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Pages 1--48 from PREFERRED CARE 2001

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2001 Preferred Care 1 Section
Preferred Care 2001
Serving: Greater Rochester and Surrounding Counties
Enrollment in this Plan is limited; see page 8
for requirements.

Enrollment codes for this Plan:
GV1 Self Only
GV2 Self and Family

A Health Maintenance Organization
This Plan has excellent accreditation
from the NCQA. See the 2001 Guide
for more information on NCQA.

http:// www. preferredcare. org

RI 73-467
For changes
in benef
its

see page
7.

Authorized for distribution by the:
United States Office of Personnel Management

Retirement and Insurance Service
http:// www. opm. gov/ insure 1
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Section 2 2001 Preferred Care 2
2 Page 3 4

Table of Contents

Table of Contents 3
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Table of Contents 4
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2001 Preferred Care 5 Section Section 1
Introduction
Preferred Care
259 Monroe Avenue
Rochester, New York 14607

This brochure describes the benefits of Preferred Care under our contract (CS 2371) with the Office of Personnel
Management (OPM), as authorized by the Federal Employees Health Benefits law. This brochure is the official
statement of benefits. No oral statement can modify or otherwise affect the benefits, limitations, and exclusions of this
brochure.

A person enrolled in this Plan is entitled to the benefits described in this brochure. If you are enrolled for Self and
Family coverage, each eligible family member is also entitled to these benefits. You do not have a right to benefits that
were available before January 1, 2001, unless those benefits are also shown in this brochure.

OPM negotiates benefits and rates with each plan annually. Benefit changes are effective January 1, 2001, and are
summarized on page 7. Rates are shown at the end of this brochure.

Plain Language
The President and Vice President are making the Government's communication more responsive, accessible, and
understandable to the public by requiring agencies to use plain language. In response, a team of health plan
representatives and OPM staff worked cooperatively to make this brochure clearer. Except for necessary technical
terms, we use common words. "You" means the enrollee or family member; "we" means Preferred Care.

The plain language team reorganized the brochure and the way we describe our benefits. When you compare this Plan
with other FEHB plans, you will find that the brochures have the same format and similar information to make
comparisons easier.

If you have comments or suggestions about how to improve this brochure, let OPM know. Visit OPM's "Rate Us"
feedback area at www. opm. gov/ insure or e-mail OPM at fehbwebcomments@ opm. gov or write to OPM at Insurance
Planning and Evaluation Division, P. O. Box 436, Washington, DC 20044-0436.

Introduction/ Plain Language 5
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Section 6 2001 Preferred Care
Section 1. Facts about this HMO plan
This Plan is a health maintenance organization (HMO). We require you to see specific physicians, hospitals, and other
providers that contract with us. These Plan providers coordinate your health care services.

HMOs emphasize preventive care such as routine office visits, physical exams, well-baby care, and immunizations, in
addition to treatment for illness and injury. Our providers follow generally accepted medical practice when prescribing
any course of treatment.

When you receive services from Plan providers, you will not have to submit claim forms or pay bills. You only pay the
copayments or coinsurance described in this brochure. When you receive emergency services from non-Plan provid-ers,
you may have to submit claim forms.

You should join an HMO because you prefer the plan's benefits, not because a particular provider is available.
You cannot change plans because a provider leaves our Plan. We cannot guarantee that any one physician,
hospital, or other provider will be available and/ or remain under contract with us.

How we pay providers
We contract with individual physicians, medical groups, and hospitals to provide the benefits in this brochure.
These Plan providers accept a negotiated payment from us, and you will only be responsible for your copayments or
coinsurance.

Patients' Bill of Rights
OPM requires that all FEHB Plans comply with the Patients' Bill of Rights, recommended by the President's Advisory
Commission on Consumer Protection and Quality in the Health Care Industry. You may get information about us, our
networks, providers, and facilities. OPM's FEHB website (www. opm. gov/ insure) lists the specific types of informa-tion
that we must make available to you. Some of the required information is listed below.

