Compare Benefit Options

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Compare Benefit Options

The Service Benefit Plan offers two types of coverage: Standard Option and Basic Option. Standard Option gives you the freedom to receive covered services from both Preferred and Non-preferred providers. Basic Option members must receive care performed by Preferred providers, except in certain situations like emergency care. Standard Option also has a calendar year deductible, while Basic Option does not. Most care under Basic Option is subject to a copayment amount. 2013 Premiums Your Share Standard Option and Basic Option Comparison Chart FEP BlueVision 2013 Premiums Your Share Outlined below is a summary of the Service Benefit Plan benefits. Refer to the Service Benefit Plan brochure (RI 71-005) for comprehensive benefit information for both options. All benefits are subject to the definitions, limitations and exclusions set forth in the 2013 Benefit Plan brochure. If you are a tribal employee, please note that rates may vary for you. Contact your Human Resources representative for additional information or to inquire about enrolling. 2013 Standard Option Self Only (104): $85.91 Family (105): $200.14 Self Only (104): $186.14 Family (105):$433.63 Category 1 Self Only (104): $64.71 Family (105): $152.92 Category 2 Self Only (104): $70.01 Family (105): $164.73 2013 Basic Option Self Only (111): $59.07 Family (112): $138.32 Self Only (111):$127.99 Family (112):$299.70 Category 1 Category 2 Self Only Self Only (111): (111): $38.99 $44.31 Family Family (112):$91.29 (112): $103.74

Non-Postal Premium Biweekly Non-Postal Premium Monthly

Postal Premium Biweekly

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Compare Benefit Options

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Non-Postal rates apply to most non-Postal employees. If you are in a special enrollment category, refer to the Guide to Federal Benefits for that category or contact the agency that maintains your health benefits enrollment. Career non-law enforcement employees may also refer to the Guide to Federal Benefits for United States Postal Service Employees, RI 70-2, to determine their rates. Different rates apply and a special Guide is published for Postal Service Inspectors and Office of Inspector General (OIG) employees (see RI 70-21N). For additional assistance, Postal Service employees can call the Human Resources Shared Service Center at 1.877.477.3273 and select option 5. Postal rates do not apply to non-career postal employees, postal retirees or associate members of any postal employee organization who are non-career postal employees. Refer to the applicable Guide to Federal Benefits. Back to top Standard Option and Basic Option Comparison Chart The following chart offers a comparison of Standard and Basic Option benefits when you use Preferred providers. PPA = Preferred Provider Allowance MAC = Maximum Allowable Charge

Benefit PHYSICIAN CARE Inpatient services, including surgery, medical care and outpatient surgery Home and office visits, and outpatient second surgical opinions and consultations HOSPITAL / FACILITY CARE Hospital Inpatient: Precertification required Outpatient Facility Care

2013 Standard Option Coverage Subject to $350 calendar year deductible. 15% PPA. $20 office visit copayment for primary care provider. $30 office visit copayment for specialist.

2013 Basic Option Coverage $150 copayment per surgeon. Nothing for other covered services. $25 office visit copayment for primary care provider. $35 office visit copayment for specialist.

$250 per admission copayment for unlimited days. Subject to $350 calendar year deductible. 15% PPA (except physical, occupational and speech therapy)

$150 per day up to $750 for unlimited days. $100 per day facility copayment.

ACCIDENTAL INJURY / EMERGENCY CARE Accidental Injury Care: Nothing for covered charges for services rendered Physician and facility care within 72 hours of the accident.

$125 copayment emergency room. $50 copayment urgent care center. $25 copayment primary care provider. $35 copayment specialist.

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Back to top Page last updated: December 31, 2012 2000-2013 Blue Cross and Blue Shield AssociationAll Rights Reserved

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