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| Primary care | $25/visit |
| Specialist | $25/visit |
| Preventive care | No Charge |
No deductible when services are rendered by a PPO provider
| Diagnostic (x-ray, blood work) | 15% coinsurance |
| Imaging (CT/PET scans, MRIs) | 15% coinsurance* |
*Precertification required. LabCorp/Quest: You pay nothing
| Generic (retail) | 20% coinsurance |
| Generic (mail order) | $15/90-day |
| Preferred brand (retail) | 30% coinsurance |
| Preferred brand (mail) | $90/90-day |
| Non-preferred brand | 50% coinsurance |
| Specialty drugs | $200/30-day |
Lower copays for hypertension, diabetes, asthma
| Outpatient | 15% coinsurance |
| Inpatient | $350 copay + 15%* |
*Precertification required, $500 penalty
| Primary care | 20% coinsurance |
| Specialist | 20% coinsurance |
| Preventive care | No Charge |
Deductible does not apply to preventive care
| Generic (retail) | 20% coinsurance |
| Generic (mail order) | 20% coinsurance ($450 max) |
| Preferred brand (retail) | 30% coinsurance |
| Preferred brand (mail) | 30% coinsurance ($450 max) |
| Non-preferred brand | 50% coinsurance |
| Primary care | $25/visit |
| Specialist | $25/visit |
| Preventive care | No Charge |
| Generic (retail) | 20% coinsurance |
| Generic (mail order) | 20% coinsurance ($250 max) |
| Preferred brand (mail) | 30% coinsurance ($350 max) |
| Non-preferred (mail) | 50% coinsurance ($450 max) |
| Specialty | $200-500/30-90 days |
You can get help if you want to continue your coverage after it ends. See the FEHB Plan brochure, contact your HR office/retirement system, contact your plan at 877-814-6252 or visit www.opm.gov.insure/health. Generally, if you lose coverage under the plan, then, depending on the circumstances, you may be eligible for a 31-day free extension of coverage, a conversion policy (a non-FEHB individual policy), spouse equity coverage, or temporary continuation of coverage (TCC).
Grievance and Appeals: If you are dissatisfied with a denial of coverage for claims under your plan, you may be able to appeal. Call 877-814-6252 for assistance.
You can get help if you want to continue your coverage after it ends. See the PSHB Plan brochure, contact your HR office/retirement system, contact your plan at 888-626-6252 or visit https://health-benefits.opm.gov/PSHB/. Generally, if you lose coverage under the plan, then, depending on the circumstances, you may be eligible for a 31-day free extension of coverage, a conversion policy (a non-PSHB individual policy), spouse equity coverage, or temporary continuation of coverage (TCC).
Grievance and Appeals: If you are dissatisfied with a denial of coverage, you may be able to appeal. Call 888-636-6252 for assistance.