Mhbp Value Plan

Mhbp Value Plan – 1 MHBP (Mail Handlers Benefit Plan) for service plans (standard option and value plan) sponsored by preferred carrier: National Union of Mail Handlers, AFL-CIO, LIUNA Division. Who can enroll in this plan: All federal employees and annuitants who are eligible to enroll in the federal employee health benefit program and are, or are, members of the National Postal Workers Union, AFL-CIO, LIUNA branch. For changes to benefits, see page 9. Become a Member or Associate Member: If you are not a postal employee/annuitant, you will become an associate member of the National You are Post Mail Handler Union when you register with MHBP. There is no membership fee for members of the National Mail Handlers Union, AFL-CIO, LIUNA Chapter. Fee: $42 per year for associate membership unless otherwise noted. New associate members will be billed by the National Postal Mail Handlers Union for their annual dues when the plan receives notice of enrollment. Associate members will then be paid an annual membership fee by the National Union of Postmen. Enrollment code for this plan: 414 Value Plan – Self Only 415 Value Plan – Self and Family Other URAC Accreditations: Caremark, Inc.: Pharmacy Benefit Management, Drug 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 See the 2012 Accreditation Guide for more information. Special Note: Information on the MHBP consumer option is provided in a separate booklet for See RI RI

2 Important MHBP Drug Coverage and Medicare Notices OPM has determined that MHBP drug coverage must pay, on average, the same amount as Medicare-standard drugs for all plan participants and is considered guaranteed coverage. So you don’t have to sign up for Medicare Part D and pay extra for drug benefits. If you later decide to enroll in Medicare Part D, you won’t have to pay a late enrollment penalty as long as you keep your FEHB coverage. However, if you decide to enroll in Medicare Part D, you can keep your FEHB coverage and coordinate your Medicare benefits. Remember: If you are an annuitant and drop FEHB coverage, you may not be able to re-enroll in the FEHB program. Please note, if you lose or miss FEHB coverage and go 63 days or more without prescription drug coverage that is at least as much as Medicare prescription drug coverage, it will increase your monthly bill by at least 1% per month. does not have such coverage. For example, if you go 19 months without Medicare Part D drug coverage, your co-pay will be at least 19 percent lower than most people pay. You must pay this higher premium as long as you have Medicare prescription drug coverage. Additionally, you may have to wait until the annual election period (October 15 – December 7) to enroll in Medicare Part D. Plans are available for Medicare treatment. Information about this program is available through the Social Security Administration (SSA) on the Internet or by calling SSA (TTY). You can get more information about Medicare health plans and coverage offered in your area at these locations: Visit Special Help Call MEDICARE ( ), (TTY ). MHBP Notice of Privacy Practices We maintain the privacy of your Protected Health Information as described in the MHBP Notice of Privacy Practices. You can get a copy of our notice by calling us or visiting our website:

Mhbp Value Plan

Mhbp Value Plan

3 Table of Contents Introduction…3 Plain Words…3 Stop Healthcare Fraud!…3 Preventing Medical Errors…4 Part 1. The Facts This is a Business Plan…7 Part 2. How? Change part 3. How you can get benefits…11 ID card…11 Where to get covered care…11 What you need to do to get covered care…-1 You need pre-plan approval for some services…13 Section 4. Covered Cost of Services…18 Copays…18 Cost Sharing…18 Deductibles…18 Coinsurance…18 If Your Provider Always Waives Your Fees…19 Payments…19 Bill Differences…19 Your Biggest Out-of-Pocket Risk Coinsurance Protection…20 Shipping…21 If We Pay More Than You…21 When the Government Pays Us…21 When You Have an Original Medicare 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. Section 6 General Exclusions…77 Section 7. Filing a Claim for Covered Services…79 Section 8. Disputed Claims Process…82 Section 9. Arranging Benefits with Other Coverage…84 When You Have Regular Coverage – You Have Different Health. ..84 What is Medicare?…84 Should I enroll in Medicare?…85 Original Medicare plan (Part A or Part B)…85 Special arrangements 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 Agency – Other THE STATE IS RESPONSIBLE FOR YOUR CARE.. .89 WHEN OTHERS ARE LIABLE FOR INJURIES…89 SECTION 10. DEFINITIONS OF TERMS WE USE IN THIS BOOKLET…92 SECTION 11. FEHB FACTS…97 NEW COVERAGE…0 NO LIMITATIONS ON EXISTING on the conditions. ..97 Where to Get Information on Enrollment in the FEHB MHBP Program (Benefit Plan (For Postmaster) 1 Header

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4 Types of Coverage Available to You and Your Family…97 Child Bill of Rights…98 When Benefits and Premiums Begin…99 When You Retire…99 When You Lose Benefits…0 When FEHB Coverage Ends…99 After Divorce…99 Temporary Continuation of Coverage (TCC). MHBP Standard Option Benefit Evaluation Information for MHBP MHBP (Postmaster Benefit Plan)

5 Introduction This booklet describes the benefits of the Mail Manager Benefit Plan (MHBP). The National Union of Mail Handlers, LIUNA Chapter, AFL-CIO, LIUNA Chapter, has entered into a contract (CS1146) with the United States Office of Labor Management as authorized by the Federal Workers’ Compensation Act – Employee Health. This plan is underwritten by First Health Life and Health Insurance Company/Cambridge Life Insurance Company. The registered office address is: MHBP PO Box 8402 London, KY This brochure is an official statement of benefits. No oral statement may modify or affect the benefits, limitations or exclusions in this brochure. It is your responsibility to disclose your health benefits. If you enroll in this plan, you are entitled to the benefits described in this brochure. If you enroll in self and family coverage, each family member is also eligible for these benefits. You are not entitled to benefits available before 1 January 2012 unless those benefits are also shown in this booklet. OPM negotiates the benefits and costs of each plan annually. The benefit changes are effective January 1, 2012 and are summarized on pages xxx-xxx. Fees are shown 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: In addition to the necessary technical terms, we use common terms. For example, we mean registrants or family members, we mean MHBP. We’ve limited the abbreviations 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, I will first tell you what they mean. Our brochure and other FEHB plan brochures have the same layout and descriptions to help you compare plans. If you have any ideas or suggestions for improving the layout of this brochure, please let OPM know. Visit OPM’s Comments Section or OPM at: fehbwebcomments@opm.gov. You can also write to OPM at the Office of the US Workers’ Compensation and Health Insurance Administration, Federal Employee Insurance Task Force, Program Analysis and System Support, 1900 E Street NW, Washington, DC Stop Healthcare Fraud! Fraud drives up the cost of health care for everyone and raises premiums for the federal employee health benefit program. OPM’s Office of Inspector General investigates all allegations of fraud, embezzlement, or abuse in the FEHB program, regardless of which agency employed you or retired from it. Protect yourself from fraud Here are some things you can do to prevent fraud: Do not give your plan number (ID) over the phone or to anyone you don’t know except your doctor, other providers, or an authorized plan or OPM representative. . Allow only appropriate medical professionals to review your medical records or provide services. Avoid a health care provider who says an item or service is often not covered but knows how to get us to pay for it. Carefully review the Explanation of Benefits (EOB) you receive from us. Please review your complaint history

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