MHBP Value Plan Summary of Benefits

MHBP Value Plan Summary of Benefits

This is a summary of the Mail Handlers Benefit Plan Value Plan. Before making a final decision, please read the official Plan brochure (RI 71-007). All benefits are subject to the definitions, limitations and exclusions set forth in the official Plan brochure.

A single annual $42 Mail Handlers Benefit Plan associate membership fee makes the MHBP Value Plan available to you.

Medical Coverage

We added No Deductible to show when the calendar deductible does not apply.

Medical Coverage

Topic	You Pay
Topic	PPO	Non-PPO
Calendar Year Deductible	$500 per person Limited to $1,000 per family	$800 per person Limited to $1,600 per family
Adult Preventive Care Annual physical exam, screening and immunizations	Nothing (no deductible)	Not covered
Well-Child Care Well-child visits, screenings and immunizations	Nothing (no deductible)	Not covered
Maternity Care	Nothing (no deductible)	40% of the Plan's allowance and any difference between our allowance and the billed amount
Primary Care Doctor's Office Visits (Family Practice, General Practice, Internal Medicine and Pediatricians)	$30 copayment per office visit (no deductible)	40% of the Plan’s allowance and any difference between our allowance and the billed amount
Convenient Care Center (such as MinuteClinics in CVS drugstores and Take Care centers in Walgreens)	$25 copayment per visit (no deductible)	40% of the Plan's allowance and any difference between our allowance and the billed amount
Non Primary Care Doctor's Office Visits	20% of the Plan's allowance	40% of the Plan's allowance and any difference between our allowance and the billed amount
Lab, X-Ray, and Diagnostic Tests	20% of the Plan's allowance	40% of the Plan's allowance and any difference between our allowance and the billed amount
Lab Savings Program	Nothing for covered lab tests with the Lab Savings Program with Quest Diagnostics (no deductible)	Nothing for covered lab tests with the Lab Savings Program with Quest Diagnostics (no deductible)
Chiropractic Care	20% of the Plan's allowance and all charges after the Plan has paid the $2,500 combined alternative, chiropractic and rehabilitative therapies maximum	Not covered
Hospitalization	20% of the Plan's allowance	40% of the Plan's allowance and any difference between our allowance and the billed amount
Outpatient Surgical Facility	$200 copayment per occurrence (no deductible)	40% of the Plan's allowance and any difference between our allowance and the billed amount
Surgery (Professional Fee) Outpatient Hospital/ASC Inpatient	Nothing (no deductible)   20% of the Plan's allowance	40% of the Plan's allowance and any difference between our allowance and the billed amount
Anesthesia	20% of the Plan's allowance	40% of the Plan's allowance and any difference between our allowance and the billed amount
Emergency Treatment	20% of the Plan's allowance	40% of the Plan's allowance and any difference between our allowance and the billed amount
Overseas Medical Expenses	PPO-level benefits for covered care received outside the United States	PPO-level benefits for covered care received outside the United States
Catastrophic Protection	Nothing after your out-of-pocket expenses for covered services from PPO providers totals $4,000 per calendar year	Nothing after your out-of-pocket expenses for covered services from PPO providers and non-PPO providers combined totals $6,000 per calendar year

Prescription Drug Coverage - Retail Pharmacy

Up to a 30-day supply. No deductible.

Retail Pharmacy - Up to a 30-Day Supply

Topic	You Pay
Topic	Network Pharmacy and Electronic Claims	Non-Network Pharmacy and Paper Claims
Generic	$10 copayment	Not covered
Non-Generic	50% of the Plan's allowance	Not covered

Prescription Drug Coverage - Mail Order Pharmacy

Up to a 90-day supply. No deductible.

Mail Order Pharmacy - Up to a 90-Day Supply

Topic	You Pay
Topic	Network and Pharmacy Claims	Non-Network Pharmacies and Paper Claims
Generic	$30 copayment	Not covered
Non-Generic	50% of the Plan's allowance	Not covered

The Mail Handlers Benefit Plan 2010 Value Plan Rates

These rates do not apply to all enrollees. If you are in a special enrollment category, please refer to your FEHBP Guide or contact the agency that maintains your health benefits enrollment.

2010 Value Plan Rates

Topic	Federal Employees (Biweekly)	Postal Employees (Biweekly)	Annuitants (Monthly)
Self Only	$27.56	$15.98	$59.71
Self & Family	$65.70	$38.11	$142.36

Special Member Benefits

Vision care discounts and savings from EyeMed Vision Care providers, laser vision correction savings from the U.S. Laser Network and QualSight, a hearing aid discount program from HearPO, healthy living and fitness benefits from GlobalFit and savings on everyday health-related items through the CVS Caremark ExtraCare Health Card program*.

*These benefits are neither offered nor guaranteed under contract with the FEHBP, but are made available to all MHBP enrollees and their covered family members. You cannot file a FEHBP disputed claim about them. The fees you pay for these services do not count toward FEHBP deductibles or out-of-pocket maximums.