2012 Benefits & Rates give you more than you expected.
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Choosing the right coverage with the benefits and rates that meet your family’s health care needs is important. But there is more to health insurance than just benefits and premiums. There is also the added value that the Service Benefit Plan can bring to you and your family’s health and wellness.
- A Preferred provider network of almost one million hospitals, physicians, pharmacies and other health care providers.
- A free nurse advice line through Blue Health Connection.
- Free online tools for you to take charge of your health and health care decisions.
- Help when you need it under MyBlue Customer eService.
- An incentive program that allows you to earn up to $50 for qualified medical expenses.
2012 INCENTIVE PROGRAM
New for 2012, the MyBlue Incentive Plan is the first step to take for a more active role in your health care decisions and the health of your family. Both Standard Option and Basic Option members can receive the MyBlue Wellness Card—a debit card that rewards our members for taking charge of their health. This debit card can be used for qualified medical expenses. Members who complete the Blue Health Assessment and up to three online coaching sessions can earn up to $50. Additional incentive programs for Diabetes management, smoking cessation and the generic pharmacy program are also available.
2012 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 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 not career postal employees. Refer to the applicable Guide to Federal Benefits.
Postal Category 1 rates apply to career employees covered by the National Postal Mail Handlers Union (NPMHU), National Association of Letter Carriers (NALC) and Postal Police bargaining units.
Postal Category 2 rates apply to other non-APWU, non-PCES, non-law enforcement Postal Service career employees, including management employees, and employees covered by the National Rural Letter Carriers’ Association bargaining unit.
PHARMACY PROGRAM
Retail Pharmacy Program—Standard & Basic Option
As a Standard Option member, you can use your local Preferred or Non-preferred retail pharmacy, or use an Internet pharmacy. Basic Option members can use local Preferred retail pharmacies or our Internet pharmacies to obtain medications. For both options, just show your Service Benefit Plan ID card at a Preferred pharmacy and you’ll receive Preferred prices on covered medications and supplies. There are no deductibles to meet. You pay only your appropriate coinsurance or copayment amount for each prescription or refill.
What You Pay—Standard Option | What You Pay—Basic Option |
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Up to a 90-day supply when you use Preferred Pharmacies or Internet Pharmacies. Nothing for the first four prescription fills or refills when you switch from certain brand-name drugs to specific generic drugs. Tier 1: 20% PPA for generic drugs. If Medicare Part B is your primary payer, you pay 15% PPA. Tier 2: 30% PPA for Preferred brand-name drugs. Tier 3: 45% PPA for Non-preferred brand-name drugs. | Up to a 34-day supply when you use Preferred Pharmacies or Internet Pharmacies. Tier 1: $10 copayment for generic drugs. Tier 2: $40 copayment for Preferred brand-name drugs. Tier 3: 50% or $50 minimum for Non-preferred brand-name drugs. |
Mail Service Pharmacy Program—Standard Option Only
The Mail Service Prescription Drug Program for Standard Option is an easy way to obtain those medications you take every day to treat chronic conditions such as high cholesterol or diabetes. It also gives you the convenience of home delivery. You pay one copayment per prescription or refill for up to a 90-day supply, as prescribed by your doctor. This benefit is not available under Basic Option.
What You Pay
Nothing for the first four prescription fills or refills when you switch from certain brand-name drugs to specific generic drugs.
Standard Option | Basic Option |
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Up to a 90-day supply when you use Preferred Pharmacies or Internet Pharmacies. Nothing for the first four prescription fills or refills when you switch from certain brand-name drugs to specific generic drugs. Tier 1: $15 copayment for generic drugs. If you have Medicare Part B as your primary coverage, you pay a $10 copayment. Tier 2: $70 each for the first 30 Preferred brand-name drug prescriptions fills or refills, $50 copayment thereafter. Tier 3: $95 each for the first 30 Non-preferred brand-name drug prescriptions, $50 copayment thereafter. | Not available. |
Specialty Pharmacy Benefits
Specialty Pharmacy Benefits are provided through Tier 4 of our pharmacy benefits. Under Standard Option, you pay an $80 copayment for Tier 4 (specialty) drugs purchased through our Specialty Drug Pharmacy Program. If you purchase specialty drugs at a retail pharmacy, you pay a 30% coinsurance amount. Basic Option members can also use the Specialty Pharmacy through Tier 4 benefits. You pay a $40 copayment for a 34-day supply or $120 for a 90-day supply. For specialty drugs purchased at a Preferred retail pharmacy, you pay a $50 copayment for a 34-day supply or $150 for a 90-day supply.
Tags:
Health Conscious, Seniors, Your Costs, Benefits and Services, Cost Conscious
Page last updated: January 03, 2012