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Health care coverage designed


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									  Welcome Texas Federal Employees and Annuitants

Health care coverage designed
   to help you stay healthy.
Finally, a Health Plan to Provide You
With Resources for a Healthy Life.
Thank you for taking the time to find out more about what makes
PacifiCare the health care plan of choice for so many federal
employees. Your health is important, and we are committed to
providing you with all the resources you need to manage it at        2005 Plan Highlights
every stage of your life.
                                                                     ■   Lower Copayments for Prescription
The information in this booklet is provided as a resource to
help you review and determine which health care options will
best fit your needs. PacifiCare has made changes to the 2005           ■   New: Chiropractic and Acupuncture Visits
medical benefits, so please review this booklet and your other
materials carefully – this will help you understand the key benefit   ■   Lower Annual Out-of-Pocket Maximum
changes as you make your health care decisions.
                                                                     ■   Now Included with your Medical Plan –
Federal employees who enroll in the PacifiCare medical plan
automatically receive the PacifiCare SignatureSavingsSM (Dental           New PacifiCare SignatureSavingsSM Dental
and Vision) plan, at no additional premium cost.                         and Vision Plan
PacifiCare also encourages you to take advantage of the new
OPM Flexible Spending Account (FSA) to maximize the efficiency
of your health care spending and to help you plan ahead.

Detailed health plan information is available in the back pocket of this brochure.
As you review the information enclosed, we know you’ll see why this plan is such
a good choice.

Also in this back pocket, you’ll find a Primary Care Physician Selection card.
In choosing PacifiCare, it is important to fill out and return this card to ensure
you have access to the doctor you choose.
Take Advantage of Programs Designed to Help
You Maintain Physical and Emotional Health.
Every day, you make decisions that affect your overall health    PacifiCare PerksSM: Access to Savings
and well-being. And we believe that one of the most
important ways to stay healthy is to make good lifestyle
                                                                 on Alternative Care Benefits and More
choices.                                                         Sometimes conventional medicine isn’t the answer for your
                                                                 health care needs. PacifiCare expands your and your family’s
This is why we provide PacifiCare members with a wide             health choices by providing members special savings. Just
variety of programs and services designed to help you and        some of these PacifiCare Perks1 programs include:
your family get the most out of a healthful life – at no
additional premium cost.                                         ■   Complementary & Alternative Care1 – savings on
                                                                     participating massage therapists.

PacifiCare HealthCreditsSM:                                       ■   Vision & Hearing – savings on eye exams, contact
                                                                     lenses, frames and corrective laser eye surgery.
Tools to Help You Stay Healthy
Everyone knows eating right and exercise are critical to good    ■   Pharmacy & Personal Care – save money on vitamins,
health, but it’s not always easy. No matter where you are in         supplements, nutrition products and much more.
your personal journey toward good health, PacifiCare offers a     ■   Healthy Home – savings on products such as air
way to help through our PacifiCare HealthCredits program,             purifiers, water filters, dehumidifiers, etc., as well as
where you can:                                                       information on how to make your home healthy
■   Browse for general health information and healthy recipes.       and safe.

