FEHB 2014 Rates and Benefits

 

 Benefits

Coverage Basics

High Option

Standard Option

Deductible

 None

Individual: $350 
Family: $700

Deductible applies to all services except as noted

Coinsurance

 None

None

Out-of-Pocket Limit

Individual: $3,000
Family: $6,000

Individual: $5,000
Family: $5,000

Primary Care Visit

$25

$25 copay

Preventive Care VisitCovered in fullCovered in full, not subject to deductible

Specialty Care Visit

 $25

$35 copay

Retail Prescription Drugs

30-day supply (or 100 unit supply, whichever is less)

 
90-day mail-order supply

 

Generic/Formulary/
Non-formulary copay:
$20/$40/$60

Generic/Formulary/
Non-formulary copay:
$40/$80/$120

(not subject to deductible)

Generic/Formulary/
Non-formulary copay:
$20/$40/$60

Generic/Formulary/
Non-formulary copay:
$40/$80/$120

 Manipulative Therapy Services
Self-refer to 20 visits per member PCY*

$25

$25 copay for primary care
$35 copay for specialty care

 Naturopathy
Self-refer to 3 visits per medical diagnosis PCY* 

$25

 

$25 copay for primary care
$35 copay for specialty care

 

 Acupuncture
Self-refer to 8 visits per medical diagnosis PCY* 

$25

 

$25 copay for primary care
$35 copay for specialty care

 

 Mental Health

Inpatient: $350 copay
per admit
Outpatient: $25

Inpatient: $500 per admit
Outpatient: $25 copay for primary care.

$35 copay for specialist 

Rehabilitation — Outpatient
Self-refer to 60 visits per medical diagnosis PCY*

$25

$25 copay

 Hospital

Inpatient: $350 copay
per admit
Outpatient: $75

Inpatient: $500 copay per admit
Outpatient: $100 copay

 Ambulance

20%

20%, not subject to deductible

 Emergency Care

$100 copay at a designated facility
$100 copay at a non-designated facility

$150 copay at a designated
facility

$150 copay at a non-designated facility

 Lab and X-ray

Covered in full

Covered in full

Dental (Preventive)

$50 individual/$150 family deductible,
$750 maximum benefit.
Preventive care covered in full after deductible is met.

Any provider: Periodontal care covered at 30% after deductible is met.
PPO provider: Periodontal care covered at 50% after deductible is met.

Not covered

 * PCY = per calendar year

 

Rates

Category 1: career bargaining unit employees covered by the Postal Police contract.

Category 2: career non-bargaining unit, non-executive, non-law enforcement and non-law enforcement Inspection Service and Forensics employees.

For additional information regarding the above categories, please call the Human Resources Shared Service Center at 1-877-477-3273, Option 5 (TTY: 1-866-260-7507).

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. For specific information please refer to the applicable Guide to Federal Benefits.

 Non-Postal Premium

CodeEnrollment Type

YOUR BIWEEKLY COST SHARE

YOUR MONTHLY COST SHARE

541High Option Self$124.94$270.70
542High Option Family$253.89$550.09
544Standard Option Self$54.19$117.42
545Standard Option Family$122.35$265.09

Postal Premium

CodeEnrollment Type

CATEGORY 1

Your Biweekly Share

CATEGORY 2

YOUR BIWEEKLY SHARE

541High Option Self$103.08$116.74
542High Option Family$205.27$235.66
544Standard Option Self$35.77$47.15
545Standard Option Family$80.75$106.44

 

FEDERAL EMPLOYEES AND RETIREES INDEX

 

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