Individuals Receiving Compensation From the Office of Workers Compensation Programs OWCP - To Guides for 2003

Guide to Federal Employees Health Benefits Plans For Individuals Receiving Compensation from the Office of Workers’ Compensation Programs (OWCP) Retirement and Insurance Service Visit our web site at www.opm.gov/insure RI 70 -6 Revised November 2002 Dear Federal Employees Health Benefits Program Participant: I am pleased to present the Federal Employees Health Benefits (FEHB) Program Guide for the FEHB Open Season. I would like to take this opportunity to encourage you to become informed about your health plan choices this year. In keeping with the President’s health care agenda, we are committed to providing FEHB Program members with affordable, quality health care choices. Fundamentally, I believe that FEHB participants are wise enough to determine the care options best suited for themselves and their families. Our strategy to maintain quality and cost this year rested on four initiatives. First, I met with FEHB carriers and challenged them to contain costs, maintain quality, and keep this program a model of consumer choice and on the cutting edge of employer-provided health benefits. I reminded them of President Bush’s principles for health care: patient-centered health care, preservation of choice, and excellent quality. I encouraged each plan to explore all reasonable options to hold down premium increases while maintaining a benefits package that is highly valued by our employees and retirees, as well as attractive to prospective Federal employees. Second, I met with our own FEHB negotiating team here at OPM and I challenged them to conduct tough negotiations on your behalf. Third, OPM initiated a comprehensive outside audit to review the potential costs of federal and state mandates over the past decade, so that this agency is better prepared to tell you, the Congress and others the true cost of mandated services. Fourth, we have maintained a respectful and full engagement with the OPM Inspector General (IG) and have supported all of his efforts to investigate fraud and waste within the FEHB and other programs. Positive relations with the IG are essential and I am proud of our strong relationship. The FEHB Program is market-driven. The health care marketplace has experienced significant increases in health care cost trends in recent years. Despite its size, the FEHB Program is not immune to such market forces. We have worked with the plans to provide health plan choices this year that maintain competitive benefit packages and yet keep health care affordable. We will continue on this path. Now, it is your turn. This is the time to reevaluate your personal needs and to change plans, if necessary, based on those needs. The Guide provides a comparison of the plans, benefits, premiums, results of a customer satisfaction survey and quality information. If you review the Guide and the health plan brochures you will have the information you need to make an informed choice. We suggest you also visit our web site at www.opm.gov/insure. Sincerely, Kay Coles James Director Ta b l e o f C o n t e n t s Page: Patient Safety ..................................................................................................................................ii FEHB and You ....................................................................................................................................1 How to Change Enrollment Getting Information and Selecting a Health Plan Quality • Member Survey Results • Accreditation Benefits Cost How the Plan Works Web Resources ..............................................................................................................................................5 Program Features ............................................................................................................................6 Definitions You May Need To Know ................................................................................................7 Long Term Care Insurance ................................................................................................................9 Stop Health Care Fraud ..................................................................................................................10 Quality and Safety Links ................................................................................................................11 Plan Comparisons Nationwide Fee-For-Service Plans Open to All ..................................................................13 Nationwide Fee-For-Service Plans Open Only to Specific Groups ..................................17 Health Maintenance Organization Plans and Plans Offering a Point of Service Product ..................................................................................................21 Addressing the Postcard ................................................................................................................ 49 Things to Remember ✔ ■ The plan you choose can make a difference in your health. ✔ ■ Be aware of benefit changes for 2003. ✔ ■ Check the premium for 2003. The information in this Guide gives you an overview of the FEHB Program and its participating plans. Read the plan brochures before you make any final decisions about health plans. i Patient Safety A 1999 report from the Institute of Medicine estimates that up to 98,000 Americans die every year from medical mistakes in hospitals alone. That's about 3,230 preventable deaths in the FEHB Program a year. While death is the most tragic outcome, medical mistakes cause other problems such as permanent disabilities, extended hospital stays, longer recoveries, and even additional treatments. By asking questions, learning more and understanding your risks, you can improve the safety of your own health care, and that of your family members. Take these simple steps: 1 2 Speak up if you have questions or concerns. Choose a doctor who you feel comfortable talking to about your health and treatment. Take a relative or friend with you if this will help you ask questions and understand the answers. It's okay to ask questions and to expect answers you can understand. Keep a list of all the medicines you take. Tell your doctor and pharmacist about the medicines that you take, including over-the-counter medicines such as aspirin, ibuprofen, and dietary supplements like vitamins and herbals. Tell them about any drug allergies you have. Ask the pharmacist about side effects and what foods or other things to avoid while taking the medicine. When you get your medicine, read the label, including warnings. Make sure it is what your doctor ordered, and you know how to use it. If the medicine looks different than you expected, ask the pharmacist about it. 3 Make sure you get the results of any test or procedure. Ask your doctor or nurse when and how you will get the results of tests or procedures. If you do not get them when expected -- in person, on the phone, or in the mail - don't assume the results are fine. Call your doctor and ask for them. Ask what the results mean for your care. Talk with your doctor and health care team about your options if you need hospital care. If you have more than one hospital to choose from, ask your doctor which one has the best care and results for your condition. Hospitals do a good job of treating a wide range of problems. However, for some procedures (such as heart bypass surgery), research shows results often are better at hospitals doing a lot of these procedures. Also, before you leave the hospital, be sure to ask about follow-up care, and be sure you understand the instructions. Make sure you understand what will happen if you need surgery. Ask your doctor and surgeon: Who will take charge of my care while I'm in the hospital? Exactly what will you be doing? How long will it take? What will happen after the surgery? How can I expect to feel during recovery? Tell the surgeon, anesthesiologist, and nurses if you have allergies or have ever had a bad reaction to anesthesia. Make sure you, your doctor, and your surgeon all agree on exactly what will be done during the operation. 4 5 ii FE H B How to Change Enrollment a n d Y o u I f you are enrolled and want to change your enrollment in Open Season, use the postcard on the back cover of this booklet to request a registration form to make a change. (Your health plan will send you its brochure. You can use the postcard to order brochures for other plans.) Cut the postcard along the perforated lines, then complete the postcard and mail it to the OWCP district office that handles your case. See page 58 for the district office addresses. If you order brochures, you will be given another form to make a change. Your new plan will mail you an identification card. If you need services before you receive your new card, contact your new plan at the member services number in your brochure. If you decide not to change your enrollment, no action by you is necessary. You may voluntarily cancel your enrollment at any time. However, once your cancellation takes effect, you probably will not be able to enroll again as a retiree. You will not be entitled to a 31-day extension of coverage for conversion to a non-group (private) policy and neither you nor your family members will be entitled to temporarily continue coverage. For more information on how to suspend your FEHB enrollment, contact the OWCP district office that handles your case. Do not cancel your enrollment before reading this section. You will not be able to reenroll in FEHB except under the following circumstances: • You have been continuously covered as a family member under another enrollment in FEHB since the date of your cancellation, and you lose the coverage because the enrollment ends or the enrollee changes from self and family to self only; or You suspended your FEHB coverage to enroll in a Medicare-sponsored health plan under the Social Security Act or because you are eligible under Medicaid or a similar State-sponsored program of medical assistance for the needy. Time limitations and other restrictions apply. For instance, you must submit documentation that you are suspending FEHB to enroll in a Medicare-sponsored health plan or furnish proof of eligibility for coverage under the Medicaid program or similar State-sponsored program of medical assistance for the needy, in case you wish to reenroll in the FEHB Program at a later time. If you had suspended FEHB coverage for either one of these reasons (and had submitted the required documentation) but now want to enroll in the FEHB Program again, you may enroll during Open Season. You may reenroll outside Open Season only if you move out of the Medicare-sponsored health plan’s service area, the Medicare-sponsored health plan is discontinued, or you involuntarily lose coverage under the Medicaid program or similar State-sponsored program of medical assistance for the needy. If you cancelled your coverage for any other reason, you cannot reenroll. • 1 FE H B a n d Y o u T he Federal Employees Health Benefits (FEHB) Program began operating in July 1960. It is the nation's largest employer-sponsored health insurance program. Almost 8.5 million people are in the Program, including 2.2 million Federal employees, 1.85 million retirees, and eligible family members. Getting information and selecting a health plan Use this Guide and plan brochures to make your health plan decision. The Guide summarizes FEHB plans’ benefits, costs, and quality performance; the plan brochures give complete benefit and cost information. You can get brochures from the health plans or your human resources office. Our web site www.opm.gov/insure provides the Guide, brochures, and other helpful information. Before selecting a health plan: • Consider quality ratings of each plan (look for accreditation and survey results) • Compare benefits in the brochures • Review costs (premiums, deductibles, copayments, etc.) • Understand how the plan works Quality Quality is how well health plans keep their members healthy or treat them when they are sick. Good quality health care means doing the right thing at the right time, in the right way, for the right person -- and getting the best possible results. Health plan quality can be measured from the enrollees' viewpoint (member surveys) and by the independent evaluations (accreditation) in this Guide. Member survey results in this Guide were collected, scored, and reported by an independent organization - not by the health plans. Here are the survey categories: Getting Needed Care. Were you satisfied with the choices your health plan gave you to select a personal doctor? Were you satisfied with the time it takes to get a referral to a specialist? 