FAQs - Standard Option

The MHBP Standard Option is setting a higher standard for federal employee health plans — at a lower cost.

The Plan keeps your costs down and provides predictable out-of-pocket expenses. With network providers, the plan pays 100% for preventive annual exams, covered lab tests, maternity care and more. For services like diagnostic tests or surgery, this plan has you covered.

Preventive care is covered at a $0 copay with an in-network provider and does not apply to the deductible.
You are responsible for meeting your deductible for certain services:

• $350 for Self Only
• $700 for Self Plus One or Self and Family

You do not need to meet your deductible for most basic services. Examples of coverage include:

• Primary care physician (PCP): $20 copay, adult; $10 copay, dependents through age 21
• Specialist visits: $30 copay

Prescriptions (30 day supply):

• $5 per generic formulary drug
• Preferred Brand: 30% of Plan allowance, limited to $200 per prescription
• Non-Preferred brand: 50% of Plan allowance, limited to $200 per prescription
• 90-day supply of maintenance medications are available through mail order or CVS Retail pharmacies.

If you are looking for a plan with comprehensive coverage and nationwide coverage, the MHBP Standard Option plan could be right for you.
MHBP provides:

• A large, nationwide network of over 2 million providers and hospitals. When you need care, it’s never too far.
• Worldwide coverage
• No referrals required to see specialists.
• Outstanding plan satisfaction, per OPM.gov Consumer Satisfaction Survey Results

No. While you can save money by visiting in-network providers, you have coverage in and out-of-network.

Use our provider directory. You can access information about our extensive network of providers, including board certification, education, specialty and languages spoken, etc.

You pay nothing for in-network preventive care. When you visit a Primary Care Provider (PCP), you'll pay a $20 copay for an adult visits or a $10 copay for dependents visits through age 21. For Specialists visits you'll pay a $30 copay.

No. You do not need a referral to see a specialist.

A copay is a fixed amount of money you pay to the provider, facility, pharmacy when you received covered services. The copay will vary, depending on where the services are delivered and by whom (e.g., PCP, specialist and pharmacy). Please review the Official Plan brochure for copay amounts.

Members do not need to file claim forms for services received by a network provider. You may need to file a claim if you use non-network providers.

Should you need to submit a claim form, you can do so at these addresses.

For a disputed claim, follow the Federal Employees Health Benefits Program disputed claims process if you disagree with our decision on your claim or request for services, drugs, or supplies, including a request for preauthorization/prior approval. View the appeals and disputed claims processes.

For a 30-day supply:

• Generic: $5 copayment per prescription
• Preferred Brand: 30% of Plan allowance, limited to $200 per prescription
• Non-Preferred brand: 50% of Plan allowance, limited to $200 per prescription
• 90-day supply of maintenance medications are available through mail order or CVS Retail pharmacies.

If you are enrolled in SilverScript Employer PDP for MHBP, see pharmacy plan details.

Yes, mail-order pharmacy is available for maintenance medications. You can also get your 90-day prescription at a CVS retail pharmacy for the same cost as mail order.
Go to your member website and select "Prescriptions" for details and forms.

Yes. Your calendar year in-network deductible is $350 for Self Only coverage and $700 for Self Plus One or Self and Family Coverage. Not all services are subject to deductible.

Once you pay your deductible, you pay a copay or coinsurance for medical services. Copay and coinsurance amounts are listed in the Official Plan brochure. They will apply until you meet your out-of-pocket maximum.

MHBP plans do not include preventive dental coverage. The MHBP Dental plan is available as a standalone option.

MHBP plans do not include preventive vision coverage. The MHBP Vision plan is available as a standalone option.

Enrollment procedures vary by agency. Detailed instructions and information on the Federal Employees Health Benefits (FEHB) Program enrollment process is available at Enroll Now. You will need to know the enrollment code for the MHBP plan you would like to enroll in. Please refer to the rate calculator for the plans available in your area and the federal enrollment codes.

For most people, benefits will begin on the first day of the first full pay period. New hires have 60 days to enroll for health coverage. Verify your effective date with the agency or retirement system that maintains your health benefits enrollment.

If you do not receive your ID card by your effective date and you are enrolled in our system, you may register on your member website and print an ID card. After you register, simply select "ID cards" and follow the instructions. You may use this printable version of your personal ID card if you need medical care.

Your member ID card is always available on your member website. When you log in, you can:

• Pull up your digital ID card and print it or email it. Your digital ID card is the same as your plastic ID card.
• Request a new ID card and we can send a new plastic ID card to your home.

Members have access to Teladoc Health (Teladoc), a convenient, lower-cost alternative to urgent care or the emergency room. Teladoc lets you access board-certified physicians by web, phone or mobile app. It's perfect for when you're traveling or when your physician isn't available. Simply visit Teladoc.com/Aetna or call 1-855-835-2362 (855-Teladoc) to get started.
Teladoc physicians prescribe medical treatment for a wide range of conditions including cold & flu symptoms, pink eye, skin rash conditions and stress and anxiety. Teladoc physicians prescribe a medication when necessary. All Teladoc physicians are U.S. board certified internists, state-licensed family practitioners or pediatricians licensed to practice medicine in the U.S.

You must tell us if you or a covered family member has coverage under any other health plan or has automobile insurance that pays health care expenses without regard to fault. This is called “double coverage”. When you have double coverage, one plan normally pays its benefits in full as the primary payor. The other plan pays a reduced benefit as the secondary payor. We, like other insurers, determine which coverage is primary according to the National Association of Insurance Commissioners’ (NAIC) guidelines. For more information on NAIC rules regarding the coordinating of benefits, visit https://content.naic.org/sites/default/files/inline-files/MDL-120.pdf
For complete details about how we coordinate with other health plans and a Primary Payor Chart, see Section 9 of the Official Plan brochure under Coordinating Benefits with Medicare and Other Coverage.

Certain health care services, such as hospitalization or outpatient surgery, require precertification to ensure coverage for those services. In most cases, your network provider will take care of getting precertification. You’re still responsible for ensuring that your care is precertified. This means you should always ask your provider whether they’ve contacted us and that we’ve approved the request. If you see an out-of-network provider or you’re admitted to an out-of-network hospital you must get prior approval or precertification by calling 1-800-410-7778 (TTY: 711). For additional information, see Section 3 of the Official Plan brochure.

Our network has doctors, hospitals and facilities across the country. Your benefits are accepted by the doctors and hospitals that participate with the Aetna Choice® POS II network in all states. Be sure to present your MHBP ID card at the time of service.

Overseas providers (those outside the continental United States, Alaska and Hawaii) will be paid at the Network level of benefits for covered services.

To update any personal information, update dependents, or make plan changes, update your agency's enrollment portal or submit an updated SF2809 to your agencies benefits personnel. If you are retired, visit RetireeFEHB.opm.gov. Or you can call 1-888-767-6738 (TTY: 1-800-878-5707), Monday to Friday, 7:40 AM to 5 PM ET.

If you’re retired, MHBP generally pays 100% of the difference between what Medicare pays and the allowed amounts for covered medical services when you have Original Medicare (Parts A and B). This includes paying Medicare’s cost-sharing, such as the per-admission hospital deductible, Part B deductible, and the coinsurance you would normally have to pay. We’ll also waive your Standard Option cost-sharing for medical services covered by both Medicare and MHBP.

MHBP Standard Option offers an Aetna Medicare Advantage Plan (PPO). This plan offers enhanced benefits and programs for members who have Medicare Parts A and B as their primary coverage. Review our retiree page for more details.