■   Build a customized fitness or diet plan.                      ■   Personal Safety – savings and information on safety
                                                                     equipment, emergency equipment, fire ladders, first-aid
■   E-mail coaches and get personalized responses to your            kits, water storage equipment, disaster preparation kits
    specific questions and issues.                                    and more.
■   Find out ways to improve your emotional well-being.
■   Create a plan to help motivate your children.                Programs to Help Manage Ongoing
And along the way toward good health, be rewarded for your
                                                                 Health Conditions
healthful lifestyle choices. By participating in PacifiCare       As a PacifiCare member, you’re entitled to extended services
HealthCredits, you can earn credits that can be used to get      over and above your traditional health care coverage at no
discounts on fitness products and become eligible for             extra premium cost. PacifiCare’s Health Management
quarterly drawings.                                              programs2 are designed to put you and your family on the
                                                                 path to better health – through education, self-care guidance
                                                                 and lifestyle suggestions that meet your specific medical
    For more detailed information on                             needs. PacifiCare’s Health Management programs focus
                                                                 on the areas of depression, asthma, heart health, diabetes
    any of these programs, please visit
                                                                 and smoking.
Access to Health Care Resources
When You Need Them.
If you’re looking for general health information on topics        Also included is our easy-to-navigate online Provider
from acupuncture to headaches, poison prevention, yoga and        Directory to help you locate a participating provider. You
more, this plan provides you with convenient, online services     can search by name, specialty or Zip Code so you can find
and customer service to fit your busy schedule.                    the health care provider who best meets your needs.
                                                                  1. Access the Federal Employee site, as described above.
Convenient Access, Day or Night                                   4. Click on the Doctor Directory tab.
With PacifiCare’s 24-Hour Health Information program you  3
                                                                  5. Select Doctor Search.
don’t need to make an appointment, rearrange your schedule
or wait for Monday morning to get answers to your general         6. Select Medical Plan and follow the directions on
health questions, from rashes to headaches, allergies to             the screen.
stomach pain, or nutrition to vaccines.                           Once you find a doctor, be sure to fill out and return the
Simply:                                                           Primary Care Physician Selection card, located in the back
                                                                  pocket of this brochure. It is very important to fill out and
■   Call the 24-Hour Nurse Line toll-free,                        return this card to ensure you have access to the doctor you
    1-866-PHS-HEALTH (1-866-747-4325).                            choose.
■   Go to www.pacificare.com and click on Live AssistTM and
    you will be connected with a Health Information Specialist.   PacifiCare SignatureSavingsSM
                                                                  ■   Dental Care – Your new PacifiCare SignatureSavings
Dedicated Federal Employee Web Site                                   dental program offers greater savings on dental services
                                                                      such as fillings and crowns. You will also enjoy savings
Find your plan-specific 2005 benefit materials on the
                                                                      from our large network on services not usually included,
dedicated Federal Employee Web site. Find information on
                                                                      such as teeth whitening and orthodontics.
the 2005 benefit highlights, decision support tools, helpful
links for Federal Employees and information on how to use         ■   Vision – At PacifiCare, we know that your vision health
your plan.                                                            is just as important as your dental health, so we’ve added
                                                                      a PacifiCare SignatureSavings vision benefits program.
1. Go to www.pacificare.com.
                                                                      You will now be able to save up to 50% on your vision
2. Click on the “Federal Employee” link in upper-righthand            needs, with no limit on how often you use the program.
   corner of the page.
3. Select your state and you are there.
Meeting the Needs of Our Members.

