Mail Handlers Benefit Program

Mail Handlers Benefit Program – 1 MHBP (Mail Handlers Benefit Plan) Reimbursement for Service Plan (Standard Choice and Value Plan) with Preferred Provider Organization Sponsor: National Union of Mail Handlers, AFL-CIO, LIUNA Chapter. Who is eligible for this plan: All federal employees and annuitants eligible for the federal employee health benefit program who are or become members or affiliates of the National Postal Operators Union, AFL-CIO, LIUNA chapter. For changes to benefits, see page 9. To become a member or associate member: If you are not a postal worker/annuitant, joining the MHBP will automatically make you an associate member of the National Union of Postal Mail Handlers. There is no dues for AFL-CIO LIUNA Chapter members. Membership Fee: $42 per year for associate membership, unless exempted by law. New affiliate members will be required to pay annual membership fees to the National Union of Postal Mail Handlers when the plan receives notice of affiliation. The National Union of Postal Operators will charge an annual membership fee to regular associate members. Enrollment codes for this plan: 414 Value Plan – Self Only 415 Value Plan – Self & Family Other URAC Accreditations: Caremark, Inc.: Pharmaceutical Benefits Management, Drug Therapy Management Caremark Rx, LLC: Specialty Pharmacy, Mail Services 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 in 2012 manual Special notice: Information on the MHBP user option is provided in a separate brochure for See RI RI

2 MHBP’s Important Notice About Our Prescription Drug Coverage and Medicare OPM determined that MHBP’s prescription drug coverage is expected to pay, on average, the standard Medicare prescription drug coverage paid for all plan participants and is considered reliable coverage. That way, you won’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 won’t have to pay a late enrollment penalty if you keep your FEHB coverage. However, if you choose to enroll in Medicare Part D, you can keep your FEHB coverage and match your benefits with Medicare. Remember: If you are an annuitant and you cancel your FEHB coverage, you cannot re-enroll in the FEHB program. Remember, if you lose or drop FEHB coverage and go 63 days or more 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 had it. they do not have this coverage. For example, if you go 19 months without a Medicare Part D prescription drug, your premium will always be at least 19 percent higher than most other people pay. You will have to pay this higher premium as long as you have Medicare prescription drug coverage. Also, you may have to wait until the next annual coordinated election period (October 15 through December 7) to sign up for Medicare Part D. A Medicare prescription drug plan is available. You can get information about this program through the Social Security Administration (SSA) online or by calling SSA on a telephone (TTY). More information about Medicare prescription drug plans and coverage in your area is available at: Visit Personal Help, call MEDICARE ( ), (TTY). MHBP Notice of Privacy Practices We protect the privacy of your protected health information as described in our current MHBP Notice of Privacy Practices. You can get a copy of our notice by calling us or visiting our website:

Mail Handlers Benefit Program

Mail Handlers Benefit Program

3 Table of Contents Introduction … 3 Plain Language … 3 Stop Healthcare Fraud! … 3 Prevention of medical errors … 4 Chapter 1. The facts about this fee-for-service plan … 7 Section 2. How we change Chapter 3. How to get benefits … 11 ID cards .. … Co-payment … 18 Cost-sharing .. .18 Deductible … 18 Co-insurance … 18 If your provider regularly waives your costs … 19 Disclaimers …19 Difference Bill …19 Out-of-pocket Catastrophe Maximum Coverage for Total Insurance … 20 Transfer … 21 If We Overpay … 21 When Government Agencies Bill Us … 21 When You Have an Original Medical Assistance Plan ( Part A, Part B or both). … …79 Section 8. Procedure for Disputed Claims…82 Section 9. Combining benefits with other insurance coverage…84 When you have other health insurance. ..84 What is Medicare?…84 Should I sign up for Medicare?…85 Original Medicare plan (Part A or Part B)…85 Private contract with a doctor…86 Medicare Advantage (Part C ) )…86 Medicare Prescription Drug Coverage (Part D)…86 TRICARE and CHAMPVA…89 Workers’ Compensation…89 Medicaid…89 When Other Government Agencies Are Responsible for Your Care…89 When Others are liable for injuries… 89 Chapter 10. Definitions of Terms Used in This Brochure… 92 Section 11. FEHB Facts… 97 Coverage Information… 0 No Preexisting Conditions Limitations… 97 Where You Can Get Information About Enrolling in the FEHB MHBP (Mail Handlers Benefit Plan) Program 1 Index

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4 Types of Coverage for You and Your Family… 97 Children Covered by Title Deed… 98 When Benefits and Contributions Begin… 99 When You Retire… 99 When You Lose Benefits… 0 When FEHB Coverage Ends …99 After Divorce…99 Temporary Extension of Coverage (TCC)…99 Converting to Individual Insurance…99 Obtaining a Group Health Plan Insurance Certificate Chapter 12. Other Federal Programs Summary of Benefits MHBP Value Plan MHBP Standard MHBP MHBP (Postmaster Benefit Plan) Index 2 Option Summary Pricing Information

5 Introduction This brochure describes the benefits of the Mail Processor Benefit Plan (MHBP). The National Union of Mail Carriers, LIUNA Chapter, AFL-CIO, LIUNA Chapter, entered into a contract (CS1146) with the United States Office of Personnel Management as authorized by the federal Workers’ Health Benefits Act. This plan is underwritten by First Health Life and Health Insurance Company / Cambridge Life Insurance Company. Administrative Office Address: MHBP PO Box 8402 London, KY This brochure is an official benefit. No oral statement shall modify or otherwise affect the benefits, limitations and exclusions in this brochure. It is your responsibility to be informed about your health benefits. If you are enrolled in this plan, you are entitled to the benefits described in this brochure. If you have individual and family coverage, all eligible family members are also eligible for these benefits. You are not entitled to benefits received before 2012. January 1, unless these benefits are also listed in this brochure. OPM negotiates benefits and rates with each plan annually. Changes to benefits come into force in 2012. January 1, and the changes 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 easy to understand. Here are some examples: Except for necessary technical terms, we use simple words. For example, you mean enrollee or family member, we mean MHBP. We only use abbreviations that you know. The FEHB is a federal employee health benefit program. OPM is the Office of Personnel Management of the United States. If we use others, we will first say what they mean. Our brochure and other FEHB plan brochures have the same layout and similar descriptions to help you compare plans. If you have comments or suggestions for improving the structure of this brochure, please let OPM know. Visit OPM’s Feedback Area Rate Us or OPM at fehbwebcomments@opm.gov. You can also write to OPM at the US Office of Personnel Management, Health Care and Insurance, Federal Employees Insurance Operations, Program Analysis and Systems Support, 1900 E Street NW, Washington, DC Stop Health Care Fraud! Fraud drives up health care costs for everyone and increases your federal employee health benefits program premium. OPM’s Office of Inspector General investigates all allegations of fraud, waste, and abuse in the FEHB program, regardless of the agency you are employed by or retired from. Protect yourself from fraud Here are some things you can do to protect yourself from fraud: Don’t give your plan identification (ID) number over the phone or to anyone you don’t know except your doctor, another provider, or an authorized plan. or OPM. representative Only appropriate healthcare professionals would review your medical records or recommend services. Avoid health care providers who say the item or service is not usually covered but know how to charge us. Please review carefully the Explanation of Benefits (EOB) you received from us. View your claim history

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