2 Getting Care Quickly. Did you get the advice or help you needed when you called your doctor during regular office hours? Could you get an appointment for regular or routine care when you wanted? How Well Doctors Communicate. Did your doctor listen carefully to you and explain things in a way you could understand? Did your doctor spend enough time with you? Customer Service. Was your plan helpful when you called its customer service department? Did you have paperwork problems? Were the plan's written materials understandable? Claims Processing. Did your plan pay your claims correctly and in a reasonable time? Overall Plan Satisfaction. How would you rate your overall experience with your health plan? FE H B a n d Y o u Accreditation is an approval by a private, independent organization. This approval is given after a nationally recognized organization carefully reviews a health plan and decides if it meets the organization's quality standards. The National Committee for Quality Assurance (NCQA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and URAC (URAC) are independent, private, not-for-profit organizations dedicated to measuring the quality of health care organizations. Compare the accreditation status of different health plans with the following key (a lower number means a better accredited plan). NCQA (www.ncqa.org): 1 = Excellent (HMO) or Full (PPO) 2 =Commendable (HMO only) 3 = Accredited (HMO) or One-Year (PPO) 4 = Provisional (HMO and PPO) 6 = New Health Plan JCAHO (www.jcaho.org): 1 = Accreditation with Full Compliance 2 = Accreditation with Requirements for Improvement 3 = Provisional 4 = Conditional URAC (www.urac.org): 1 = Full Accreditation 2 = Conditional Accreditation 3 = Provisional Accreditation Also, you should check your health plan’s provider directory to see which provider networks are accredited or credentialed. • Read plan brochures and the Change page carefully. • Know what services are covered • Know what services are not covered Cost The premium you pay is an important consideration. What can you afford biweekly or monthly? Plans that offer two options distinguish the difference between the two by the benefits or services provided, and this in turn affects the premium and out-of-pocket costs you pay. What benefits and services do you need, and how much do you have to pay? You also need to consider other costs: Check to see how you are protected by the plan's annual out-ofpocket maximum. If you need to go to the hospital, how much will you pay? What will you pay for an emergency room visit? If you have children, what will you pay for a well-child visit? What will you pay for your prescription? Do you pay a deductible for the services you need? You share medical expenses by paying a coinsurance (a percentage of the bill) or a copayment (a fixed dollar amount). Which option do you prefer? Does the plan limit the dollar amount it pays for certain services, making you pay the rest? • Review the benefit summary in this Guide. • Check plan brochures for specific information. How the Plan Works Different types of plans help you get and pay for care differently. Fee-For-Service (FFS) plans generally use two approaches. In the first approach, you use a FeeFor-Service plan's Preferred Provider Organization (PPO), which offers you a choice of doctors and hospitals within a network. Most networks are quite wide, but they may not have the specific doctor or hospital you want. Using PPO providers usually will save you money and reduce your paperwork. In a PPO-only option, you must use the PPO's providers to receive benefits. In the second approach, you choose any doctor and hospital. This may be more expensive for you and require extra paperwork. 3 Benefits What type of services do you think you and your family will need? Are there limits on the number of visits for the services you want or the types of services you want? All FEHB plans cover major medical benefits -hospital costs, doctors' inpatient and outpatient visits -but your share of the costs vary by plan. Don't assume benefits will be the same as they were last year. FE H B In the second approach, you choose any doctor and hospital. This may be more expensive for you and require extra paperwork. a n d Y o u You are in a FFS plan’s “PPO-only” option: • You must use network providers to receive benefits. You belong to an HMO: • You will have limitations on the doctors, providers, and facilities you can use • You will usually pay less when you get care • You will have little, if any, paperwork • More preventive health care services may be covered You belong to a POS plan and... You use only the providers in that network: • You will pay less when you get care • You will get full network benefits and coverage • You will have very little paperwork You do not use the network providers or referral procedures: • You will pay more when you get care • You generally have to file claims for services yourself • Some services may not be covered out of network at all Things to do to make a plan work best for you • When you need care, use your brochure to find out about the plan's rules and coverage. Know what services require precertification, prior approval, or referral before you use them. Verify physician participation. • Request generic drugs instead of brand name drugs. A generic medication is a copy of a brand name drug. It has the same active ingredients and receives the same Food and Drug Administration approval but costs less. Most plans charge you a lower copay if you use generic drugs. • If you're in a FFS plan, use the plan's PPO if it has one. (Be aware, however, that some of the services provided in a PPO hospital may not be covered by PPO arrangements. Room and board will be covered, but anesthesia and radiology, for instance, will probably be covered under non-PPO benefits.) • Ask questions. You deserve a voice in your own health care. 4 Enrolling in a FFS plan does not guarantee that a PPO will be available in your area. PPOs have a stronger presence in some regions than others, and in areas where there is no PPO, the non-PPO benefit is the only benefit. In a PPO-only option, you must use the PPO's providers to receive benefits. Health Maintenance Organizations (HMOs) generally limit their networks of physicians and facilities. You must use their network to get covered services and follow their guidance for referrals, prior authorizations, and other services. HMOs limit your out-ofpocket costs to the relatively low amounts shown in the benefit brochures. Some plans are Point Of Service (POS) plans and have features similar to both FFS plans and HMOs. POS plans are identified in the charts by lines for "In-Network" and "Out-of-Network." Be sure to look at the primary care physicians, specialists, and hospitals with whom your health plan contracts (the provider network). Does it have the specialists to treat your chronic condition? Does it contract with primary doctors and hospitals that are convenient to you? You are in a FFS plan and… You use the PPO: • You will generally pay less when you get care • More preventive health care services may be covered • You may have less paperwork You do not use the PPO (or one is not available): • You will generally pay more when you get care • Fewer preventative health care services may be covered • You will have to file your own claims for services you receive NOTE: APWU’s Consumer Driven Option differs from its FFS option in many important ways. Read the brochure for details. F E Hl B n W Ce ob m R e s io su or nc se s P a p a r Use the FEHB web site for additional help in choosing the health plan that is right for you. The FEHB web site at www.opm.gov/insure/health can help you to choose your health plan and enroll. In addition to the information found in this Guide you will find: • An interactive tool that will allow you to find the health plans that service your area and will allow you to make side-by-side comparisons of the costs, benefits, and quality indicators of the plans that interest you. • Electronic versions of all plan brochures. • Information on enrolling, with the ability to enroll online for annuitants and employees of selected agencies. • Information on how plans in the FEHB Program coordinate benefit payments with Medicare. • A comprehensive set of Frequently Asked Questions and answers on all aspects of the Program. • An online version of the FEHB Handbook for detailed guidance on FEHB policies and procedures. 5 Pr o g r a m F e a t u r e s • No Waiting Periods. You can use your benefits as soon as your coverage becomes effective. There are no pre-existing condition limitations. • A Choice of Coverage. Choose between self only or self and family. • A Choice of Plans and Options. Select from Fee-For-Service, Health Maintenance Organization, or Point of Service plans. • A Government Contribution. The Government pays 72 percent of the average premium toward the total cost of your premium, but not more than 75 percent of the total premium for any plan. • Salary Deduction. You pay your share of the premium through a payroll deduction. • Annual Opportunity to Change Plans. Each year you can change your health plan enrollment. This year the Open Season runs from November 11, 2002 through December 9, 2002. • Continued Group Coverage. Eligibility for you or your family members may continue following your divorce or death. Contact the OWCP district office that handles your case for more information. • Coverage After FEHB Ends. You or your family members may be eligible for temporary continuation of FEHB coverage or for conversion to non-group (private) coverage when FEHB coverage ends. Contact the OWCP district office that handles your case for more information. Better Information Better Choices Better Health 6 De f i n i t i o n s Accreditation - A rigorous and comprehensive evaluation performed by independent organizations that includes a review of records as well as on-site reviews of managed care organizations. Accreditation also includes an assessment of the care and service plans are delivering in important areas of public concern such as immunization rates, mammography rates, and member satisfaction. The following three