FAQs - Value Plan

The MHBP Value Plan is our most affordable plan – with predictable costs for doctor visits, maternity care and covered lab tests.

The Value Plan balances low cost and high satisfaction. That makes it a great choice for healthy people who don’t typically need a lot of medical services. Plus, you pay nothing for preventive care from network providers. Including services such as an annual exam, screenings, immunizations and well-child visits.

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:

• $600 for Self Only
• $1,200 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): $30 copay ($10 copay for dependents under 21)
• Specialist visits: $50 copay (after deductible)
• Other covered services: 20% coinsurance

Prescriptions:

• $10 per generic formulary drug for a 30-day supply
• Preferred Brand: 45% of Plan allowance, limited to $300
• Non-Preferred brand: 75% of Plan allowance, limited to $500
• Mail-order pharmacy is available for a 90-day supply of maintenance medications

If you are looking for a lower premium plan with 100% coverage for in-network preventive care and nationwide coverage, the MHBP Value plan could be right for you.
MHBP provides:

• A large, nationwide network of over 1.9 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

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

Find a Provider

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

Find a Provider

You pay nothing for in-network preventive care. When you visit a Primary Care Provider (PCP), you'll pay a $30 copay for an adult visits or a $10 copay for dependents visits through age 21. For Specialist visits you'll pay a $50 copay (deductible applies to specialist).

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

Yes, professional non-emergency services provided in a MinuteClinic®, including telehealth visits are covered with $0 copay.

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, inpatient hospital stay, emergency room, outpatient hospital and pharmacy). Please review the Official Plan brochure for copay amounts.

Members usually do not need to file claim forms except in some non-network emergency care situations.

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

Medical claims:
MHBP
PO Box 981106
El Paso, TX 79998

Prescription drug claims:
CVS Caremark®
PO Box 52136
Phoenix, AZ 85072-2136

MHBP Dental Plan claims:
MHBP
PO Box 7402
London, KY 40742

MHBP Vision Plan claims:
VSP
PO Box 385018
Birmingham, AL 35238-5018

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/disputed claims process.

For a 30-day supply:
- Generic: $10 copayment per prescription
- Preferred Brand: 45% of Plan allowance, limited to $300
- Non-Preferred brand: 75% of Plan allowance, limited to $500
‐ Mail-order pharmacy is available for a 90-day supply of maintenance medications

If 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 participating retail pharmacy for the same cost as mail order.
Go to your member website and select "pharmacy benefits" for details and forms.

Yes. Your calendar year in-network deductible is $600 for Self Only coverage and $1,200 for Self Plus One or Self and Family Coverage

Once you pay your deductible, you pay coinsurance for most 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 dental coverage. The MHBP Dental plan is available as a standalone option.

MHBP plans do not include 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 the Enroll Now link on the website (link to Enroll now page). 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, you may use a copy of your SF2809 Form or electronic enrollment (e.g., Employee Express, MyPay, etc.) confirmation. If you are enrolled in our system, you may register on your member website and print an ID card. After you register, simply select "Get an ID card" and follow the instructions. You may use this printable version of your personal ID card if you need medical care.

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

Please note: Teladoc and Teladoc physicians are independent contractors and are not agents of Aetna. Visit Teladoc.com/Aetna for a complete description of the limitations of Teladoc services. Teladoc, Teladoc Health and the Teladoc Health logo are registered trademarks of Teladoc Health, Inc.

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).

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.

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 through Friday, 7:40 AM to 5 PM.