What To Consider When Making Health Care Coverage Choices

The Blue Cross and Blue Shield Service Benefit Plan offers two types of coverage to federal employees and retirees — Standard Option and Basic Option. Both Options fill in most gaps in coverage that Medicare does not pay. When combined with Medicare coverage, your Service Benefit Plan generally covers 100 percent of your health care expenses.

Standard And Basic Option Benefits

Both Standard Option and Basic Option provide benefits for the following types of care unless indicated.

If you have Basic Option coverage, a Preferred network provider must perform the care to be eligible for benefits except in certain situations such as emergency care.

• Inpatient hospital care

• Surgical care

• Physical exams and certain preventive screening tests

• Surgery

• Accidental injury care

• Physical, speech and occupational therapies

• Mental health/substance abuse care

• Home hospice care

• Retail Pharmacy Program

• Mail Service Prescription Drug Program (Standard Option only)

• Flu and pneumonia immunizations

• Skilled nursing facility care (limited benefit for Standard Option members with Medicare Part A as primary coverage)

• Routine dental care

After you retire from the federal government, your Service Benefit Plan coverage will continue automatically if you meet the eligibility requirements set by the U.S. Office of Personnel Management.

Medicare covers each person separately, so remember that you may need coverage for your family members. Service Benefit Plan coverage allows you to sign up for family coverage when you have eligible dependents. Therefore, if you have Medicare and Blue Cross and Blue Shield Service Benefit Plan family coverage, you will be covered by both Medicare and the Service Benefit Plan. However, if your spouse does not have Medicare, he or she would depend entirely on your Service Benefit Plan family coverage. So, when deciding between Standard and Basic Option to supplement your Medicare coverage, it's important to keep your dependents' health care needs in mind.

Changes Can Affect Your Needs

Changes in your family situation can affect your health coverage needs.

Beginning on the 30th day before you become eligible for Medicare, you may make a change in your Federal Employees Health Benefits Program (FEHBP) enrollment. For example, you can change options within the Service Benefit Plan.

When certain family changes occur, you can also change your federal employee coverage.

• When your child reaches age 22, he or she can no longer be covered under your federal employee health insurance.* If you have no other dependents to provide coverage for, you will want to change from Self and Family coverage to Self Only coverage.**

• If your husband or wife dies and you have no other dependents to cover, you will want to change from Self and Family coverage to Self Only coverage.***

• If you get married and want to provide coverage for your husband or wife and have Self Only coverage, you will want to change to Self and Family coverage.***

If you are a surviving spouse, you may keep your coverage if you meet certain requirements established by the Office of Personnel Management. However, you may not add any new family members.

There are annual Open Seasons when you can change health insurance regardless of Medicare eligibility or family changes. If you're retired, contact the Office of Personnel Management for information about how and when you can change your federal coverage. If you're working for the federal government, contact your agency personnel or employing office.

If You Don't Have Medicare

If you are over age 65 and do not have Medicare, under FEHB law we must limit our payments for inpatient hospital care and physician care to those benefits you would be entitled to if you had Medicare. And your physician and hospital cannot bill you for more than they could bill you if you had Medicare.

Outpatient hospital care is not covered by this law and regular benefits apply.

See Section 4 in the 2007 Service Benefit Plan brochure for more information.

* If a child over age 21 is dependent upon you because of a disability that occurred before age 22, coverage may be available. Retirees, contact the Office of Personnel Management; employees, contact your agency personnel office for more information.

** You don't have to wait for Open Season to make this change. You have 60 days after the child's 22nd birthday to change to Self Only coverage.

*** You don't have to wait for Open Season to make this change. You have 31 days prior to the date of the change in marital status and 60 days after the date of the death or marriage to change your coverage.

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