organizations perform accreditation reviews we recognize: JCAHO - The Joint Commission on Accreditation of Healthcare Organizations. These are JCAHO's accreditation levels: • Accreditation with Full Compliance Demonstrates satisfactory compliance with JCAHO standards in all performance areas. • Accreditation with Requirements for Improvement - Demonstrates satisfactory compliance with JCAHO standards in most performance areas. • Provisional - Demonstrates a previously unaccredited plan's satisfactory compliance with a subset of standards. • Conditional - Demonstrates failure to meet standard(s) or specific policy requirement(s) but is believed capable to do so in a specified time period. NCQA -The National Committee for Quality Assurance. These are NCQA's accreditation levels. • Excellent - NCQA's highest status. Levels of service and clinical quality that meet or exceed NCQA's requirements for consumer protection and quality improvement AND achieve health plan performance results that are in the highest range of national or regional performance. • Commendable - Meets or exceeds NCQA's requirements for consumer protection and quality improvement. • Accredited - Meets most of NCQA's requirements for consumer protection and quality improvement. • Provisional - Meets some but not all of NCQA's requirements for consumer protection and quality improvement. • New Health Plan - Applies to health plans that are less than two years old. URAC - Formerly known as the American Accreditation Healthcare Commission. These are URAC's accreditation levels. • Full Accreditation - Demonstrates full compliance with standards. • Conditional Accreditation - Meets most of the standards but needs some improvement before achieving full compliance. • Provisional Accreditation - A plan that has otherwise complied with all standards but has been in operation for less than 6 months. 7 De f i n i t i o n s Coinsurance - The amount you pay as your share of the medical services you receive, like for a doctor's visit. Coinsurance is a percentage of the cost of the service (e.g., 20%). Consumer Driven Option - A fee-for-service option under the FEHB that offers you greater control over choices of your health care expenditures. You decide which health care services will be reimbursed under the health plan funded Personal Care Account. Unused funds from the account will roll over at the end of the year. If you spend the entire account fund before the end of the year, then you must satisfy a member responsibility/deductible before benefits are payable under the traditional type of insurance covered by your plan. You decide whether to use PPO or Non-PPO providers to reach the maximum fund allowed under your account. Copayment - The amount you pay as your share of the medical services you receive, like for a doctor's visit. Copayment is a fixed dollar amount (e.g., $15). Fee-For-Service (FFS) - Health coverage in which doctors and other providers receive a fee for each service such as an office visit, test, procedure, or other health care service. The health plan will either pay the medical provider directly or reimburse you for covered services after you have paid the bill and filed an insurance claim. When you need medical attention, you visit the doctor or hospital of your choice. Health Maintenance Organization (HMO)- A health plan that provides care through contracted or employed physicians and hospitals located in particular geographic or service areas. HMOs emphasize prevention and early detection of illness. Your eligibility to enroll in an HMO is determined by where you live or, in some plans, where you work. In-Network - You receive treatment from the doctors, clinics, health centers, hospitals, medical practices, and other providers with whom your plan has an agreement to care for its members. Examples include a Fee-For-Service plan's PPO or a Health Maintenance Organization. Members have fewer out-of-pocket costs when they use in-network providers. Managed care - A very broad term that generally refers to a system that manages the quality of health care, access to care, and the cost of that care. For example, a formulary controls the quality of medications dispensed to enrollees; a referral ensures that you see the right specialist for your condition; and going to a hospital that has an agreement with your plan can save both you and the plan money. Out-of-Network - You receive treatment from doctors, hospitals, and medical practitioners other than those with whom the plan has an agreement, and pay more to do so. Members in a PPO-only option who receive services outside the PPO network generally pay all charges. Point of Service (POS) - A product offered by an HMO or FFS plan that has both in-network and outof-network features. In a POS you don't have to use the plan's network of providers, but there are advantages if you do. Preferred Provider Organization (PPO) - The PPO is similar to FFS insurance except it uses a network of providers. PPOs give you the choice of using doctors and other providers within the plan's network (the PPO benefit), or using ones outside the plan's network. You don't have to use the PPO, but there are advantages if you do. (Be aware, however, that some of the services provided in a PPO hospital may not be covered by PPO arrangements. Room and board will be covered, but anesthesia and radiology, for instance, will probably be covered under non-PPO benefits.) Note that some FFS plans may offer an enrollment option that is “PPO-only.” Under this option you must use network providers to receive benefits. Provider - A doctor, hospital, health care practitioner, pharmacy, or health care facility. 8 L ong Term Car e Insurance Is Still Available! Open Season for Long Term Care Insurance • You can protect yourself against the high cost of long term care by applying for insurance in the Federal Long Term Care Insurance Program. • Open Season to apply for long term care insurance through LTC Partners ends on December 31, 2002. • If you're a Federal employee, you and your spouse need only answer a few questions about your health during Open Season. • If you apply during the Open Season, your premiums will be based on your age as of July 1, 2002. After Open Season, your premiums will be based on your age at the time LTC Partners receives your application. FEHB Doesn't Cover It • Neither FEHB plans nor Medicare cover the cost of long term care. Also called "custodial care", long term care helps you perform the activities of daily living such as bathing or dressing yourself. It can also provide help you may need due to a severe cognitive impairment such as Alzheimer’s disease. You Can Also Apply Later, But… • Employees and their spouses can still apply for coverage after the Federal Long Term Care Insurance Program Open Season ends, but they will have to answer more health-related questions. • For annuitants and other qualified relatives, the number of health-related questions that you need to answer is the same during and after the Open Season. You Must Act to Receive an Application • Unlike other benefit programs, YOU have to take action – you won’t receive an application automatically. You must request one through the toll-free number or website listed below. • Open Season ends December 31, 2002 – act NOW so you won’t miss the abbreviated underwriting available to employees and their spouses, and the July 1 “age freeze!” Find Out More -- Contact LTC Partners by calling 1-800-LTC-FEDS (1-800-582-3337) (TDD for the hearing impaired: 1-800-843-3557) or visiting www.ltcfeds.com to get more information and to request an application. 9 St o p Health Care Fraud! F raud increases the cost of health care for everyone and increases your Federal Employees Health Benefits Program (FEHBP) premium. OPM's Office of the Inspector General investigates all allegations of fraud, waste, and abuse in the FEHBP 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: • Be wary of giving your health plan identification number over the telephone or to people you do not know, except to your doctor, other provider, or authorized plan or OPM representative. • Let only the appropriate medical professionals review your medical record or recommend services. • Avoid health care providers who say that an item or service is not usually covered, but they know how to bill your health plan to get it paid. • Carefully review explanations of benefits (EOBs) that you receive from your health plan. • Do not ask your doctor to make false entries on certificates, bills or records in order to get your health plan to pay for an item or service. • If you suspect that a provider has charged you for services you did not receive, billed you twice for the same service, or misrepresented any information, do the following: • Call the provider and ask for an explanation. There may be an error. • If the provider does not resolve the matter, call your health plan and explain the situation. • If they do not resolve the issue: CALL -- THE HEALTH CARE FRAUD HOTLINE 202-418-3300 OR WRITE TO: The United States Office of Personnel Management Office of the Inspector General Fraud Hotline 1900 E Street, NW, Room 6400 Washington, DC 20415 • Do not maintain as a family member under your FEHB coverage: • your former spouse after a divorce decree or annulment is final (even if a court orders it); or • your child over age 22 unless he/she is incapable of self support. • If you have any questions about the eligibility of a dependent, check with your human resource office if you are employed or with OPM if you are retired. • You can be prosecuted for fraud and your agency may take action against you if you falsify a claim to obtain FEHBP benefits or try to obtain services for someone who is not an eligible family member or who is no longer enrolled in the Plan. 10 Q uality and Safety Links Want more information on health care quality and safety? The following web sites have information consumers can use when considering health plans, doctors and hospitals, medications, and more. www.ihealthcoalition.org/content/tips.html • This site offers tips on what to look for when searching for health information on the Internet. www.ahrq.gov/consumer/pathqpack.htm • The Agency for Healthcare Research and Quality has made available a wideranging list of topics to help consumers choose quality healthcare providers and improve the quality of care they receive. www.npsf.org • The National Patient Safety Foundation has information for patients on how to ensure safer healthcare for you and your family. www.talkaboutrx.org/consumer.html • The National Council on Patient Information and Education is dedicated to improving communication about the safe, appropriate use of medicines. http://medlineplus.gov • The world’s largest medical library offering health information from the National Library of Medicine/National Institutes of Health. www.leapfroggroup.com • The Leapfrog Group is active in promoting safe practices in hospital care. www.ahqa.org • The American Health Quality Association represents organizations and healthcare professionals working to improve patient safety and the quality of healthcare nationwide. www.quic.gov/report • Find out what Federal agencies are doing to identify threats to patient safety and help prevent mistakes in the Nation’s healthcare delivery system. www.nchc.org/releases/medical_error.pdf • The National Coalition on Health Care and the Institute for Healthcare Improvement offer profiles on what institutions and organizations are doing to reduce medical errors and improve patient safety. 