A Special Focus on Women’s                                        Help With Every Stage of Life
Health SolutionsSM                                                PacifiCare understands that through life, there are changes
PacifiCare provides access to programs and services designed       that can be confusing, and even scary. In order to help you
to help women and those they make decisions for prevent           filter through all the myths and stories, PacifiCare has
illness, save time, access important health information and       designed several programs to help you.
potentially save money. Let PacifiCare’s Women’s Health            ■   Cosmetic Services – get access to resources to help you
Solutions help empower you to achieve better health, wellness         learn about new products, procedures and technologies
and balance.                                                          to maintain or restore a youthful appearance.
One of our goals is to help every woman become aware of her       ■   Menopause: Understanding Your Options – helps
risk of heart disease and learn how to prevent it and reverse         you make informed decisions about your health.
its effects. That’s why our Foundation has made a grant to
support the American Heart Association in a multiyear             ■   Caregiver Resources – through an association with
national awareness campaign called Go Red For Women.                  Caregivers Marketplace, you have access to discounted
                                                                      products and rebates that are commonly used when
                                                                      caring for an aging loved one.
Resources to Help With Parenting
PacifiCare has programs and services to help at every stage
of parenting – from pregnancy to adolescents. PacifiCare
                                                                  Latino Health Solutions
offers these programs to help you navigate through the very       PacifiCare understands that Hispanics/Latinos have unique
difficult, but rewarding, job of being a parent:                   health care and cultural preferences, and many prefer
                                                                  Spanish-language communication, especially when dealing
■   Pregnancy to Preschool – an Internet-based program            with complicated or personal subjects such as their health
    that provides you with valuable information, interactive      and health care coverage. Therefore, we offer a broad range
    tools and personalized e-mail reminders on topics from        of Spanish services to serve our unique Hispanic/Latino
    conception to the classroom – all from a single resource.     members, including a dedicated toll-free Spanish-language
■   Parenting Adolescents – provides information and free         Customer Service number, 1-800-730-7270 and a Spanish-
    advice on teen health, teen eating disorders, how to better   language Web site, www.pacificarelatino.com.
    communicate with your teens, recognizing a teen in
    trouble, and keeping teens away from drugs, smoking
    and alcohol.
■   Healthy Moms & Kids1 – savings on services and
    products that every Mom needs, such as Gymboree®
    Play and Music programs and breast-feeding accessories.
2005 Benefit Summary.
  Member Copayments                                                                                Red indicates an improvement over 2004
                                                    2005                                                     2004
  Annual Copayment Maximum                          $3,000 Individual/$9,000 Family                          $5,000/$15,000
  Physician Office Visit Copayment                   $20 Primary/$40 Specialist                               $20 Primary/$40 Specialist
  Inpatient Hospital Copayment                      $400 per day, $2,000 maximum                             $400 per day, $2,000 maximum
  Outpatient Surgery Copayment                      $200 per procedure                                       $200
  Emergency Copayment                               $250 per visit (not waived if admitted)                  $250
  Mental Health & Substance Abuse                   $40 per visit                                            $40
  Chiropractic & Acupuncture                        $20 per visit, up to 20 combined                         Not covered
                                                    Chiropractic and Acupuncture visits
  Retail Pharmacy Rx Copayment (30-day supply)      $10 Generic/$40 Brand/$50 Non-Formulary                  $20/$40/$50
  Mail Order Rx Copayment (90-day supply)           $20 Generic/$80 Brand/$100 Non-Formulary                 $40/$80/$100
  Dental Exam4                                      $21                                                      Covered at 100% UCR5
  Routine Teeth Cleaning4                           $41                                                      Covered at 100% UCR5
  Vision Lenses                                     Discounts on select lenses and lens options              Not covered
  Vision Frames                                     Discounts on select frames                               Not covered
  Durable Medical Equipment Coinsurance             80% up to the annual $1,500 limit                        100%
                                                    per benefit year, all charges thereafter
  Specialized Scanning Copayment                    $200 per procedure                                       $200
  (MRI, CT, PET and SPECT)
  Self-Injectables Copayment (excluding insulin)    $50 per prescription                                     100%
  Infertility Copayment                             50% up to 3 cycles, excludes fertility medication        50%