More than 2,600 doctors and area health centers participate with Preferred Care to provide primary care as well as
specialty services to the membership. In addition to doctors, the Plan has arranged for hospital, skilled nursing facility,
home health, and other covered health services.

All members must choose a primary care doctor who will provide, arrange, and coordinate all medically necessary
services. All female members are strongly encouraged to select an obstetrician/ gynecologist in addition to a primary
care doctor. The OB/ GYN will treat for any gynecological or obstetrical condition. Members do not need a referral
from their primary care doctor to see their OB/ GYN. A women's OB/ GYN is considered an additional primary care
doctor. New York State law does provide coverage with Nurse Midwives and the Plan maintains Nurse Midwives on
the provider panel. Plan members may elect a Nurse Midwife instead of an OB/ GYN.

If you want more information about us, call us at (716) 325-3113, toll free at (800) 950-3224 or write to 259 Monroe
Avenue, Rochester, New York, 14607. You may also contact us by fax at (716) 327-2298, or our e-mail address at
customercare@ preferredcare. org, or visit our website at www. preferredcare. org.

Service Area
To enroll in this plan, you must live or work in our service area. This is where our providers practice. Our service area
is: Monroe, Genesee, Livingston, Ontario, Orleans, Seneca, Wayne, Wyoming, and Yates Counties in New York State.

Ordinarily, you must get care from providers who contract with us. If you receive care outside our service area, we will
pay only for urgent or emergency care, except for students attending school or college outside of the service area. With
prior authorization from the Plan, follow up care for students is covered.

If you or a covered family member move outside of our service area, you can enroll in another plan. If your dependents
live out of the area, you should consider enrolling in a fee for service plan or an HMO that has agreements with
affiliates in other areas. If you or a family member move, you do not have to wait until Open Season to change plans.
Contact your employing or retirement office.

Section 1 6
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2001 Preferred Care 7 Section
Section 2. How we change for 2001
Program-wide changes
° The plain language team reorganized the brochure and the way we describe our benefits. We hope this will make
it easier for you to compare plans.

° This year, the Federal Employees Health Benefits Program is implementing network mental health and substance
abuse parity. This means that your coverage for mental health, substance abuse, medical, surgical, and hospital
services from providers in our plan network will be the same with regard to coinsurance, copays, and day and visit
limitations when you follow a treatment plan that we approve. Previously, we placed higher patient cost sharing
and shorter day or visit limitations on mental health and substance abuse services than we did on services to treat
physical illness, injury, or disease.

° Many healthcare organizations have turned their attention this past year to improving healthcare quality and
patient safety. OPM asked all FEHB plans to join them in this effort. You can find specific information on our
patient safety activities by calling us at (716) 325-3113 or checking our website at www. preferredcare. org. You
can find out more about patient safety on the OPM website, www. opm. gov/ insure. To improve your healthcare,
take these five steps:

°° Speak up if you have questions or concerns.
°° Keep a list of all the medicines you take.
°° Make sure you get the results of any test or procedure.
°° Talk with your doctor and health care team about your options if you need hospital care.
°° Make sure you understand what will happen if you need surgery.
° We clarified the language to show that anyone who needs a mastectomy may choose to have the procedure
performed on an inpatient basis and remain in the hospital up to 48 hours after the procedure. Previously, the
language referenced only women.

Changes to this Plan
° Your share of the non-Postal premium will increase by 26.5% for Self Only or 26.4% for Self and Family.
° We now cover your prescription drugs under a three-tier copayment arrangement. The copayments you pay will
vary depending on where we categorize your medication. The amount you pay also depends on whether you
purchase your prescriptions at a Plan pharmacy or through the mail order program.

For medications purchased at a Plan pharmacy, you are responsible for a $10 copayment per generic prescription
or refill, a $20 copayment per preferred brand name prescription or refill, or a $35 copayment per non-preferred
brand name prescription or refill, for each 30 day supply you purchase.

