Summary of Benefits

Here's How MHBP Standard Option and Medicare Work Together for You

This is a summary of the Mail Handlers Benefit Plan Standard Option. Before making a final decision, please read the MHBP official Plan brochure (RI 71-007). All benefits are subject to the definitions, limitations and exclusions set forth in the MHBP official Plan brochure. This also is a summary of Medicare features. For more information on Medicare, call 1-800-MEDICAR or visit www.medicare.gov.

MHBP Standard Option With Medicare Parts A & B Primary

This chart assumes that Medicare is the primary payer and that covered services are provided by doctors and facilities that participate with Medicare. MHBP does not pay 100% when services are provided by a doctor under a private contract that provides for direct billing and no Medicare coverage.

No deductible applies when Medicare Parts A & B are primary.

Medical Coverage

Topic	You Pay
Calendar Year Deductible	Nothing. MHBP waives most medical deductibles and most copayments and coinsurance, and pays Medicare's deductibles and coinsurance.
Annual Physical Exam (PPO)	Nothing
Preventive Screenings—Includes cholesterol screenings, mammograms, PAP tests, PSA tests, urinalysis, bone density screenings, colon cancer screenings and more	Nothing
Doctor's Office Visits	Nothing
Lab, X-Ray And Diagnostic Tests	Nothing
Lab Savings Program	Nothing for covered lab tests wit the Lab Savings Program with Quest® Diagnostics
Chiropractic Care (PPO)	Nothing (up to $2,500 combined maximum for alternative, c hiropractic and rehabilitative therapies maximum)
Hospitalization	Nothing
Outpatient Surgical Facility	Nothing
Surgery And Anesthesia	Nothing
Emergency Treatment	Nothing
Overseas Medical Expenses	PPO-level benefits for covered care received outside the United States (Medicare alone usually does not provide any benefits for services received outside the United States)

Prescription Drug Coverage—Retail Pharmacy

Up to a 30-day supply. No deductible applies.

† Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring.

Retail Network Pharmacy and Electronic Claims

Topic	You Pay
Generic	$10 copayment
Preferred brand name	$40 copayment
Non-preferred brand name	$60 copayment
Specialty†	$100 copayment

Prescription Drug Coverage—Mail Order Pharmacy

Up to a 90-day supply. No deductible applies

† Specialty drugs are used to treat chronic, complex conditions and typically require special handling and close monitoring.

Mail Order Pharmacy

Topic	You Pay
Generic	$15 copayment
Preferred brand name	$65 copayment
Non-preferred brand name	$90 copayment
Specialty†	$300 copayment

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, hearing aid discount program from HearPO and healthy living and fitness benefits from GlobalFit*.

*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 the FEHBP deductibles or out-of-pocket maximums.