The benefits and rates for your Service Benefit Plan coverage are determined during negotiations with the US Office of Personnel Management (OPM). But, there is more to health insurance that just benefits and premiums. There is also the added value your Blue Cross and Blue Shield Service Benefit Plan coverage brings to you and your family. This includes:
- Our Preferred network of almost one million providers
- Blue Health Connection's free nurse line
- Free health and wellness programs such as WalkingWorks® and our Blue Health Assessment
We have expanded our free online health programs and Blue Health Connection for 2010, bringing additional value to your coverage and to give you the help you need to make informed health care decisions.
You Can Get More Information
The 2010 Blue Cross and Blue Shield Service Benefit Plan brochure (RI 71-005) provides the contractual description of your benefits. A complete list of benefit changes for 2010 is in Section 2 of the brochure. We urge you to read the list of 2010 benefit changes, as well as the reference pages and Sections included with each change. It is especially important to read the information about how benefits are provided differently for Preferred and Non-preferred providers to help plan any out-of-pocket expenses.
Information about benefit changes for 2010 is on our web site. Beginning October 26 through December 31, you can call our Open Season Information Center at 1.800.411.BLUE or 1.800.411.2583. The Center is open between 7 am ET and 11 pm ET Monday through Friday, and from 9 am ET through 2 pm ET on Saturday and Sunday. It is closed Thanksgiving and Christmas.
Important Prescription Drug Changes For 2010
Under Standard Option, your 20 percent coinsurance amount is waived for the first four prescription fills or refills purchased at a Preferred retail pharmacy when you switch from certain brand-name drugs to certain generic drugs. A list of eligible drugs is in the 2010 brochure.
Important Health And Wellness Changes For 2010
- The Standard Option copayment for visits to a Preferred specialist increases from $20 to $30.
- Under Standard Option, the calendar year deductible is not credited to your Catastrophic Protection Benefit.
- The Standard Option coinsurance amount for care by Non-participating providers increases from 30 percent to 35 percent.
- The Standard Option per admission copayment for Non-member hospitals increases from $300 to $350.
- Under Basic Option, the copayment for visits to a Preferred specialist increases from $30 to $35 per visit.
- Under Basic Option you pay a $150 copayment for inpatient care and nothing for outpatient care for maternity care in Preferred facilities.
- The Basic Option inpatient hospital copayment increases from $100 to $150 per day. The maximum per admission increases from $500 to $750.
- Under Basic Option, the outpatient facility copayment increases from $50 to $75 per facility per day.
Wellness Incentive Program
We want to help you get the best value for your health care dollars. So, in 2010 the $20 Standard Option copayment and $25 Basic Option copayment for your annual physical is waived if you take the Blue Health Assessment prior to your physical and use a Preferred physician. More information about this program appears later in this newsletter.
Mental Health Parity
Effective January 1, 2010, a new federal law provides that benefits for both in-network and out-of-network care must be the same for the treatment of mental health/substance abuse and physical conditions. Your Service Benefit Plan already covers both types of conditions the same when you use a Preferred provider. Beginning January 1, benefits will also be provided equally when you use a Non-preferred provider. For more information about 2010 benefits for mental conditions and substance abuse, please see Section 5(c) in the 2010 Service Benefit Plan brochure. In the absence of treatment and visit limitations, it is extremely important to obtain prior approval for mental health and substance abuse services. If you do not obtain prior approval, the services will be denied with no benefit applied. Your identification card has a toll-free number specifically for mental health and substance abuse services. Please call that number prior to receiving service to ensure you obtain prior approval.
Open Season Dates
The 2009 Open Season for health insurance changes is scheduled for November 9 through December 14, 2009.
2010 Premiums — Your Share
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Non-Postal Premium |
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Non-Postal Premium |
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Postal Premium |
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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