2005 Non-FEHB Benefits.
This is only a brief summary of the many non-FEHB                          Medicare Advantage HMO – As a member of Secure
optional benefit programs offered to plan members to                        Horizons, you benefit from low or no plan copayments,
enhance your existing health care coverage. In Texas, for an               low or no deductibles, and virtually no paperwork. Secure
added monthly premium, you can select and enroll in one of                 Horizons offers peace of mind for Medicare beneficiaries
the following programs to supplement your plan coverage.                   residing in parts of Arizona, California, Colorado, Nevada,
                                                                           Oklahoma, Oregon, Texas and Washington by offering
                                                                           more services than original Medicare for an additional
Medicare Managed Care and Medicare                                         cost. For more information, call toll-free 1-800-637-9284,
Supplement Plans                                                           1-800-647-6038 (TDHI) or visit www.securehorizons.com.
If you are Medicare eligible, enhance your coverage options                Medicare Supplement – Secure Horizons Medicare
with Medicare Managed Care and Medicare Supplement                         Supplement plans pick up where Medicare leaves off, so
Plans – a Non-FEHB benefit offered by Secure Horizons.                      you don’t have the worry about overwhelming medical
If you are Medicare eligible and are interesting in enrolling              bills. Better yet, as a Medicare beneficiary you can choose
in a Medicare HMO or a Medicare Supplement Plan                            the level of coverage you feel best suits your needs. Choices
sponsored by PacifiCare without dropping your enrollment                    range from a plan that covers some basic hospitalization
in PacifiCare’s FEHB plan, call 1-800-637-9284 or                           and medical coinsurance expenses to a plan with a richer
1-800-647-6038 (TDHI).                                                     benefit package that includes foreign travel emergency
                                                                           and at-home recovery. For more information, call toll-free
                                                                           1-800-637-9284, 1-800-647-6038 (TDHI) or visit
Mandated Disclosures
1. Special arrangements are only for PacifiCare enrollees whose plan benefits do not include products/services described or whose
PacifiCare plan benefits covering these products/services have reached the allowable maximum. Vendor participation and actual,
usual and customary charges may vary, exclude certain items or require additional charges. PacifiCare does not endorse or guarantee
products noted.
2. Physicians must direct enrollment in Disease Management programs; other requirements may apply.
3. The 24-Hour Health Information Program’s intent is to provide general information regarding common health questions or
conditions. If you have a specific question relating to a condition or medical course of treatment for yourself or others, please
consult your physician. If you believe you need emergency services, call 911, or its local equivalent, or go to the nearest medical
facility for treatment.
4. Member’s discounted fee will vary by geographic location.
5. Usual, customary and reasonable.
PacifiCare HealthCreditsSM is offered by PacifiCare Health Plan Administrators, Inc. Programs subject to availability by state;
components may change. PacifiCare HealthCreditsSM is available to PacifiCare enrollees.
Programs vary by state; components may change. Women’s Health SolutionsSM programs and services available to enrollees only.
PacifiCare products and services are offered by one or more of the following PacifiCare family of companies: Health plan products
and services are offered by PacifiCare of Arizona, Inc.; PacifiCare of California; PacifiCare of Colorado, Inc.; PacifiCare of Nevada,
Inc.; PacifiCare of Oklahoma, Inc.; PacifiCare of Oregon, Inc.; PacifiCare of Texas, Inc.; PacifiCare of Washington, Inc.; PacifiCare
Dental of Colorado, Inc.; PacifiCare Behavioral Health of California, Inc.; PacifiCare Health Insurance Company of Micronesia, Inc.;
and PacifiCare Dental (in California). Indemnity insurance products (including PPO products) offered in California are underwritten
by PacifiCare Life and Health Insurance Company. Indemnity insurance products (including PPO products) offered in Arizona,
Colorado, Nevada, Washington, Oregon, Texas and Oklahoma are underwritten by PacifiCare Life Assurance Company. Other
products and services are offered by PacifiCare Health Plan Administrators, Inc.; PacifiCare Southwest Operations, Inc.; RxSolutions,
Inc.; SeniorCo, Inc.; and PacifiCare Behavioral Health, Inc. PacifiCare® is a federally registered trademark of PacifiCare Life and
Health Insurance Company.

      2005 Rate Information
                                                                 Non-Postal Premium                          Postal Premium
                                                      Biweekly                        Monthly                     Biweekly
        Type of Enrollment        Code      Gov’t Share     Your Share     Gov’t Share     Your Share   USPS Share     Your Share
        Self Only                 GF1       $131.08         $44.33         $284.01         $96.05       $154.74        $20.67
        Self and Family           GF2       $298.23         $104.59        $646.17         $226.61      $352.08        $50.74
                              Additional Disclosures

PacifiCare updates Provider Directories periodically. PacifiCare cannot guarantee the
availability of the physicians or other providers in the contracting network. Please
verify a doctor's participation status prior to obtaining services by calling the
PacifiCare Customer Service department. The phone number is located on your
Identification Card.

PacifiCare SignatureSavingsSM is a program/service that only provides discounts on
health care services obtained from participating providers within the plan. For more
information, please visit www.pacificare-dental.com

Secure Horizons Group Retiree Medicare + Choice Plans are offered by PacifiCare®
that contracts with the federal government. Limitations, copayments and coinsurance
will apply. Group Retiree prospects must meet the eligibility requirements to enroll
for group coverage. Health plan premiums and benefits may vary by employer group.
Pharmacy benefits are limited to a Formulary that is subject to change without notice
during the contract year. Contact PacifiCare/Secure Horizons for additional details.


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