For certain medications that may be purchased through the mail order program, you will be responsible for a $20
copayment per generic prescription or refill, a $40 copayment per preferred brand name prescription or refill, or a
$70 copayment per non-preferred brand name prescription or refill, for each 90 day supply you purchase. By
using the mail order program, you save one copayment for each 90-day supply you purchase.

Section 2 7
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Section 8 2001 Preferred Care
Section 3. How you get care
Identification cards We will send you an identification (ID) card when you enroll. You should carry your ID card with you at all times. You must show it whenever you
receive services from a Plan provider, or obtain a prescription at a Plan
pharmacy. Until you receive your ID card, use your copy of the Health
Benefits Election Form, SF-2809, your health benefits enrollment confirma-tion
(for annuitants), or your Employee Express confirmation letter.

If you do not receive your ID card within 30 days after the effective date of
your enrollment, or if you need replacement cards, call us at (716) 325-3113
or (800) 950-3224, or if you have a speech or hearing impairment and have
TTY/ TDD equipment (716) 325-2629.

Where you get covered care You get care from "Plan providers" and "Plan facilities." You will only pay copays and/ or coinsurance, and you will not have to file claims.

° Plan providers Plan providers are physicians, including primary care physicians and special
ists and other health care professionals in our service area that we contract
with to provide covered services to our members. Providers are credentialed
to ensure that they meet strict standards of quality.

We list Plan providers in the provider directory, which we update periodically.
This list is also on our website at www. preferredcare. org.

° Plan facilities Plan facilities are hospitals and other facilities in our service area that we
contract with to provide covered services to our members. We list these in the
provider directory, which we update periodically. The list is also on our
website.

What you must do to get It depends on the type of care you need. First, you and each family member covered care must choose a primary care physician. This decision is important since your

primary care physician provides or arranges for most of your health care.
To select a primary care physician, either choose one from our provider
directory or contact a Customer Care representative who will assist you.

° Primary care Your primary care physician can be a family or general practitioner, an
internist or a pediatrician. Your primary care physician will provide most of
your health care, or give you a referral to see a specialist. Women may choose
an OB/ GYN in addition to their primary care physician.

If you want to change primary care physicians or if your primary care physi-cian
leaves the Plan, call us. We will help you select a new one.

° Specialty care Your primary care physician will refer you to a specialist for needed care.
However, you may see an OB/ GYN without a referral.

Here are other things you should know about specialty care:
° If you need to see a specialist frequently because of a chronic, complex,
or serious medical condition, your primary care physician will develop a
treatment plan that allows you to see your specialist for a certain number
of visits or a certain period of time without additional referrals. Your
primary care physician will use our criteria when creating your treatment
plan and will obtain approval, when required, beforehand.

° If you are seeing a specialist when you enroll in our Plan, talk to your
primary care physician. Your primary care physician will decide what
treatment you need. If he or she decides to refer you to a specialist, ask if

Section 3 8
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2001 Preferred Care 9 Section Section 3
you can see your current specialist. If your current specialist does not
participate with us, you must receive treatment from a specialist who
does. Generally, we will not pay for you to see a specialist who does not
participate with our Plan.

° If you are seeing a specialist and your specialist leaves the Plan, call your
primary care physician, who will arrange for you to see another specialist.
You may receive services from your current specialist until we can make
arrangements for you to see someone else.

° If you have a chronic or disabling condition and lose access to your
specialist because we:

°° terminate our contract with your specialist for other than cause; or
°° drop out of the Federal Employees Health Benefits (FEHB) Program
and you enroll in another FEHB Plan; or

°° reduce our service area and you enroll in another FEHB Plan,
You may be able to continue seeing your specialist for up to 90 days after
you receive notice of the change. Contact us, or if we drop out of the
Program, contact your new plan.

If you are in the second or third trimester of pregnancy and you lose access to
your specialist based on the above circumstances, you can continue to see your
specialist until the end of your postpartum care, even if it is beyond the 90
days.

° Hospital care Your Plan primary care physician or specialist will make necessary hospital
arrangements and supervise your care. This includes admission to a skilled
nursing or other type of facility.

