Mhbp Health Insurance

Mhbp Health Insurance – 1 MHBP (Mail Handler Benefit Plan) Service plan fee (standard and value plan) with preferred provider organization. Sponsored by: National Postal Service Association, AFL-CIO, LIUNA Chapter. Who may enroll in this plan: All federal employees and retirees who are eligible to enroll in the federal employee health benefits program and who are or are members or associate members of the National Postal Service Union, AFL-CIO, a chapter of LIUNA. For information about changes to benefits, see page 9. To become a member or associate member: If you are not a postal worker or retiree, when you register with the MHBP you will automatically become an associate member of the National Union of Postmasters. Members of the National Union of Postal Carriers, AFL-CIO, a branch of LIUNA, do not pay a membership fee. Membership Fees: $42 per year for affiliate membership, except where exempt by law. New associate members will be charged an annual fee by the National Association of Postal Service Operators after the Plan receives notice of enrollment. Permanent associate members will be paid by the National Union of Postal Carriers for annual membership. Enrollment codes for this plan: Value Plan 414 – Just for You Value Plan 415 – For You and Family Other URAC Accreditations: Caremark, Inc.: Pharmacy Benefits Management, Medication Therapy 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 More information about accreditation can be found in the 2012 Guide. Special Note: Information about the MHBP Consumer Option is available in a separate See RI RI brochure

2 Important Notice from MHBP Regarding Our Prescription Drug Coverage and Medicare OPM has determined that MHBP prescription drug coverage is expected to cover, on average, what standard Medicare prescription drug coverage will cover all plan participants and is considered reliable insurance. Therefore, there is no need to enroll in Medicare Part D and pay additional prescription drug benefits. If you decide to enroll in Medicare Part D later, you won’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 maintain your FEHB coverage and coordinate your benefits with Medicare. Remember: If you are a retiree and you cancel your FEHB insurance, you will not be able to re-enroll in the FEHB Program. Note If you lose or terminate your FEHB coverage and go 63 or more days 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 time you work a month has no such range. For example, if you go 19 months without Medicare Part D coverage for prescription drugs, your premium will always be at least 19 percent higher than most people pay. You will have to pay this higher premium for 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 Benefits for People with Low Income Additional help is available to help pay for a Medicare prescription drug plan for people with limited income and resources. Information about this program can be obtained from the Social Security Administration (SSA) online or by calling SSA at (TTY). You can learn more about Medicare prescription drug plans and coverage in your area at the following places: Visit for personalized 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 may obtain a copy of our Notice by calling us or visiting our website:

Mhbp Health Insurance

Mhbp Health Insurance

3 Table of Contents Introduction…3 Plain Language…3 Stopping Health Care Fraud!…3 Preventing Medical Errors…4 Section 1. Facts About This Fee for Service Plan…7 Section 2. How We Changed Section 3 How to Get Benefits… 11 ID Card… 11 Where to Get Covered Care… 11 What You Need to Do to Get Covered Care…-1 Prior Plan Approval Required for Certain Services… 13 Section 4. Your Costs for Covered Services…18 Copayment…18 Cost Sharing…18 Deductibility…18 Coinsurance…18 If Your Provider Routinely Waives Your Costs…19 Exceptions… 19 Billing Variations…19 Your Disaster Protection Maximum Insurance Outlays…20 Transfers…21 If We Overpay…21 When the Government Bills Us…21 When You Have Original Medicare (Part A, Part B or both)…22 Section 5. Standard Option and Value Plan Benefits…24 Non-FEHB Benefits Available to Plan Members…74 Section 6. General Exclusions Do Not Cover… 77 Section 7. Filing application for covered benefits…79 Section 8. Disputed Claim Process…82 Section 9. Coordination of Benefits with Other Insurance…84 When You Have Other Health Insurance . ..84 What is Medicare?…84 Should I sign up for Medicare?…85 Original Medicare (Part A or Part B)…85 Private doctor contract…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 Responsible for Your Injuries…89 Section 10. Definitions of Terms Used in This Booklet…92 Section 11. FEHB Facts…97 Insurance Information…0 No Limitations Due to Pre-existing Conditions… . 97 you can find information about enrolling in the FEHB MHBP (Mail Handler Benefit Plan) 1 Table of Contents

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4 Types of insurance available to you and your family…97 Child Equity Act…98 When benefits and contributions start…99 When you retire…99 When you lose benefits…0 When FEHB cover ends …99 After Divorce …99 Temporary Continuation Coverage (TCC) …99 Switching to Individual Insurance …99 Obtaining a Certificate of Coverage from a Group Health Plan, Section 12. Other Programs Federal Value Plan Benefit Summary MHBP MHBP Standard Option Benefit Summary MHBP Rate Information MHBP (Mail Service Benefit Plan) 2 Index

5 Introduction This brochure describes the benefits of the Mail Handler Benefit Plan (MHBP). The National Postal Service Union, LIUNA Division, AFL-CIO, LIUNA Division, has entered into an agreement (CS1146) with the United States Office of Personnel Management, pursuant to the authority of the federal Employee Health Benefits Act. This plan is insured by First Health Life and Health Insurance Company/ Cambridge Life Insurance Company. The administrative office address is: MHBP PO Box 8402 London, KY This prospectus is an official statement of benefits. No oral statement shall modify or otherwise affect the benefits, limitations and exclusions contained in this prospectus. It is your responsibility to be informed about the health benefits. If you are enrolled in this Plan, you are entitled to the benefits described in this booklet. If you are covered by Self-Employment and Family Insurance, any eligible family member is also entitled to these benefits. You are not entitled to benefits available before January 1, 2012, unless those benefits are also listed on this leaflet. OPM negotiates benefits and rates for each plan annually. The changes to benefits will come into force on January 1, 2012, and a summary of the changes can be found on pages xxx-xxx. Fees 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 common words. For example, if you mean an enrollee or family member, we mean MHBP. We limit acronyms to those you know. FEHB is a federal employee health benefits program. OPM is the United States Office of Personnel Management. If we use others, we first say what they mean. Our brochure and other FEHB plan brochures follow the same format and similar descriptions to help you compare plans. If you have comments or suggestions on how to improve the structure of this brochure, please contact OPM. Visit the OPM Rate Us comments area or OPM at fehbwebcomments@opm.gov. You can also write to OPM at U.S. Office of Workforce Management, Health Care and Insurance, Federal Office of Employee Insurance, Program Analysis and Systems Support, 1900 E Street NW, Washington, DC. Fraud increases health care costs for everyone and increases contributions to the federal employee health benefits program. OPM’s Office of Inspector General investigates all allegations of fraud, waste and abuse in the FEHB Program, regardless of the agency that employs you or from which you retired. Protect yourself from fraud Here are some things you can do to prevent fraud: Don’t give your plan identification (ID) number over the phone or to anyone you don’t know, except your doctor, other provider, or your authorized plan or OPM. representative Allow only appropriate medical professionals to review your medical history or recommend services. Avoid using health care providers who claim an item or service is not usually covered by insurance but know how to bill us for payment. Please carefully review the explanations of the benefits you receive from us. Review your claims history

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