Mail Handlers Benefit Plan Consumer Option – 1 MHBP (Postal Clerks Benefit Plan) Fee for service plan with preferred provider organization (Standard Choice and Value Plan) Sponsorship: National Postal Clerks Union, AFL-CIO, LIUNA chapter. Who can enroll in this Plan: All federal employees and annuitants who are eligible to enroll in the Federal Employees Health Benefits Program and who are a chapter or member or associate member of the National Union of Mailers, AFL-CIO. LIUNA See page 9 for changes to benefits. To become a member or associate member: If you are a non-postal employee/annuitant, you will automatically become an associate member of the National Union of Postal Workers after registering with the MHBP. There is no membership fee for members of the AFL-CIO National Union of Postal Workers, a division of LIUNA. Membership fees: $42 per year for associate membership, unless exempted by law. New associate members will be billed for annual National Mailers Association dues when they receive notice of enrollment in the Plan. Continuing associate members will be billed by the National Association of Postal Mail Handlers for their annual membership. Enrollment codes for this Plan: 414 Value Plan – Self Only 415 Value Plan – Self and Family Other URAC Accreditation: Caremark, Inc.: Pharmacy Benefits Management, Medication Management Caremark Rx, LLC: Specialty Pharmacy, Mail Service Pharmacy 454 Standard Option – Self Only United Behavioral Health, Houston Care Advocacy: Health Utilization Management 455 Standard Option – Self and Family For more information on Accreditation, see the 2012 Guide. Special Note: Information on MHBP Consumer Options is in a separate brochure for Bax RI RI
2 Important Notice from MHBP About Our Prescription Drug Coverage and Medicare OPM has determined and believes that MHBP’s prescription drug coverage is expected to pay, on average, what standard Medicare prescription drug coverage would pay for all participating in the Plan. Valid Scope. So you don’t have to enroll in Medicare Part D and pay extra for prescription drug benefits. If you later decide to enroll in Medicare Part D, you don’t have to pay a late enrollment penalty as long as you keep your FEHB coverage. However, if you choose to enroll in Medicare Part D, you can keep your FEHB coverage, and you’ll have Medicare-linked benefits. Note: If you are an annuitant and cancel your FEHB coverage, you cannot re-enroll in the FEHB Program. Please note that if you lose or cancel your FEHB coverage and go 63 days or longer without prescription drug coverage that is at least as good as Medicare prescription drug coverage, your premium will increase by at least 1 % per month for each month you have. does not have this scope. For example, if you go 19 months without Medicare Part D prescription drug coverage, your premium will always be at least 19 percent higher than what other people would pay. You will have to pay this higher premium as long as you have Medicare prescription drug coverage. Additionally, you may have to wait until the next Annual Coordinated Election Period (October 15 to December 7) to enroll in Medicare Part D. Medicare Low Income Benefits A fee-for-service plan of Medicare prescription drugs are available for extra help for people with limited income and resources. Information about this program is available online through the Social Security Administration (SSA) or by calling SSA (TTY). You can learn more about Medicare prescription drug plans and the coverage offered in your area at: Visit For personalized help, call MEDICARE ( ), (TTY ). MHBP Notice of Privacy Practices We maintain the privacy of your protected health information as described in our existing MHBP Notice of Privacy Practices. You can obtain a copy of our notice by calling us or visiting our website:
Mail Handlers Benefit Plan Consumer Option
3 Contents Introduction…3 Plain language…3 Stop Health Care Fraud!…3 Avoiding Medical Errors…4 Section 1. The facts about the fee-for-plan this service…7 Section 2. How we change for Section 3. How you can get benefits…11 ID card…11 Where you’re covered…11 What you need to do to get insured care…-1 You need early Plan approval for some work services…13 Section 4. Your costs for covered services…18 Copay…18 Cost sharing…18 Deductible…18 Coinsurance…18 If regularly waived by your provider your costs… 19 Waiver …19 Billing Differences … 19 Your Catastrophic Coverage Out-of-Pocket Maximum … 20 Carriage … 21 If We Overpay You … 21 When Government Entities Bill Us … 21 Original Medicare Plan (Part A, Part B, or both)…22 Section 5. Standard Choice and Value Plan Benefits…24 Non- FEHB Benefits for Plan Members…74 Section 6. General Exclusions Coverage…77 Section 7. Filing a claim for covered services…79 Section 8. Disputed claims process…82 Section 9. Pag -links benefits with other insurance coverage…84 If you have other health insurance. ..84 What is Medicare?…84 Should I enroll in Medicare?…85 Original Medicare Plan (Part A or Part B)…85 A private contract with your doctor…86 Medicare Advantage ( Part C ) ..86 Medicare prescription drug coverage (Part D)…86 TRICARE and CHAMPVA…89 Workers’ compensation…89 Medicaid…89 When another government agency is responsible for your care…89 Liability for damages when others …89 Section 10. Definitions of Terms We Use in This Brochure…92 Section 11. FEHB Facts…97 Information on Coverage…0 No Pre-Existing Condition Limitation…97 FEHB Program MHBP (Mail Handlers Benefit Plan) 1 You can find information about subscribing in the Table of Contents.
