Mhbp Standard Plan

Mhbp Standard Plan – 1 The MHBP (Mail Handlers Benefit Plan) rate for service plan (fixed option and value plan) is sponsored by a preferred provider organization: the National Mail Handlers Union, AFL-CIO, a division of LIUNA. Who can enroll in this program: All federal employees and beneficiaries who are eligible to enroll in the Federal Employee Health Benefits Program and who are members or affiliated members of a chapter of the National Postal Mail Handlers Association, AFL-CIO. See page 9 for benefit changes. Become a Member or Associate Member: If you are not a postal employee/beneficiary, you will automatically become an associate member of the National Postal Mail Handlers Association upon registration with the MHBP. There is no membership fee for members of the National Postal Mail Handlers Association, AFL-CIO, a division of LIUNA. Membership Fees: $42 per year per associate member unless exempt by law. New associate members pay annual dues to the National Union of Postal Mail Handlers. The National Postal Mail Handlers Association will pay annual membership dues to permanent associate members. Enrollment codes for this plan: 414 Value Plan – Self Only 415 Value Plan – Self and Family Other URAC accreditations: Caremark, Inc.: Pharmacy Benefit 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 – See the 2012 Guide for more information on self and family authorization. Special Notice: Information about the MHBP Consumer Option IR is available in a separate brochure for reference to the IR

2 Important Notice from MHBP About Our Prescription Drug Coverage and Medicare OPM has determined how much MHBP prescription drug coverage should pay, on average, for standard Medicare drug coverage for all plan participants. Reliability coverage. Therefore, you do not need to enroll in Medicare Part D and pay extra for prescription drug benefits. If you decide to enroll in Medicare Part D, you won’t have to pay a late enrollment penalty as long as you maintain your FEHB coverage. However, if you choose to enroll in Medicare Part D, you can maintain your FEHB coverage and integrate benefits into Medicare. Remember: If you are a beneficiary and cancel your FEHB coverage, you will not be able to re-enroll in the FEHB plan. If you lose or cancel your FEHB coverage and go 63 days or more without drug coverage better than Medicare prescription drug coverage, your premium will increase by at least 1% each month. This coverage does not exist. For example, if you go 19 months without Medicare Part D prescription drug coverage, your premium will always be at least 19% higher than what others would pay. You will have to pay this higher premium as long as you have Medicare drug coverage. Additionally, there is a Medicare prescription drug plan where you will have to wait until next year’s consolidated election period (October 15 to December 7). Information about this program is available online through the Social Security Administration (SSA) or by calling SSA at (TTY). You can learn more about prescription drug plans and coverage in your area at: Visit 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 Standard Plan

Mhbp Standard Plan

3 Table of Contents Introduction…3 Plain language…3 End healthcare fraud!…3 Prevent medical errors…4 Section 1. The facts about the payment plan for this service…7 Section 2. How we got to Section 3 We change. HOW TO GET BENEFITS… 11 ID CARDS… 11 WHERE YOU ARE COVERED… 11 WHAT YOU NEED TO GET COVERAGE…-1 SOME SERVICES REQUIRE PRIOR PLAN APPROVAL…13 SECTION 4. YOUR COSTS FOR COVERAGE SERVICES…18 Copayments…18 Cost Sharing…18 Deductible…18 Insurance…18 Whether Your Provider Normally Waives Your Cost…19 Discounts…19 Differences on bills…19 Your disaster For maximum insurance coverage…20 Transfer…21 If we overpay…21 When government facilities charge us…21 When you have an original health insurance plan (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. SUBMITTING A CLAIM FOR COVERED SERVICES… 79 SECTION 8. Disputed Claims Process…82 Section 9. Combining Benefits with Other Coverages…84 When You Have Other Health Coverage. ..84 What is Medicare?…84 Should I Enroll in Medicare?…85 Original Medicare Plan (Part A or Part B)…85 Individual Contract with Your Doctor…86 Medicaid Benefit (Part C) ) )…86 Prescription Drug Coverage (Part D)…86 Tricare and Champa…89 Workers’ Compensation…89 Medicaid…89 When Other Government Agencies Are Responsible for Your Care… 89 When Others LIABILITY FOR INJURIES…89 SECTION 10. DEFINITIONS OF THE TERMS WE USE IN THIS BROCHURE…92 SECTION 11. FEHB FACTS…97 COVERAGE INFORMATION…0 NO LIMITATIONS ON PRE-EXISTING CONDITIONS.. .97 WHERE YOU CAN SIGN UP FOR THE FEHB PLAN Available MHBP (Benefits Scheme for Postal Handlers) 1 Index

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4 types of coverage available to you and your family…97 Child Equity Act…98 When benefits and premiums begin…99 When you retire…99 When you lose benefits…0 When FEHB coverage ends. ..99 For Divorce Then…99 Temporary Continuation of Coverage (TCC)…Transfers to 99 Individual Coverage…99 Obtaining a Certificate of Group Health Plan Coverage Section 12. Other Federal Programs Benefits Summary of the MHBP value plan MHBP standard option MHBP Benefits MHBP (Postal Operator Benefits Plan) 2 Table of Contents

5 Introduction This brochure describes the benefits of the Mail Processor Benefit Plan (MHBP). The AFL-CIO, a division of LIUNA, and the National Postal Mail Handlers Union, a division of LIUNA, have entered into an agreement (CS1146) with the U.S. Office of Personnel Management authorized by the Federal Employee Benefits Act. The plan is underwritten by FirstHealth Life and Health Insurance Company/Cambridge Life Insurance Company. Administrative Offices Address: MHBP PO Box 8402 London, KY This booklet is the official statement of benefits. NO ORAL STATEMENT MAY CHANGE OR AFFECT THE BENEFITS, LIMITATIONS AND EXCLUSIONS OF THIS BROCHURE. It is your responsibility to communicate your health interests. If you are enrolled in this plan, you will be entitled to the benefits described in this leaflet. If you are enrolled in self and family coverage, each eligible family member is entitled to these benefits. If benefits received before January 1, 2012 are not listed in this leaflet, you will not be entitled to them. OPM negotiates benefits and fees with each program annually. Changes to benefits will take effect from January 1, 2012 and are summarized on pages xxx-xxx. Fees are shown at the end of this leaflet. Plain language All FEHB brochures are written in plain language for easy understanding. Here are some examples: In addition to the necessary technical terms, we use general terms. For example, you mean enrollee or family member, we mean MHBP. We limit acronyms to what you know. FEHB is the Federal Employee Health Benefits Program. OPM is the United States Office of Personnel Management. If we use others, we will first say what they mean. Our brochure and other FEHB plan brochures have similar designs and descriptions 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 the comments section of the OPM assessment or contact OPM at fehbwebcomments@opm.gov. You can also write to OPM at the U.S. Office of Health and Insurance Personnel Management, Federal Employee Insurance Operations, Program Analysis and Systems Support, 1900 E Street NW, Washington, DC Stop Health Care Fraud ! Fraud increases healthcare costs for everyone and increases federal employee health benefits plan premiums. The OPM Inspector General investigates all allegations of fraud, waste and abuse in the FEHB program, regardless of the company that employed or retired you. Protect yourself from fraud Here are some things you can do to prevent fraud: Never give your plan identification number (ID) over the phone or to anyone you don’t know except your doctor, another provider, or an approved plan or OPM. Representative. Only appropriate medical professionals should review your medical record or prescribe services. Avoid using health care providers who claim that an item or service is generally not covered. Carefully review the Explanations of Benefits (EOBs) you receive from us. Review your complaint history

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