11 Pl a n C o m p a r i s o n s Nationwide Fee-For-Service Plans Open to All (Pages 14 through 16) Fee-For-Service (FFS) Plans with a Preferred Provider Organization (PPO) — A FFS option that allows you to see medical providers who reduce their charges to the plan; you pay less money out-of-pocket when you use a PPO provider. When you visit a PPO you usually won’t have to file claims or paperwork. However, going to a PPO hospital does not guarantee PPO benefits for all services received within that hospital. For instance, lab work and radiology services from independent practitioners within the hospital may not be covered by the PPO agreement. Fee-For-Service (FFS) Plans (non-PPO) — A traditional type of insurance in which the health plan will either pay the medical provider directly or reimburse you after you have filed an insurance claim for each covered medical expense. When you need medical attention, you visit the doctor or hospital of your choice. In PPO-only options, you must use PPO providers to receive benefits. Consumer Driven Option offers three major benefit elements. A) In-Network Preventive Care – you pay nothing for preventive services provided in PPO. Your in-network preventive care does not count against your Personal Care Account. B) Personal Care Account – you pay nothing for the first $1,000 ($2,000 for self and family enrollment) in covered services by your FFS plan. A PPO or Non-PPO provider may provide your service. These services may include limited dental and vision care that you select. C) Traditional Health Care – you pay stated coinsurance after spending the amount allowed in the Personal Care Account and satisfy the member responsibility/deductible. A PPO or Non-PPO provider may provide your service. 13 Nationwide Fee-for-Service Plans Open to All How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. The chart does not show all of your possible out-of-pocket costs. The Deductibles shown are the amount of covered expenses that you pay before your health plan begins to pay. Calendar Year deductibles for families are two or more times the per person amount shown. In some plans your combined Prescription Drug purchases from Home delivery and local pharmacies count toward the deductible. In other plans only purchases from local pharmacies count. Some plans require each family member to meet a per person deductible. The Per Stay Hospital Inpatient deductible is what you pay each time you are admitted to a hospital. What you pay for Doctors (inpatient visits and surgical services) and Outpatient Tests (provided, or ordered, and billed by a physician or physicians’ group). Enrollment code Twice – Biweekly Premium Your Share Plan name Alliance Health Plan (AHP) APWU Health Plan-High (APWU) APWU Health Plan-Consumer Driven (APWU) Blue Cross and Blue Shield Service Benefit Plan-Std (BCBS) Blue Cross and Blue Shield Service Benefit Plan-Basic (BCBS) GEHA Benefit Plan-High (GEHA) GEHA Benefit Plan-Std (GEHA) Mail Handlers-High (MH) Mail Handlers-Std (MH) NALC PBP Health Plan-High (PBP) PBP Health Plan-Std (PBP) Telephone number 202/939-6325 800/222-2798 800/222-2798 Local phone # Local phone # 800/821-6136 800/821-6136 800/410-7778 800/410-7778 888/636-6252 800-544-7111 800-544-7111 Self only 1R1 471 474 104 111 311 314 451 454 321 361 364 Self & family 1R2 472 475 105 112 312 315 452 455 322 362 365 Self only 144.98 104.16 72.80 91.32 69.98 134.34 55.00 128.58 56.18 96.88 319.64 96.90 Self & family 271.56 209.06 172.60 210.44 164.54 268.88 125.00 233.08 121.94 174.90 662.04 215.40 14 Your share of Hospital Inpatient Room and Board and Other (e.g., nursing, supplies, and medications) covered charges are shown, usually after any per stay deductible. Services provided and billed by the hospital for outpatient care (other than surgery) are shown as Hospital Outpatient Other expenses. A Generic drug is a copy of the manufacturer’s Brand Name drug and is approved by the Food and Drug Administration. Non-formulary drugs are Brand Names that are not on your health plan’s list of preferred drugs. Prescription drug benefits have become more complex as you can see from the many variations below. Multiple numbers for a plan mean there are different levels of cost sharing. For instance, you may pay one amount for your first prescription (e.g., 10% or $5) and then a different amount for some refills (e.g., 50%). You may have to pay the greater of a dollar amount or a percentage (e.g., $10 or 20%). In some cases, you’ll pay less for a Brand Name drug that has no Generic equivalent than for a Brand Name that has a Generic (e.g., $15 versus $30). A few plans have lower copays for Medicare members. Plans vary in the number of days supply of drugs you get for the copays shown, and you’ll almost always pay more if you use a non-PPO pharmacy (e.g., the + sign means you pay the amount shown plus a differential.) Read the brochures for details. Medical-Surgical – You pay Deductible Per Person Copay ($)/Coinsurance (%) Benefit type Plan AHP APWU-High APWU BCBS-Std BCBS-Basic GEHA-High GEHA-Std MH-High MH-Std NALC PBP-High PBP-Std PPO Non-PPO PPO Non-PPO Prescription drugs Hospital Per stay Doctors & Home Delivery Hospital Outpatient Inpatient NonOutpatient Generic Brand Tests Calendar Prescription inpatient Name formulary Generic Brand other R&B Other Drug Year Name $200 $400 $275 $350 $200 $200 None None $150 $250 None $200 10% 30% 10% 30% 10% 30% 10% 30% 10% 30% 10% 30% 10% 30% 10% 30% 10%/50% 15%/50% 10%/50% + 15%/50%+ $7 45% 25% 45% 15%/50% 15%/50%+ 25% 45% 20% 20% $10 $10 25% 25% 20% 20% See pages 8 and 13 of this Guide for a benefit APWU brochure for details. See pages 7 and 11 of this Guide for a benefit description, and carefully read thedescription, and carefully read the APWU brochure for details. PPO Non-PPO PPO PPO Non-PPO PPO Non-PPO PPO Non-PPO PPO Non-PPO PPO Non-PPO PPO Non-PPO PPO Non-PPO $250 $250 None $350 $350 $450 $450 $250 $250 $300 $300 $250 $300 $200 $450 $250 $500 None None None None None None None $250 $250 $600 $600 None $25 for Retail $90 $90 $90 $90 $100 $300 $100/day x 5 $100 $300 None None None $250 $150 $300 None $100 None $150 None $250 10% 25% $20/$30 10% 25% 15% 35% 10% 30% 10% 30% 15% 30% 10% 15%-25% 9% 30% Nothing Nothing 30% 30% Nothing Nothing Nothing Nothing 15% 35% 10% 25% 15% 35% 10% 25% $30 10% 25% 15% 35% 10% 30% 10% 30% 15% 30% 10% 25% 9% 30% 25% 45%+ $10 25% 45%+ $25 25% 45%+ $35 or 50% $10/25% 45%+ $10 * $10 $10 $15 $15 $10 $10 $10 $10 $10 $10 $6 $6 $8 $8 $35/25% 45%+ $25 * $40/$55 $40/$55 50% 50% $30/$45 $30/$45 $40/$55 $40/$55 $30 $30 $25/ $40 or 20% $30/ $40 or 20% $5/50% $20/50% $20/$35/50% $5/50% + $20/50% + $20/$35/50% + $5 $5 + $7 50% $8 50% 25% 40%+ $3 20%+ $4 30%+ 50% 50% + $23 50% $28 50% 25% 40%+ $25 or 20% 20%+ $30 or 20% 30%+ 50% 50% + $35 50% $40 50% 25% 40%+ $40 or 20% 20%+ $40 or 20% 30%+ Nothing Nothing Nothing Nothing Nothing Nothing Nothing Nothing 10% 30% 10% 25% 9% 30% 10% 30% 10% 25% 9% 30% * Home delivery is available from Internet pharmacies and may be available from certain retail pharmacies. The Mail Service Program is not available under Basic Option. 15 Nationwide Fee-for-Service Plans Open to All Member Survey Results — See page 2 for a description. Member Survey Results h above average, * average, f below average Overall plan satisfaction Getting needed care Getting care quickly How well doctors communicate h * Customer service Claims processing Plan name Alliance Health Plan APWU Health Plan-High APWU Health Plan-Consumer Driven Blue Cross and Blue Shield Service Benefit Plan-Std Blue Cross and Blue Shield Service Benefit Plan-Basic GEHA Benefit Plan-High GEHA Benefit Plan-Std Mail Handlers-High Mail Handlers-Std NALC PBP Health Plan-High PBP Health Plan-Std Plan code 1R 47 47 10 11 31 31 45 45 32 36 36 h h f f h f f * * f f h * * f f f f h h h f * f * h * * h * * h * h * * f f f * * h h h h h * * h f f h h f f h f f 16 Pl a n C o m p a r i s o n s Nationwide Fee-For-Service Plans Open Only to Specific Groups (Pages 18 through 20) Fee-For-Service (FFS) Plans with a Preferred Provider Organization (PPO) — A FFS option that allows you to see medical providers who reduce their charges to the plan; you pay less money out-of-pocket when you use a PPO provider. When you visit a PPO you usually won’t have to file claims or paperwork. However, going to a PPO hospital does not guarantee PPO benefits for all services received within that hospital. For instance, lab work and radiology services from independent practitioners within the hospital may not be covered by the PPO agreement. Fee-For-Service (FFS) Plans (non-PPO) — A traditional type of insurance in which the health plan will either pay the medical provider directly or reimburse you after you have filed an insurance claim for each covered medical expense. When you need medical attention, you visit the doctor or hospital of your choice. 17 Nationwide Fee-for-Service Plans Open Only to Specific Groups How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. The chart does not show all of your possible out-of-pocket costs. The Deductibles shown are the amount of covered expenses that you pay before your health plan begins to pay. Calendar Year deductibles for families are two or more times the per person amount shown. Some plans apply Prescription Drug purchases to the Calendar Year deductible. The Per Stay Hospital Inpatient deductible is what you pay each time you are admitted to a hospital. What you pay for Doctors (inpatient visits and surgical services) and Outpatient Tests (provided, or ordered, and billed by a physician or physicians’ group). Enrollment code Twice – Biweekly Premium Your Share Plan name Association Benefit Plan (ABP) Foreign Service Benefit Plan (FS) Panama Canal Area Benefit Plan (PCA) Rural Carrier Benefit Plan (Rural) SAMBA Secret Service (SS) Telephone number 800/634-0069 202/833-4910 800/548-8969 800/638-8432 800/638-6589 800/424-7474 Self only 421 401 431 381 441 Y71 Self & family 422 402 432 382 442 Y72 Self only 109.10 78.52 72.48 141.36 147.32 74.30 Self & family 255.68 222.38 151.30 233.96 362.52 194.92 18 Your share of Hospital Inpatient Room and Board and Other (e.g., nursing, supplies, and medications) covered charges are shown, usually after any per stay deductible. Services provided and billed by the hospital for outpatient care (other than surgery) are shown as Hospital Outpatient Other expenses. A Generic drug is a copy of the manufacturer’s Brand Name drug and is approved by the Food and Drug Administration. Non-formulary drugs are Brand Names that are not on your health plan’s list of preferred drugs. Prescription drug benefits have become more complex as you can see from the many variations below. Multiple numbers for a plan mean there are different levels of cost sharing. For instance, you may pay one amount for your first prescription (e.g., 10% or $5) and then a different amount for some refills (e.g. 50%). You may have to pay the greater of a dollar amount or a percentage (e.g., $10 or 20%). In some cases, you’ll pay less for a Brand Name drug that has no Generic equivalent than for a Brand Name that has a Generic (e.g., $15 versus $30). A few plans have lower copays for Medicare members. Plans vary in the number of days supply of drugs you get for the copays shown, and you’ll almost always pay more if you use a non-PPO pharmacy (e.g., the + sign means you pay the amount shown plus a differential). Read the brochures for details. Medical-Surgical – You pay Deductible Per Person Copay ($)/Coinsurance (%) Benefit type Plan ABP FS PCA Rural SAMBA SS PPO Non-PPO PPO Non-PPO POS FFS PPO Non-PPO PPO Non-PPO No PPO Prescription drugs Hospital Per stay Doctors & Home Delivery Hospital Outpatient Inpatient Outpatient NonTests Generic Brand Calendar Prescription inpatient other Name formulary Generic Brand R&B Other Drug Year Name $300 $300 $300 $300 None None $350 $350 $350 $350 $200 None None None None $400 $400 CY Applies CY Applies None None None $100 $200 Nothing $200 $50 $125 Nothing $200 $200 $300 $100 10% 30% 10% 30% Nothing 50% 10%/15% 15%/25% 10% 30% 20% Nothing Nothing 30% 30% Nothing Nothing 20% 20% Nothing Nothing 50% 50% Nothing Nothing 15% 15% Nothing 30% 10% 30% 10% 30% 10% 30% Nothing 50% 15% 25% $100/10% $150/30% Nothing $10 $10 $10/25% $10/25% 50% 50% 25% 25% $10 $10 $10 $20 $20 $20/25% $20/25% 50% 50% 25% 25% $25 $25 $20 $30/30% $30/30% $20/25% $20/25% 50% 50% 25% 25% $40 $40 $20 $20 $20 $20 $20 N/A N/A $15 $15 $10 $10 $20 $40/ $45 or 30% $40 $40 N/A N/A $25 $25 $35/$50 $35/$50 $40 Nothing Nothing *The Panama Canal Area Plan provides a point-of-service product within the Republic of Panama. 