ENROLLMENT, DISENROLLMENT

Q. What is the effective date for Basic Option enrollments, enrollment codes 111 and 112?

A. The effective date for Basic Option coverage is January 1 for annuitants and the first day of the first pay period for active federal employees.

Q. What if I discover that my new health plan doesn't meet my needs - can I switch to another type of coverage during the year?

A. Unfortunately, you may switch health insurance plans only during Open Season. There are a few exceptions to this limitation. For example, members may change their coverage from self-only to family if they get married, or from family to self-only coverage if they get divorced. But generally speaking, changes in health plans, like changing from one carrier to another, or even changing options within the same health plan, can only be made once a year, during Open Season.

Q. Can I select Basic Option coverage for myself and Standard Option coverage for my spouse?

A. If both you and your spouse are federal employees or retirees and both eligible for FEHBP health insurance benefits, you can each select self-only coverage under the option that is best for you. However, if only one of you is eligible for FEHBP coverage, you must select family coverage under only one of the two options. The family coverage you select will then become the plan under which you and all of your eligible dependents, including your spouse, will be covered.

OPTIONS AVAILABLE

Q. What are my health plan options?

A.We encourage you to look carefully at all of your health benefit options before deciding what coverage will best meet your needs and the needs of your family. Take a look at the Blue Cross and Blue Shield Service Benefit Plan brochure, as well as our Web site, www.fepblue.org. You may also want to check with your personnel (or retirement) office for more information about the various other plans you can choose from. OPM has a Web site with information on the various other plans available. The address is www.opm.gov.

Under the Service Benefit Plan, there are two options:
Basic Option features lower premiums and reasonable out-of-pocket costs. For example, there's no deductible to meet and the copayment for office visits with primary care providers is $20. Basic Option also provides preventive dental services twice annually for a $20 copayment. Members receive benefits only when they go to doctors, hospitals and other health care providers that are in the Plan's Preferred Provider Network.

If you prefer a plan that offers members a wider choice of doctors and hospitals, where benefits are available with Participating or Non-participating providers, you will want to consider Standard Option. Standard Option gives members the freedom to choose their own doctors and hospitals. However, you pay more when you use Non-Preferred providers.

Q. How will I know where to get my prescription drugs?

A. MEMBER CHOOSES STANDARD OPTION
Under Standard Option coverage, you can continue to use the Mail Service and Retail Pharmacy Programs. Under the Standard Option Mail Service Program, there is a $10 copayment for generic drugs and a $35 copayment for brand name drugs for up to a 90-day supply in 2007. You will pay 25% PPA for a 90-day supply of medications at a network retail pharmacy or Internet pharmacy.

Under Basic Option coverage, you can use only Basic Option network retail or Internet pharmacies. There is no Mail Service benefit. In addition, Basic Option coverage for prescription drugs is based on a formulary. For up to a 30-day supply of medication, you will pay $10 for generic drugs, $30 for formulary brand name drugs and 50% coinsurance (with a minimum of $35), for Non-formulary brand name drugs. Continuing prescriptions and refills can be filled up to a 90-day supply. A 90-day supply will cost you 3 times the copay of a single 30-day supply.

BASIC OPTION BENEFIT QUESTIONS

Q. How do you determine whether the primary care or specialty copayment should be applied for my care?

A. The primary care copayment applies for the following types of doctors:
Internal medicine
Family practice
General practice
Pediatricians and
Obstetricians/gynecologists

If the services are billed for by a multi-specialty clinic and we cannot determine the provider specialty based on the information on the claim, then the primary care office visit copayment of $20 will be applied. In addition, if the primary care physician has more than one specialty, the primary care copayment will be applied.

The specialist copayment is $30

Q. Are benefits available for chiropractic care?

A. Under Basic Option coverage and Standard Option, benefits are available for covered services provided by Preferred chiropractors. Covered services include the initial office visit, spinal manipulations and the initial set of X-rays. Under Basic Option, you pay a $20 copayment for the office visit. Benefits are limited to 20 manipulations per year. Under Standard Option, you pay a $15 copay for the office visit. Benefits are limited to 12 spinal manipulations per year when you use a provider in our network.

Q. How are benefits for dental services covered?

A. With Basic Option, you pay a $20 copayment for each dental evaluation provided by a Preferred dentist, including the exam, cleaning and annual bitewing X-rays. Benefits are available for two oral exams every year. Benefits for children's care, up to age 16, including sealants and topical fluoride treatments, are also subject to the $20 copayment. Under Standard Option, benefits are paid according to a fee schedule that can be found in the 2007 service benefit plan brochure.

Q. How are Basic Option benefits coordinated with Medicare?

A. For members with Medicare Parts A and B as the primary payer, most copayments are waived when Preferred providers are used. Prescription drug copayments are not waived.