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4 types of coverage for you and your family…97 Child Rights Act…98 When benefits and awards start…99 When you retire…99 When you lose benefits… 0 When FEHB coverage ends.. .99 After Divorce…99 Temporary Continuation of Coverage (TCC)…99 Converting to Individual Coverage…99 Obtaining a Health Plan’s Certificate of Coverage of the Group Section 12. Other Federal Programs MHBP Value Plan Benefits Summary MHBP Standard Choice Benefits MHBP MHBP (Mail Tariff Information for Handlers Benefit Plan) 2 Table of Contents
5 Introduction This brochure describes the benefits of the Postal Employees Benefit Plan (PSB). The AFL-CIO, a division of LIUNA, and the National Union of Mailmen, a division of LIUNA, entered into a contract (CS1146) with the United States Office of Personnel Management authorized by the Federal Employees Health Benefit Act. This Plan is written by First Health Life and Health Insurance Company/Cambridge Life Insurance Company. Administrative offices are at: MHBP PO Box 8402 London, KY This brochure is the official statement of benefits. No oral statement may change or otherwise affect the benefits, limitations or exclusions of this brochure. It is your responsibility to be aware of your health benefits. If you are enrolled in this Plan, you are entitled to the benefits described in this brochure. If you have enrolled Yourself and Your Family in coverage, each eligible family member is also eligible for these benefits. You are not entitled to benefits available before 1 January 2012, unless these benefits are also listed in this leaflet. OPM negotiates benefits and rates with each plan each year. The benefit changes are effective January 1, 2012 and are summarized on pages xxx-xxx. Prices are listed at the end of this brochure. Plain language All FEHB brochures are written in plain language to make them easier to understand. Here are some examples: We use general words other than necessary technical terms. For example, you mean enrollee or family member, we mean MHBP. We limit the acronyms to what you know. FEHB is the Federal Employees Health Benefits Program. OPM is the United States Office of Personnel Management. If we use something else, we’ll tell you what it means. Our brochure and other FEHB plan brochures have the same format and similar pictures to help you compare plans. If you have comments or suggestions about how to improve the structure of this brochure, please let OPM know. Visit OPM’s Rate Us comment field or OPM at firstname.lastname@example.org. You can also write to OPM at the US Office of Health and Insurance, Office of Personnel Management, Federal Employees Insurance Operations, Program Analysis and Systems Support, 1900 E Street NW, Washington, DC. Fraud increases health care costs for everyone and raises Federal Employees Health Benefits Program premiums. OPM’s Office of the Inspector General investigates all allegations of fraud, waste, and abuse in the FEHB Program, regardless of the agency you work for or retire from. Protect yourself from fraud Here are some things you can do to prevent fraud: Do not give your plan identification (ID) number to your doctor, another provider, or over the phone or to anyone you do not know, except a authorized plan or OPM. representative Allow only appropriate medical professionals to review your medical records or recommend services. Avoid using health care providers who say they usually don’t cover an item or service, but know how to bill us for payment. Carefully review the explanation of benefits (EOB) you receive from us. Please review your claim history