19 Nationwide Fee-for-Service Plans Open Only to Specific Groups Member Survey Results — See page 2 for a description. Member Survey Results h above average, * average, f below average Overall plan satisfaction Getting needed care Getting care quickly How well doctors communicate Customer service Claims processing Plan name Association Benefit Plan Foreign Service Benefit Plan Panama Canal Area Benefit Plan Rural Carrier Benefit Plan SAMBA Secret Service Plan code 42 40 43 38 44 Y7 h * f h f h h * f * * * h f f h f f h * * f * * f f h f * * 20 Pl a n C o m p a r i s o n s Health Maintenance Organization Plans and Plans Offering a Point of Service Product (Pages 22 through 47) Health Maintenance Organization (HMO) — A health plan that provides care through a network of physicians and hospitals in particular geographic or service areas. HMOs coordinate the health care service you receive and free you from completing paperwork or being billed for covered services. Your eligibility to enroll in an HMO is determined by where you live or, for some plans, where you work. Some HMOs are affiliated with or have arrangements with HMOs in other service areas for non-emergency care if you travel or are away from home for extended periods. Plans that offer reciprocity discuss it in their brochure. ● The HMO provides a comprehensive set of services — as long as you use the doctors and hospitals affiliated with the HMO. HMOs charge a copayment for primary physician and specialist visits and generally no deductible or coinsurance for inhospital care. ● Most HMOs ask you to choose a doctor or medical group to be your primary care physician (PCP). Your PCP provides your general medical care. In many HMOs, you must get authorization or a “referral” from your PCP to see other providers. The referral is a recommendation by your physician for you to be evaluated and/or treated by a different physician or medical professional. The referral ensures that you see the right provider for the care most appropriate to your condition. ● Care received from a provider not in the plan’s network is not covered unless it’s emergency care or the plan has a reciprocity arrangement. Plans Offering a Point of Service (POS) Product — A product similar to an HMO and FFS plan. The POS product lets you use providers who are not part of the HMO network. However, you pay more for using these non-network providers. You usually pay higher deductibles and coinsurances than you pay with a plan provider. You will also need to file a claim for reimbursement, like in a FFS plan. The HMO plan wants you to use its network of providers, but recognizes that sometimes enrollees want to choose their own provider. The POS plans have two rows for “In Network” and “Out of Network” benefits. In Network shows what you pay if you go to the plan’s providers; Out of Network shows what you pay if you decide not to go to the plan’s providers. 21 Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location Alabama PrimeHealth of Alabama, Inc. - Southern Alabama and the Montgomery Area The Oath - A Health Plan for Alabama, Inc. - Birmingham/Other Areas Telephone number Self only Self & family Self only Self & family 800/236-9421 800/947-5093 AA1 DF1 AA2 DF2 53.20 89.74 136.34 290.10 Arizona Aetna Health Inc. - Phoenix/Tucson Areas Health Net of Arizona, Inc. - Maricopa/Pima/Other AZ counties PacifiCare Health Plans - Maricopa/Pima/parts of Apache Junction 800/537-9384 800/289-2818 800/531-3341 WQ1 A71 A31 WQ2 A72 A32 52.22 63.80 64.98 143.44 161.64 214.64 NCQA 1 NCQA 2 NCQA 1 California Aetna Health Inc. - Southern California Area Blue Cross- HMO - Most of California Blue Shield of CA Access+ - Most of California CIGNA HealthCare of California - Northern/Southern California Health Net - Most of California Kaiser Permanente - Northern California Kaiser Permanente - Southern California PacifiCare Health Plans - Most of California UHP Healthcare - LA/Orange/San Bernardino Counties Universal Care - Southern California 800/537-9384 800/235-8631 800/880-8086 800/244-6224 800/522-0088 800/464-4000 800/464-4000 800/531-3341 800/544-0088 800/257-3087 2X1 M51 SJ1 9T1 LB1 591 621 CY1 C41 6Q1 2X2 M52 SJ2 9T2 LB2 592 622 CY2 C42 6Q2 53.98 66.68 65.46 66.96 62.94 69.06 64.66 52.80 52.70 52.02 128.08 181.34 162.40 147.34 149.00 164.84 149.44 136.64 112.22 137.36 NCQA 2 NCQA 2 NCQA 2 NCQA 2 NCQA 2 NCQA 1 NCQA 1 NCQA 1 JCAHO 1 NCQA 2 Colorado Kaiser Permanente - Denver/Colorado Springs Areas PacifiCare of Colorado-High -Denver/Colorado Springs/Ft.Collins PacifiCare of Colorado-Std - Denver/Colorado Springs/Ft.Collins 800/632-9700 800/877-9777 800/877-9777 651 D61 D64 652 D62 D65 67.16 72.64 51.88 204.52 256.18 134.90 NCQA 1 NCQA 1 NCQA 1 22 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name Alabama PrimeHealth of Alabama, Inc. The Oath - A Health Plan for Alabama, Inc. $15 $20 $25 $20 $150/day x 4 $100 $10 $10 $20 $20 $40 $30 * h * * h h h h * * Arizona Aetna Health Inc. Health Net of Arizona, Inc. PacifiCare Health Plans $20 $10 $10 $25 $10 $20 $250/day x 3 $100/day x 5 None $10 $10 $10 $25 $30 $20 $40 $45 $20 * f f f f f f f f f f * f f * * f * California Aetna Health Inc. Blue Cross- HMO Blue Shield of CA Access+ CIGNA HealthCare of California Health Net Kaiser Permanente Kaiser Permanente PacifiCare Health Plans UHP Healthcare Universal Care $20 $10 $10 $15 $10 $15 $10 $10 $10 $10 $25 $10 $10 $25 $10 $15 $10 $20 $10 $10 $250/day x 3 None None $250 $100 None None None None $100/day x 3 $10 $5 $5 $7 $10 $10 $10 $10 $10 $10 $25 $10 $10 $15 $20 $25 $25 $20 $20 $20 $40 50% $25 $35 $35 $25 $25 $20 $20 $30 * f f * * * f f * f f * * * f f f f f * * f f f f f f f f f f * * f f f f f f * * f f * h f f * * f f * * * Colorado Kaiser Permanente PacifiCare of Colorado-High PacifiCare of Colorado-Std $10 $10 $15 $20 $20 $30 $100 $100 $300 $10 $10 $10 $20 $20 $30 $20 $30 $40 * f f * f f f * * f * * * * * * * * 23 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay NonBrand Generic copay copay Name formulary Prescription drugs h above average, * average, f below average * * Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location Connecticut ConnectiCare - All of Connecticut Telephone number Self only Self & family Self only Self & family 800/251-7722 TE1 TE2 67.34 206.10 NCQA 1 District of Columbia Aetna Health Inc.-High -Washington, DC Area Aetna Health Inc.-Std - Washington, DC Area CareFirst BlueChoice - Washington, D.C. Metro Area Kaiser Permanente - Washington, DC Area MD-IPA - Washington, DC Area 800/537-9384 800/537-9384 866/520-6099 301/468-6000 800/251-0956 JN1 JN4 2G1 E31 JP1 JN2 JN5 2G2 E32 JP2 70.72 52.86 102.82 61.62 69.40 159.28 123.72 223.92 146.64 167.10 NCQA 1 NCQA 1 NCQA 1 NCQA 2 NCQA 1 Florida Av-Med Health Plan (North Florida) - Tampa Av-Med Health Plan (South Florida) - Broward, Dade and Palm Beach Capital Health Plan - Tallahassee Area Foundation Health - Southern Florida Healthplan Southeast - North Florida Humana Medical Plan - South Florida JMH Health Plan - Broward-Dade counties Total Health Choice - Broward/Dade/Palm Beach Counties Vista Healthplan - South Florida 800/882-8633 800/882-8633 850/383-3311 800/441-5501 850/668-3000 888/393-6765 800/721-2993 305/408-5823 866/847-8235 EM1 ML1 EA1 5E1 RK1 EE1 J81 4A1 3N1 EM2 ML2 EA2 5E2 RK2 EE2 J82 4A2 3N2 70.96 62.76 71.00 45.52 64.70 59.42 48.46 58.40 68.88 281.36 191.00 255.82 125.22 191.88 148.58 119.20 145.50 269.54 NCQA 2 URAC 1 NCQA 2 NCQA 2 NCQA 1 NCQA 2 Georgia Aetna Health Inc. - Atlanta and Athens Areas Kaiser Permanente - Atlanta Area 800/537-9384 800/611-1811 2U1 F81 2U2 F82 69.76 57.58 173.82 146.20 NCQA 1 NCQA 1 24 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name Connecticut ConnectiCare $10 $10 None $10 $20 $35 h h h * h District of Columbia Aetna Health Inc.-High Aetna Health Inc.-Std CareFirst BlueChoice Kaiser Permanente MD-IPA $15 $20 $20 $10 $10 $20 $25 $30 $20 $20 $150/day x 3 $250/day x 3 None $100 None $10 $10 $10 $25 $25 $20 $40 $40 $35 * * * * h * * * * h * * f * * * * f f * * * f h h * * f * * $10 $20Net$20 $40Net $20 $40Net $8 $17 $33 Florida Av-Med Health Plan (North Florida) Av-Med Health Plan (South Florida) Capital Health Plan Foundation Health Healthplan Southeast Humana Medical Plan JMH HEALTH PLAN Total Health Choice Vista Healthplan $20 $15 $10 $10 $10 $10 $10 $10 $10 $30 $15 $10 $15 $10 $20 $10 $10 $20 $100/day x 5 $100 $100 $200 Nothing $100/day x 3 None $100 $250 $15 $10 $7 $7 $7 $5/$20 $5 $5 $10 $30 $20 $20 $14 $20 $20/$40 50% $15 $20 $50 $30 $35 $34 $35 $100 50% $15 $40 f * f * * * * f f f * * * * h f f f h f f f * f * * * f * * h f * * h * Georgia Aetna Health Inc. Kaiser Permanente $20 $10 $25 $10 $250/day x 3 None $10 $25 $40 * h f h f * * * * h * * $10 $16 Com$10 $16Com$10 $16Com 25 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay NonBrand Generic copay copay Name formulary Prescription drugs h above average, * average, f below average h Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location Guam PacifiCare Asia Pacific-High -Guam/N. Mariana Islands/Palau PacifiCare Asia Pacific-Std - Guam/N. Mariana Islands/Palau Telephone number Self only Self & family Self only Self & family 671/647-3526 671/647-3526 JK1 JK4 JK2 JK5 59.24 50.54 155.68 133.48 Hawaii HMSA - All of Hawaii Kaiser Permanente-High -Islands of Hawaii/Maui/Oahu/Kauai Kaiser Permanente-Std - Islands of Hawaii/Maui/Oahu/Kauai 808/948-6499 808/432-5955 808/432-5955 871 631 634 872 632 635 60.24 71.60 54.36 134.08 153.92 116.88 NCQA 1 NCQA 1 NCQA 1 Idaho Group Health Cooperative - Kootenai and Latah 888/901-4636 VR1 VR2 72.48 245.40 NCQA 1 Illinois BlueCHOICE - Madison and St. Clair counties Group Health Plan - Southern/Metro East/Central Health Alliance HMO - Central/E.Central/N.West/South/West IL Humana Health Plan Inc.-High -Chicago Area Humana Health Plan Inc.