pharmacies And Paper Claims |
| Generic | $10 copayment | Not covered |
| Non-Generic | 50% of the plan's allowance | Not covered |
Prescription Drug Coverage—Mail Order Pharmacy
Up to a 90-day supply. No deductible.
| Topic | You Pay | |
|---|---|---|
| Topic | Network Pharmacy And Electronic Claims | Non-Network Pharmacies And Paper Claims |
| Generic | $30 copayment | Not covered |
| Non-Generic | 50% of the plan's allowance | Not covered |
The Mail Handlers Benefit Plan 2009 Value Plan Rates
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.
| Topic | Federal Employees Biweekly | Postal Employees Biweekly | Annuitants Monthly |
|---|---|---|---|
| Self Only (414) | $21.53 | $11.63 | $46.65 |
| Self & Family (415) | $51.33 | $27.72 | $111.22 |
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, hearing aid discount program from HearPO, and healthy living and fitness benefits from GlobalFit*.
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