-Std - Chicago Area John Deere Health Plan - Bloomingtn/Joliet/Moline/Peoria/RockIsld Mercy Health Plans/Premier Health Plans - Southwest Illinois OSF HealthPlans - Central/Central-Northwestern Illinois PersonalCare's HMO - Central Illinois Unicare HMO - Chicagoland Area Union Health Service - Chicago Area 800/634-4395 800/755-3901 800/851-3379 888/393-6765 888/393-6765 800/247-9110 800/327-0763 800/673-5222 800/431-1211 888/234-8855 312/829-4224 9G1 MM1 FX1 751 754 YH1 7M1 9F1 GE1 171 761 9G2 MM2 FX2 752 755 YH2 7M2 9F2 GE2 172 762 69.80 113.68 83.90 67.26 51.06 62.08 129.88 56.80 58.90 61.10 53.64 151.12 218.48 206.78 161.32 122.44 152.10 311.34 149.36 151.50 201.14 133.00 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 URAC 1 NCQA 1 26 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Generic Plan name Guam PacifiCare Asia Pacific-High PacifiCare Asia Pacific-Std $10 $15 $10 $15 None $150 $5 $5 NonBrand Name formulary $20 $20 $20 $20 * * * * f f h h * * Hawaii HMSA -In-Network - Out-of-Network Kaiser Permanente-High Kaiser Permanente-Std 20% 30% $10 $15 20% 30% $10 $15 None 30% None None $5 $15 $15 or 50% $5+20%+$15+20%+$15 or 50%+ $10 $10 $10 $10 $10 $10 h h h h * * h * * h * * h h h h * * Idaho Group Health Cooperative $15 $15 $200/day x 3 $15 $25 $50 * * h * h h Illinois BlueCHOICE Group Health Plan Health Alliance HMO Humana Health Plan Inc.-High Humana Health Plan Inc.-Std John Deere Health Plan Mercy Health Plans/ Premier Health Plans OSF HealthPlans PersonalCare's HMO Unicare HMO Union Health Service - In-Network - Out-of-Network $10 $10 $15 $10 $15 $15 $10 30% $20 $20 $15 $10 $10 $20 $15 $20 $25 $15 $20 30% $20 $20 $15 $10 None $100 $100 $100/day x 3 $250/day x 3 $100 None 30% $500 $100/day X 5 None None $7 $8 $10 $5/$15 $12 $20 $20 $15/$35 $25 $35 $40 25% 25% $35 $35 N/A $40 $50 $25 N/A * h f f h h h h f * * * * h * h h f h h f f h h h h * * h * * h h h * * * h f f h h * h f * h f f h h h * f $10/$25 $25/$45 $10 $10 N/A $10 $10 $5 $15 $20 $20 N/A $20 $20 $15 $15 27 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay copay copay Prescription drugs h above average, * average, f below average * * Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location Indiana Advantage Health Plan, Inc. - Most of Indiana Aetna Health Inc. - Southeastern Indiana Arnett HMO - Lafayette Area Health Alliance HMO - Fountain/Vermillion/Warren Counties Humana Health Plan - Southern Indiana Humana Health Plan Inc.-High -Lake/Porter/LaPorte Counties Humana Health Plan Inc.-Std - Lake/Porter/LaPorte Counties M*Plan - Indiana Metropolitan Areas Physicians Health Plan of Northern Indiana - Northeast Indiana Unicare HMO - Lake/Porter Counties Telephone number Self only Self & family Self only Self & family 800/553-8933 800/537-9384 765/448-7440 800/851-3379 888/393-6765 888/393-6765 888/393-6765 317/571-5320 260/432-6690 888/234-8855 6Y1 RD1 G21 FX1 D21 751 754 IN1 DQ1 171 6Y2 RD2 G22 FX2 D22 752 755 IN2 DQ2 172 73.44 69.98 69.90 83.90 74.78 67.26 51.06 120.48 64.76 61.10 186.46 188.74 227.90 206.78 234.32 161.32 122.44 278.98 145.54 201.14 NCQA 6 NCQA 1 NCQA 1 NCQA 1 URAC 1 NCQA 1 NCQA 1 Iowa Avera Health Plans - Northwestern Iowa Coventry Health Care of Iowa - Central Iowa/Cedar Rapids/Sioux City Health Alliance HMO - Central and Eastern Iowa John Deere Health Plan - Central/Eastern Iowa 888/322-2115 800/257-4692 800/851-3379 800/247-9110 AV1 SV1 FX1 YH1 AV2 SV2 FX2 YH2 59.08 58.32 83.90 62.08 137.98 157.50 206.78 152.10 NCQA 1 NCQA 1 Kansas Coventry Health Care of Kansas - Wichita/Salina Areas Coventry Health Care of Kansas - Kansas City - Kansas City Area Humana Health Plan, Inc.-High -Kansas City Area Humana Health Plan, Inc.-Std - Kansas City Area Preferred Plus of Kansas - S. Central Area 800/664-9251 800/969-3343 888/393-6765 888/393-6765 800/660-8114 7W1 HA1 MS1 MS4 VA1 7W2 HA2 MS2 MS5 VA2 94.38 56.98 70.40 40.94 73.72 298.84 147.04 176.40 98.20 278.34 URAC 1 URAC 1 JCAHO 2 Kentucky Humana Health Plan - Louisville Area United Healthcare of Ohio, Inc. - Northern Kentucky 888/393-6765 800/231-2918 D21 3U1 D22 3U2 74.78 137.04 234.32 318.76 URAC 1 NCQA 1 28 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name Indiana Advantage Health Plan, Inc. Aetna Health Inc. Arnett HMO Health Alliance HMO Humana Health Plan Humana Health Plan Inc.-High Humana Health Plan Inc.-Std M*Plan Physicians Health Plan of Northern Indiana Unicare HMO $15 $20 $10 $15 $15 $10 $15 $10 $10 $15 $30 $25 $10 $15 $25 $20 $25 $15 $10 $15 $400 $250/day x 3 None $100 $250/day x 3 $100/day x 3 $250/day x 3 $250 20%of$2500 None Generic NonBrand Name formulary $10 $10 $5 $10 $30 $25 $15 $20 $50 $40 $30 $40 25% 25% 25% $50 $40 $25 f * h h * f f * h f * * h * f * * * h f * * h h f f f h h * * * * h f * * h h * f * h h * f f * h f $10/$25 $25/$45 $5/$15 $15/$35 $10/$25 $25/$45 $5/$10 $5 $5 $15 $15 $15 Iowa Avera Health Plans Coventry Health Care of Iowa Health Alliance HMO John Deere Health Plan $10 $10 $15 $15 $15 $10 $15 $15 $100/dayx3 None $100 $100 $10 $5 $10 $10 $20 $15 $20 $20 $35 or 50% $30 $40 $35 f h h h * h h h h * h h f h h * h h Kansas Coventry Health Care of Kansas Coventry Health Care of Kansas - Kansas City Humana Health Plan, Inc.-High Humana Health Plan, Inc.-Std Preferred Plus of Kansas $15 $15 $10 $15 $10 $15 $15 $20 $25 $10 $100/day x 3 $100/day x 3 $100/day x 3 $250/day x 3 $50/day x 10 $5 $10 $5/$20 $15 $20 $20/$40 $45 $50 25% 25% $15 f f f * * * * * * * f f f f f f f f $10/$25 $25/$45 $5 $15 Kentucky Humana Health Plan United Healthcare of Ohio, Inc. $15 $15 $25 $15 $250/day x 3 $250 $10/$25 $25/$45 $10 $15 25% $30 * * f h f h f * * * f * 29 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay copay copay Prescription drugs h above average, * average, f below average f * h h f f f * h f Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Telephone number Plan name – location Louisiana Coventry Healthcare Louisiana - New Orleans Area Coventry Healthcare Louisiana - Baton Rouge Area Vantage Health Plan - Monroe Area Vantage Health Plan - Shreveport/Alexandria Areas 800/341-6613 800/341-6613 888/823-1910 888/823-1910 Self only Self & family Self only Self & family BJ1 JA1 AQ1 MV1 BJ2 JA2 AQ2 MV2 64.94 68.46 87.76 106.10 150.82 158.98 322.68 371.94 Maryland Aetna Health Inc.-High -North/Central/Southern Maryland Aetna Health Inc.-Std - North/Central/Southern Maryland CareFirst BlueChoice - All of Maryland Kaiser Permanente - Baltimore/Washington, DC Areas MD-IPA - All of Maryland 800/537-9384 800/537-9384 866/520-6099 301/468-6000 800/251-0956 JN1 JN4 2G1 E31 JP1 JN2 JN5 2G2 E32 JP2 70.72 52.86 102.82 61.62 69.40 159.28 123.72 223.92 146.64 167.10 NCQA 1 NCQA 1 NCQA 1 NCQA 2 NCQA 1 Massachusetts Blue Chip, Coord Hlth Partners - Southeastern Massachusetts ConnectiCare - Counties Hampden, Hampshire, Franklin Fallon Community Health Plan - Central/Eastern Massachusetts 401/459-5500 800/251-7722 800/868-5200 DA1 TE1 JV1 DA2 TE2 JV2 106.18 67.34 70.64 332.32 206.10 227.06 NCQA 1 NCQA 1 NCQA 1 30 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name Louisiana Coventry Healthcare Louisiana Coventry Healthcare Louisiana Vantage Health Plan Vantage Health Plan $15 $15 $15 $15 $15 $15 $15 $15 $100/day x 3 $100/day x 3 $250 $250 $10 $10 $10 $10 $20 $20 $20 $20 $45 $45 $35 $35 f f f f f f * * f f Maryland Aetna Health Inc.-High Aetna Health Inc.-Std CareFirst BlueChoice Kaiser Permanente MD-IPA $15 $20 $20 $10 $10 $20 $25 $30 $20 $20 $150/day x 3 $250/day x 3 None $100 None $10 $10 $10 $25 $25 $20 $40 $40 $35 * * * * h * * * * h * * f * * * * f f * * * f h h * * f * * $10 $20Net $20 $40Net $20 $40Net $8 $17 $33 Massachusetts Blue Chip, Coord Hlth Partners - In-Network - Out-of-Network ConnectiCare Fallon Community Health Plan $15 30% $10 $10 $25 30% $10 $10 $500 None None None $7 $25 $40 $40 + 20% $40 + 20% $40 + 20% $10 $5 $20 $15 $35 $35 h h h h h * * h h * * * 31 Claims processing Customer service Primary Hospital care per Specialist NonBrand doctor stay office Generic Name formulary office deductible/ copay copay copay Prescription drugs Member Survey Results h above average, * average, f below average f f Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location Michigan Bluecare Network of MI - Cheboygan and Roscommon Counties Area Bluecare Network of MI - Midland County Area Bluecare Network of MI - Kalamazoo County Area Bluecare Network of MI - Genesee County Area Bluecare Network of MI - Kent County Area Bluecare Network of MI - Mid Michigan Bluecare Network of MI - Southeast MI Grand Valley Health Plan - Grand Rapids Area Health Alliance Plan - Southeastern Michigan/Flint Area HealthPlus MI - Flint/Saginaw Areas M-Care - Mid and Southeastern Michigan OmniCare - Southeastern Michigan The Wellness Plan - Detroit/Flint Areas Total Health Care - Greater Detroit/Flint Areas Telephone number Self only Self & family Self only Self & family 800/662-6667 800/662-6667 800/662-6667 800/662-6667 800/662-6667 800/662-6667 800/662-6667 616/949-2410 800/422-4641 800/332-9161 800/658-8878 800/477-6664 800/875-9355 800/826-2862 G71 K51 KF1 KN1 KR1 LN1 LX1 RL1 521 X51 EG1 KA1 K31 N21 G72 K52 KF2 KN2 KR2 LN2 LX2 RL2 522 X52 EG2 KA2 K32 N22 265.56 66.16 130.10 70.74 73.42 136.78 51.34 67.30 61.76 81.54 59.58 60.08 49.32 59.24 725.04 240.42 460.78 291.70 344.20 356.48 153.52 256.72 163.62 236.58 157.90 147.78 133.32 150.70 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 4 Minnesota Avera Health Plans - Southwestern Minnesota HealthPartners Classic - Minneapolis/St. Paul/St. Cloud Areas HealthPartners Primary Clinic Plan - Minneapolis/St. Paul/St. Cloud Areas 888/322-2115 952/883-5000 952/883-5000 AV1 531 HQ1 AV2 532 HQ2 59.08 107.66 187.50 137.98 283.78 475.38 NCQA 1 32 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name Michigan Bluecare Network of MI Bluecare Network of MI Bluecare Network of MI Bluecare Network of MI Bluecare Network of MI Bluecare Network of MI Bluecare Network of MI Grand Valley Health Plan Health Alliance Plan HealthPlus MI M-Care OmniCare The Wellness Plan Total Health Care $15 $15 $15 $15 $15 $15 $15 $10 $10 $10 $10 $10 $10 $10 $15 $15 $15 $15 $15 $15 $15 $10 $10 $10 $10 $10 $10 Nothing $250 $250 $250 $250 $250 $250 $250 None None None None None None None $10 $10 $10 $10 $10 $10 $10 $5 $10 $5 $10 $2 $5 $20 $20 $20 $20 $20 $20 $20 $5 $20 $10 $20 $2 $5 $20 $20 $20 $20 $20 $20 $20 $5 $30 $10 $30 $2 $5 Nothing * * * * * * * h * h h f f f * * * * * * * * * h * f f f h h h h h h h h * h * f f f * * * * * * * * h h * * f f * * * * * * * h * h h * f f Nothing Nothing Minnesota Avera Health Plans HealthPartners Classic HealthPartners Primary $10 $15 $20 $15 $15 $20 $100/dayx3 $100 $200 $10 $12 $12 $20 $12 $12 $35 or 50% $24 $24 * * * * * * * * * * * * 33 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay NonBrand copay copay Generic Name formulary Prescription drugs h above average, * average, f below average * * * * * * * * * h h f f * Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location Missouri BlueCHOICE - StLouis/Central/SW Areas Coventry Health Care of Kansas - Kansas City - Kansas City Area Group Health Plan - St. Louis Area Humana Health Plan, Inc.-High -Kansas City Area Humana Health Plan, Inc.-Std - Kansas City Area Mercy Health Plans/Premier Health Plans - East/Central;Southwest Missouri Telephone number Self only Self & family Self only Self & family 800/634-4395 800-969-3343 800/755-3901 888/393-6765 888/393-6765 800/327-0763; 800/836-0402 9G1 HA1 MM1 MS1 MS4 7M1 9G2 HA2 MM2 MS2 MS5 7M2 69.80 56.98 113.68 70.40 40.94 129.88 151.12 147.04 218.48 176.40 98.20 311.34 NCQA 1 URAC 1 URAC 1 URAC 1 Montana New West Health Plan - Most of Montana 800/290-3657 NV1 NV2 66.58 148.18 Nevada Health Plan of Nevada - Las Vegas/Reno Areas PacifiCare Health Plans - Clark County 800/777-1840 800/531-3341 NM1 K91 NM2 K92 48.90 62.24 125.24 169.24 NCQA 3 NCQA 2 New Jersey Aetna Health Inc. - All of New Jersey AmeriHealth HMO - All of New Jersey GHI Health Plan - Northern New Jersey 800/537-9384 800/454-7651 212/501-4444 P31 FK1 801 P32 FK2 802 78.42 75.94 118.70 217.44 202.76 343.96 NCQA 1 NCQA 1 URAC 1 New Mexico Cimarron Health Plan - All of New Mexico Lovelace Health Plan - All of New Mexico 800/473-0391 800/244-6224 PX1 Q11 PX2 Q12 65.22 66.92 186.88 196.72 NCQA 2 NCQA 2 JCAHO 1 NCQA 2 Presbyterian Health Plan - All NM counties except Otero & S. Eddy 505/923-5678 P21 P22 62.06 161.84 34 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name Missouri BlueCHOICE Coventry Health Care of Kansas - Kansas City Group Health Plan Humana Health Plan, Inc.-High Humana Health Plan, Inc.-Std Mercy Health Plans/ Premier Health Plans - In-Network - Out-of-Network $10 $15 $10 $10 $15 $10 30% $10 $15 $20 $20 $25 $20 30% None $100/day x 3 $100 $100/day x 3 $7 $10 $8 $5/$20 $12 $20 $20 $20/$40 $25 $50 $35 25% 25% $35 N/A * f * f f h * * * * * * h * h * * * h * * f f * * f * f f h $250/day x 3 $10/$25 $25/$45 None 30% $10 N/A $20 N/A Montana New West Health Plan $15 $15 $100 $10 $20 $20 Nevada Health Plan of Nevada PacifiCare Health Plans Nothing $10 $10 $20 $100 None $5 $10 $20 $20 $35 $20 f f f f f f f f f f * * New Jersey Aetna Health Inc. AmeriHealth HMO GHI Health Plan $20 $30 $25 $35 $250/day x 3 $200/day x 3 None None $10 $20 $10 N/A $25 $40 $20 N/A $40 50% $50 N/A * f * * h h * * * * * * * * * * f * - In-Network $15 $15 - Out-of-Network 50% of sch. 50% of sch. New Mexico Cimarron Health Plan Lovelace Health Plan $10 $15 $10 $25 None $250 $5 $7 $10 $15 $25 $35 * * f * f * * * * * * * Presbyterian Health Plan $10 $10 None $5 $15 $35 * * f f * 35 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay NonBrand copay copay Generic Name formulary Prescription drugs h above average, * average, f below average * f * f f h h Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location New York Aetna Health Inc. - NYC Area and Dutchess/Sullivan/Ulster Blue Choice - Rochester Area Capital District Physicians Health Plan - Albany/Cooperstown Areas Capital District Physicians Health Plan - Hudson Valley Area Capital District Physicians Health Plan - Capital District Area GHI Health Plan - All of New York GHI HMO Select - Brnx/Brklyn/Manhat/Queen/Richmon/Westche GHI HMO Select - Capital/Hudson Valley Regions HIP of Greater New York-High -New York City Area HIP of Greater New York-Std - New York City Area HMO Blue - Utica/Rome/Central New York Areas HMO-CNY - Syracuse/Binghamton/Elmira Areas Independent Health Assoc - Western New York MVP Health Care - Eastern Region MVP Health Care - Central Region MVP Health Care - Mid-Hudson Region Preferred Care - Rochester Area Univera Healthcare - Western New York (Southern Counties) Univera Healthcare - Western New York Vytra Health Plans - Queens/Nassau/Suffolk Counties Telephone number Self only Self & family Self only Self & family 800/537-9384 800/462-0108 518/641-3700 518/641-3700 518/641-3700 212/501-4444 877/244-4466 877/244-4466 800/HIP-TALK 800/HIP-TALK 800/722-7884 800/828-2887 800/453-1910 888/687-6277 888/687-6277 888/687-6277 800/950-3224 716/847-0881 716/847-0881 800/406-0806 JC1 MK1 PW1 QB1 SG1 801 6V1 X41 511 514 AH1 EB1 QA1 GA1 M91 MX1 GV1 KQ1 Q81 J61 JC2 MK2 PW2 QB2 SG2 802 6V2 X42 512 515 AH2 EB2 QA2 GA2 M92 MX2 GV2 KQ2 Q82 J62 66.18 67.62 68.80 66.14 64.34 118.70 89.72 70.02 67.20 53.74 96.66 98.74 50.66 59.40 64.02 68.34 54.42 65.96 55.52 69.80 165.64 178.20 204.60 180.62 164.74 343.96 289.54 168.10 254.74 150.50 304.04 341.66 140.50 153.42 165.36 206.74 145.32 200.36 157.40 232.48 NCQA 1 NCQA 2 NCQA 1 NCQA 1 NCQA 1 URAC 1 NCQA 6 NCQA 6 NCQA 2 NCQA 2 NCQA 1 NCQA 1 NCQA 1 NCQA 2 NCQA 2 NCQA 2 NCQA 1 NCQA 1 36 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name New York Aetna Health Inc. Blue Choice Capital District Physicians Health Plan Capital District Physicians Health Plan Capital District Physicians Health Plan GHI Health Plan GHI HMO Select GHI HMO Select HIP of Greater New York-High HIP of Greater New York-Std HMO Blue HMO-CNY Independent Health Assoc MVP Health Care MVP Health Care MVP Health Care Preferred Care Univera Healthcare Univera Healthcare Vytra Health Plans $20 $10 $10 $10 $10 $25 $10 $10 $10 $10 $250/day x 3 None $100 $100 $100 None None None None None $500 $240 None None $240 $240 $240 None $250 $250 None $10 $5 $5 $5 $5 $10 N/A $10 $10 $10 $10 $10 $5 $10 $5 $5 $5 $10 $5 $5 $5 $25 $15 $20 $20 $20 $20 N/A $20 $20 $15 $20 $25 $20 $20 $20 $20 $20 $20 $15 $15 $10 $40 $30 $20 $20 $20 $50 N/A $30 $30 $40 $40 $40 $35 $35 $40 $40 $40 $35 $35 $35 $10 * h h h h * f f * * * f h h h h h * h h h h h f f * * h h h h h h h * h h h h * f f f f h h h h h h h f h h h h * f f * * h * h h h h h * * h h h * f f * * * f h h h h h - In-Network $15 $15 - Out-of-Network 50% of sch. 50% of sch. $10 $10 $10 $10 $15 $10 $15 $15 $15 $15 $15 $15 $15 $10 $10 $10 $10 $20 $15 $10 $15 $15 $15 $15 $15 $15 $15 $10 * h h h h * h * * h 37 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay NonBrand Generic copay copay Name formulary Prescription drugs h above average, * average, f below average * h h h h * f f f f * * h h h h h h * Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location North Dakota Heart of America HMO - Northcentral North Dakota Telephone number Self only Self & family Self only Self & family 701/776-5848 RU1 RU2 58.32 144.06 Ohio Aetna Health Inc. - Cleveland Area Aetna Health Inc. - Greater Cincinnati Area AultCare HMO - Stark/Carroll/Holmes/Tuscarawas/Wayne Co Blue HMO - Most of Ohio Health Plan of the Upper Ohio Valley-High -Eastern Ohio Health Plan of the Upper Ohio Valley-Std - Eastern Ohio HMO Health Ohio - Northeast Ohio Kaiser Permanente - Cleveland/Akron Areas Paramount Health Care - Northwest/North Central Ohio SummaCare Health Plan - Cleveland, Akron Areas SuperMed HMO - Northeast Ohio United Healthcare of Ohio, Inc. - Cincinnati/Dayton/Springfield Areas 800/537-9384 800/537-9384 330/438-6360 800/228-4375 800/624-6961 800/624-6961 800/522-2066 800/686-7100 800/462-3589 330/996-8700 800/522-2066 800/231-2918 7D1 RD1 3A1 R51 U41 U44 L41 641 U21 5W1 5M1 3U1 7D2 RD2 3A2 R52 U42 U45 L42 642 U22 5W2 5M2 3U2 69.86 69.98 82.24 79.60 80.18 69.40 66.84 68.50 70.10 66.30 90.60 137.04 173.86 188.74 262.66 241.42 322.42 264.28 184.68 173.12 243.14 230.08 291.66 318.76 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 2 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 Oklahoma PacifiCare Health Plans - Central/Northeastern Oklahoma 800/531-3341 2N1 2N2 77.96 250.04 NCQA 1 Oregon Kaiser Permanente-High -Portland/Salem Areas Kaiser Permanente-Std - Portland/Salem Areas PacifiCare Health Plans - Metro Portland/Salem/Corvalis/Eugene 800/813-2000 800/813-2000 800/531-3341 571 574 7Z1 572 575 7Z2 88.00 68.52 105.56 204.38 157.28 218.96 NCQA 1 NCQA 1 NCQA 1 38 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name North Dakota Heart of America HMO $10 Nothing None 50% 50% 50% Ohio Aetna Health Inc. Aetna Health Inc. AultCare HMO Blue HMO Health Plan of the Upper Ohio Valley-High Health Plan of the Upper Ohio Valley-Std HMO Health Ohio Kaiser Permanente Paramount Health Care SummaCare Health Plan SuperMed HMO United Healthcare of Ohio, Inc. $20 $20 $10 $10 $10 $10 $10 $10 $10 $10 $10 $15 $25 $25 $10 $10 $10 $20 $10 $10 $20 $10 $10 $15 $250/day x 3 $250/day x 3 None None None None None None $300 None None $250 $10 $10 $5 $10 $10 $15 $10 $5 $5 $8 $10 $10 $25 $25 $10 $20 $20 $30 $20 $15 $15 $15 $20 $15 $40 $40 $10 $30 $35 $50 $20 $15 $25 $30 $20 $30 * * h * h h * h h h * * * * h * h h * h h h * h * * h h h h * * * h * h * * h * h h * * * h * * * * h * h h f h h h f * * * h * h h f * h f f * Oklahoma PacifiCare Health Plans $10 $20 None $10 $20 $20 * f f * f h Oregon Kaiser Permanente-High Kaiser Permanente-Std PacifiCare Health Plans $10 $15 $10 $10 $15 $20 None None None $10 $15 $10 $20 $30 $20 $20 $30 $20 * * f * * f f f * f f * h h f * * * 39 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay NonBrand copay copay Generic Name formulary Prescription drugs h above average, * average, f below average Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location Pennsylvania Aetna Health Inc. - Philadelphia and Southeastern PA Health Net of Pennsylvania - Scranton/Wilkes Barre Areas HealthAmerica Pennsylvania - Greater Pittsburgh Area HealthAmerica Pennsylvania - Central Pennsylvania HealthGuard - Berks/Cmbrlnd/Dauphine/Lanc/Lebanon/York Keystone Health Plan Central - Harrisburg/Northern Region/Lehigh Valley Keystone Health Plan East - Philadelphia Area UPMC Health Plan - Western Pennsylvania Area Telephone number Self only Self & family Self only Self & family 800/537-9384 877/747-9585 800/735-4404 800/788-8445 800/822-0350 800/622-2843 800/227-3115 888/876-2756 P31 2K1 261 SW1 NQ1 S41 ED1 8W1 P32 2K2 262 SW2 NQ2 S42 ED2 8W2 78.42 74.38 68.52 70.90 60.40 93.82 74.66 69.44 217.44 219.76 213.32 238.26 157.32 257.48 274.14 209.34 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 Puerto Rico Humana Health Plans of Puerto Rico - Puerto Rico 800/314-3121 ZJ1 ZJ2 37.96 87.30 Triple-S - All of Puerto Rico 787/749-4777 891 892 47.84 102.78 Rhode Island Blue Chip, Coord Hlth Partners - All of Rhode Island 401/459-5500 DA1 DA2 106.18 332.32 NCQA 1 South Dakota Avera Health Plans - Eastern and Central South Dakota Sioux Valley Health Plan - Eastern/Central/Rapid City Areas 888/322-2115 800/752-5863 AV1 AU1 AV2 AU2 59.08 115.58 137.98 266.04 NCQA 6 JCAHO 1 40 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name Pennsylvania Aetna Health Inc. Health Net of Pennsylvania HealthAmerica Pennsylvania HealthAmerica Pennsylvania HealthGuard Keystone Health Plan Central Keystone Health Plan East UPMC Health Plan $20 $10 $10 $10 $10 $10 $10 $10 $25 $10 $15 $15 $20 $10 $15 $10 $250/day x 3 None None None None None None None $10 $10 $8 $8 $10 $10 $5 $5 $25 $20 $14 $14 $25 $25 $15 $15 $40 $35 $35 $35 $40 $40 $25 $35 * f h h h h f * h * h h h h h h h h h h h h * * * h h h * h * * * f * * * h * * Puerto Rico Humana Health Plans of Puerto Rico Triple-S - In-Network - Out-of-Network $5 $8 $5 $8 None $50 None None $2.50 N/A $2 25% $5 N/A $5/$10 25% $5 N/A $10 or 20% 25% h h f h * * - In-Network $7.50 $10 - Out-of-Network $7.50 + 10% $10 + 10% Rhode Island Blue Chip, Coord Hlth Partners - In-Network - Out-of-Network $15 30% $25 30% $500 None $7 $25 $40 $40 + 20%$40 + 20% $40 + 20% * h h * * * South Dakota Avera Health Plans Sioux Valley Health Plan - In-Network - Out-of-Network $10 $20 40% $15 $20 40% $100/dayx3 $100 40% $10 $10 N/A $20 $20 N/A $35 or 50% $35 N/A f h h h * * 41 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay NonBrand copay copay Generic Name formulary Prescription drugs h above average, * average, f below average * f h h h h * * Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location Tennessee Aetna Health Inc. - Nashville/Middle Tennessee Areas Aetna Health Inc. - Memphis Area HealthSpring-High -Nashville/Middle Tennessee Area HealthSpring-Std - Nashville/Middle Tennessee Area Telephone number Self only Self & family Self only Self & family 800/537-9384 800/537-9384 615/291-5030 615/291-5030 6J1 UB1 6K1 6K4 6J2 UB2 6K2 6K5 59.14 64.38 77.98 61.90 160.20 189.88 327.26 190.68 NCQA 1 NCQA 1 Texas Amcare Health Plans - Houston/El Paso Areas Amcare Health Plans - Austin/San Antonio/Dallas/Ft Worth Areas FIRSTCARE - Waco Area FIRSTCARE - West Texas HMO Blue Texas - Houston Humana Health Plan of Texas-High -San Antonio Area Humana Health Plan of Texas-Std - San Antonio Area Mercy Health Plans/Premier Health Plans - Webb/Zapata/Duval/Jim Hogg Counties PacifiCare Health Plans - San Antonio/Dallas/Ft Worth 800/782-8373 800/782-8373 800/884-4901 800/884-4901 800/833-5318 888/393-6765 888/393-6765 800/617-3433 800/531-3341 2V1 ZG1 6U1 CK1 YM1 UR1 UR4 HM1 GF1 2V2 ZG2 6U2 CK2 YM2 UR2 UR5 HM2 GF2 69.08 59.28 61.78 134.42 69.24 66.88 53.78 129.62 71.54 219.28 154.16 132.70 259.02 178.76 188.48 138.22 371.34 244.42 NCQA 2 NCQA 2 NCQA 6 NCQA 6 Utah Altius Health Plans - Wasatch Front 800/377-4161 9K1 9K2 107.32 217.80 42 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name Tennessee Aetna Health Inc. Aetna Health Inc. HealthSpring-High HealthSpring-Std $20 $20 $15 $20 $25 $25 $25 $20 $250/day x 3 $250/day x 3 $250 $250 $10 $10 $10 $10 $25 $25 $20 $20 $40 $40 $35 50% f f f f * * * * * * Texas Amcare Health Plans Amcare Health Plans FIRSTCARE FIRSTCARE HMO Blue Texas Humana Health Plan of Texas-High Humana Health Plan of Texas-Std Mercy Health Plans/Premier PacifiCare Health Plans - In-Network - Out-of-Network $10 $10 $15 $15 $20 $10 $15 $10 40% $10 $10 $10 $25 $25 $20 $20 $25 $10 40% $20 None None $100 $100 $100/dayx4 $100/day x 3 $250/day x 3 None 40% None $5 $5 $10 $10 $10 $5/$20 $15 $15 $20 $20 $25 $20/$40 50% 50% $40 $40 $40 25% 25% $25 N/A $20 f f * * f * * h f f f * h f f f * f f f * * f f f f f * * h h f f f h * f f h h f * * * f f f * h f * * * f $10/$25 $25/$45 $7 N/A $10 $12 N/A $20 Utah Altius Health Plans $10 $15 None $10 $20 $40 * * * * f f 43 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay NonBrand copay copay Generic Name formulary Prescription drugs h above average, * average, f below average f f Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location Vermont MVP Health Care - All of Vermont Telephone number Self only Self & family Self only Self & family 888/687-6277 VW1 VW2 134.12 411.74 NCQA 2 Virginia Aetna Health Inc.-High -N.VA/Fredericksburg Areas Aetna Health Inc.-Std - N.VA/Fredericksburg Areas CareFirst BlueChoice - Northern Virginia Kaiser Permanente - Washington, DC Area MD-IPA - N.VA/Cntrl VA/Richmond/Tidewater/Roanoke Optima Health Plan - Peninsula/Southside Hampton Roads Piedmont Community Healthcare - Lynchburg Area 800/537-9384 800/537-9384 866/520-6099 301/468-6000 800/251-0956 800/206-1060 888/674-3368 JN1 JN4 2G1 E31 JP1 9R1 2C1 JN2 JN5 2G2 E32 JP2 9R2 2C2 70.72 52.86 102.82 61.62 69.40 105.20 103.12 159.28 123.72 223.92 146.64 167.10 266.92 237.48 NCQA 1 NCQA 1 NCQA 1 NCQA 2 NCQA 1 NCQA 1 Washington Aetna Health Inc. - Western/Southeast Washington Group Health Cooperative - Most of Western Washington Group Health Cooperative - Central WA/Spokane/Pullman Kaiser Permanente-High -Vancouver/Longview Kaiser Permanente-Std - Vancouver/Longview KPS Health Plans-High -Most of Western Washington KPS Health Plans-Std - Most of Western Washington PacifiCare Health Plans - Clark County PacifiCare Health Plans - Puget Sound/Most West WA 800/537-9384 888/901-4636 888/901-4636 800/813-2000 800/813-2000 800/552-7114 800/552-7114 800/531-3341 800/531-3341 8J1 541 VR1 571 574 VT1 VT4 7Z1 WB1 8J2 542 VR2 572 575 VT2 VT5 7Z2 WB2 62.96 88.38 72.48 88.00 68.52 226.68 94.38 105.56 76.02 160.12 193.80 245.40 204.38 157.28 453.22 184.64 218.96 202.54 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 NCQA 1 44 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name Vermont MVP Health Care $15 $15 $240 $5 $20 $40 h h h h h Virginia Aetna Health Inc.-High Aetna Health Inc.-Std CareFirst BlueChoice Kaiser Permanente MD-IPA Optima Health Plan Piedmont Community - In-Network HealthcareVermont - Out-of-Network $15 $20 $20 $10 $10 $10 $20 40% $20 $25 $30 $20 $20 $20 $20 30% $150/day x 3 $250/day x 3 None $100 None $250 None None $10 $10 $10 $25 $25 $20 $40 $40 $35 * * * * h * * * * * h h * * f * * * * * f f * * * * f h h h * * f * * h $10 $20Net$20 $40Net $20 $40Net $8 $10 $10 $10 $17 $20 $20 $20 $33 $40 $20 $20 Washington Aetna Health Inc. Group Health Cooperative Group Health Cooperative Kaiser Permanente-High Kaiser Permanente-Std KPS Health Plans-High KPS Health Plans-Std PacifiCare Health Plans PacifiCare Health Plans $20 $15 $15 $10 $15 $10 $20 $10 $10 $25 $15 $15 $10 $15 $10 $20 $20 $20 $250/day x 3 $200/day x 3 $200/day x 3 None None $100/day x 10 None None None $10 $15 $15 $10 $15 $5 $5 $10 $10 $25 $25 $25 $20 $30 50% $20 $20 $20 $40 $50 $50 $20 $30 50% $100or50% $20 $20 f * * * * h h * * f * * * * h h f f * h h f f h h * * * * * f f h h * * f h h h h h h * * * h h * * h h * * 45 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay NonBrand copay copay Generic Name formulary Prescription drugs h above average, * average, f below average h Health Maintenance Organization (HMO) and Point of Service (POS) Plans How to read this chart: The table below highlights selected features that may help you narrow your choice of health plans. Always consult plan brochures before making your final decision. This chart does not show all of your possible out-of-pocket costs. Primary Care Doctor Office shows what you pay for each office visit to your primary care doctor. Specialist Office Copay shows what you pay for each office visit to a specialist. Contact your plan to find out what providers it considers specialists. Hospital per Stay Deductible/Copay is the amount you pay when you are admitted into a hospital. Plan name – location West Virginia Health Plan of the Upper Ohio Valley-High -Northern/Central West Virginia Health Plan of the Upper Ohio Valley-Std - Northern/Central West Virginia Telephone number Self only Self & family Self only Self & family 800/624-6961 800/624-6961 U41 U44 U42 U45 80.18 69.40 322.42 264.28 NCQA 1 NCQA 1 Wisconsin Dean Health Plan - South Central Wisconsin Group Health Cooperative - South Central Wisconsin Group Health Cooperative/Eau Claire - West Central Wisconsin HealthPartners Classic - West Central Wisconsin HealthPartners Primary Clinic Plan - West Central Wisconsin 800/279-1301 608/251-3356 715/552-4300 952/883-5000 952/883-5000 WD1 WJ1 WT1 531 HQ1 WD2 WJ2 WT2 532 HQ2 63.58 65.14 149.34 107.66 187.50 187.48 199.60 449.60 283.78 475.38 NCQA 1 NCQA 1 NCQA 1 Wyoming WINhealth Partners - Wyoming 307/638-7700 PV1 PV2 61.80 173.78 46 Accredited Enrollment code Twice – Biweekly Premium Your Share Prescription drugs — Generic, Brand Name, and Non-formulary shows what you pay for prescriptions when you use a plan pharmacy. Non-formulary refers to prescriptions that are not on the plan’s preferred list. Some plans charge different amounts for some drugs and for mail orders. In many plans, if you get the brand name instead of the generic drug, you also pay the difference between the two. Member Survey Results — See page 3 for a description. Accredited — The National Committee for Quality Assurance (N); the Joint Commission on Accreditation of Healthcare Organizations (J); and/or URAC (U). See pages 3 and 7 for details. A lower number means a better accreditation. Member Survey Results How well doctors communicate Getting needed care Overall plan satisfaction Getting care quickly Plan name West Virginia Health Plan of the Upper Ohio Valley-High Health Plan of the Upper Ohio Valley-Std $10 $10 $10 $20 None None $10 $15 $20 $30 $35 $50 h h h h h h h h h h Wisconsin Dean Health Plan Group Health Cooperative Group Health Cooperative/Eau Claire HealthPartners Classic HealthPartners Primary $10 $20 $10 $15 $20 $10 $20 $10 $15 $20 None None None $100 $200 $10 $6 $10 $12 $12 30% to 1500 $12 $20 $12 $12 N/A $12 $20 $24 $24 h h h * * h h h * * h h h * * * * h * * h h h * * h h h * * Wyoming WINhealth Partners $10 $10 None $10 $15 $40 47 Claims processing Customer service Primary Hospital care per Specialist doctor stay office office deductible/ copay NonBrand Generic copay copay Name formulary Prescription drugs h above average, * average, f below average h h Ad d r e s s i n g t h e P o s t c a r d Instructions for addressing the Postcard on the Back of this Booklet L 01 02 isted below are the OWCP District Office addresses. To identify the district office serving your compensation case file, look at the address label on the back of this booklet. Locate the two digit identifier which corresponds with the two digit identifier below. (Please note: The two digit identifier is not part of the case file number. The identifier stands alone.) Print the address shown next to that two digit identifier on the front of the postcard. Fiscal Officer US DEPARTMENT OF LABOR,OWCP JFK Federal Building, Room E260 Boston, MA 02203 Fiscal Officer US DEPARTMENT OF LABOR, OWCP P.O. Box 566 New York, NY 10014-0566 Fiscal Officer US DEPARTMENT OF LABOR, OWCP Curtis Center, Suite 715 East 170 S. Independence Mall West Philadelphia, PA 19016-3308 Fiscal Officer US DEPARTMENT OF LABOR, OWCP 214 North Hogan, Suite 1010 Jacksonville, FL 32202 25 09 Fiscal Officer US DEPARTMENT OF LABOR, OWCP 1240 East Ninth Street, Room 865 Cleveland, OH 44199 50 10 Fiscal Officer US DEPARTMENT OF LABOR, OWCP 230 South Dearborn Street, 8th Floor Chicago, IL 60604 Fiscal Officer US DEPARTMENT OF LABOR, OWCP City Center Square, Suite 750 1100 Main Street Kansas City, MO 64105 49 12 Fiscal Officer US DEPARTMENT OF LABOR, OWCP 1999 Broadway, Suite 600 Denver, CO 80202 Fiscal Officer US DEPARTMENT OF LABOR, OWCP P.O. Box 193769 San Francisco, CA 94119-3769 Fiscal Officer US DEPARTMENT OF LABOR, OWCP 1111 - 3rd Avenue, Suite 650 Seattle, WA 98101 Fiscal Officer US DEPARTMENT OF LABOR, OWCP 525 Griffin Square, Room 100 Dallas, TX 75202 Fiscal Officer US DEPARTMENT OF LABOR, OWCP 800 N. Capitol Street, NW Washington, DC 20211 Fiscal Officer US DEPARTMENT OF LABOR, OWCP National Office P.O. Box 37117 Washington, DC 20013-7117 13 03 14 16 06 11 RETURN ADDRESS NAME STREET Place postage stamp here STATE Address of OWCP Office: ZIP CODE CITY Request for Registration Form or Brochures U.S. Department of Labor Employment Standards Administration Office of Worker’s Compensation Programs Washington, D.C. 20210 Official Business Penalty for Private Use $300 Forwarding and Address Correction Requested Detach Request For Registration Form Or Brochures This special postcard has been prepared to speed the return of health benefits open season information to you. Mail this form to the proper OWCP office (see page 49). Do not use it for any other purpose. ❑ ❑ I want to make a change during open season and know what plan or option I wish to enroll in. I have the brochure of that plan and don’t need brochures. Please send me a registration form (SF 2809) only. I am considering making a change during open season but would like more information. Please send me a registration form (SF 2809) and a brochure for each of the plans I have listed below. CODE CODE Name CODE CODE CODE CODE List enrollment codes of the plans for the brochures you want. Codes for each FEHB plan appear in the plan comparison chart. IMPORTANT HMOs and Plans with a Point of Service product are open to compensationers in the plan’s area. Fee-for Service plans sponsored by employee organizations have specific membership requirements. Some are restricted and open only to compensationers who are already members of the sponsoring organization. Print or type your full name and mailing address here. Address the other side and add a stamp. Then drop card in mail box. Street address City, state, and ZIP code Signature Date Check here if we need to change your mailing (home) address in our records. Do not send this card to OPM. Keep a record of the date you mail this.