If you are in the hospital when your enrollment in our Plan begins, call our
Customer Care Center immediately at 716/ 325-3113. If you are new to the
FEHB Program, we will arrange for you to receive care.

If you changed from another FEHB plan to us, your former plan will pay for
the hospital stay until:

° You are discharged, not merely moved to an alternative care center; or
° The day your benefits from your former plan run out; or
° The 92 nd day after you become a member of this Plan, whichever happens
first.

These provisions apply only to the hospital benefit of the hospitalized person;
we cover your other non-hospital care.

Circumstances beyond Under certain extraordinary circumstances, such as natural disasters, we may our control have to delay your services or we may be unable to provide them. In that case,

we will make all reasonable efforts to provide you with the necessary care.
Services requiring our Your primary care physician has authority to refer you for most services. prior approval For certain services, however, your physician must obtain approval from us.

Before giving approval, we consider if the service is covered, medically
necessary, and follows generally accepted medical practice.

We call this review and approval process "precertification". Your primary care
physician is familiar with the procedures that require a prior approval and will
make all necessary arrangements on your behalf. 9
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Section 10 2001 Preferred Care
Section 4. Your costs for covered services
You must share the cost of some services. You are responsible for:
° Copayments A copayment is a fixed amount of money you pay when you receive services.
Example: When you see your primary care physician, you pay a copayment of
$10 per office visit.

° Deductible We do not have a deductible.
° Coinsurance Coinsurance is the percentage of our negotiated fee that you must pay for your
care.

Example: In our Plan, you pay 20% of our allowance for durable medical
equipment.

Your out-of-pocket After your copayments and coinsurance total $3,300 per person or $8,400 maximum for copayments per family enrollment in any calendar year, you do not have to pay any more

and coinsurance for covered services. However, copayments for the following services do not count toward your out-of-pocket maximum, and you must continue to pay
copayments for this service:
° Prescription Drugs.
Be sure to keep accurate records of your copayments and coinsurance since
you are responsible for informing us when you reach these maximums.

Section 4 10
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2001 Preferred Care 11 Section Section 5
Section 5. Benefits Ð OVERVIEW
(See page 7 for how our benefits changed this year and page 47 for a benefits summary.)

NOTE: This benefits section is divided into subsections. Please read the important things you should keep in mind at
the beginning of each subsection. Also read the General Exclusions in Section 6; they apply to the benefits in the
following subsections. To obtain claims forms, claims filing advice, or more information about our benefits, contact
us at (716) 325-3113 or (800) 950-3224 or if you have a speech or hearing impairment and have TTY/ TDD equipment
(716) 325-2629 or visit our website at www. preferredcare. org.

(a) Medical services and supplies provided by physicians and other health care professionals ............................. 12 -19
° Diagnostic and treatment services
° Lab, X-ray, and other diagnostic tests
° Preventive care, adult
° Preventive care, children
° Maternity care
° Family planning
° Infertility services
° Allergy care
° Treatment therapies
° Rehabilitative therapies

(b) Surgical and anesthesia services provided by physicians and other health care professionals .......................... 20 -22
° Surgical procedures
° Reconstructive surgery
° Oral and maxillofacial surgery

(c) Services provided by a hospital or other facility, and ambulance services ........................................................ 23 -24
° Inpatient hospital
° Outpatient hospital or ambulatory
surgical center

(d) Emergency services/ accidents ............................................................................................................................ 25 -26
° Medical emergency

(e) Mental health and substance abuse benefits ...................................................................................................... 27 -28
(f) Prescription drug benefits .................................................................................................................................. 29 -30
(g) Special features ......................................................................................................................................................... 31
° Flexible Benefits Option.
° Services for Deaf and Hearing Impaired
° Travel Benefit/ Services Overseas

(h) Dental benefits .......................................................................................................................................................... 32
(i) Non-FEHB benefits available to Plan members ........................................................................................................ 33

Summary of benefits ....................................................................................................................................................... 47

° Hearing services (testing, treatment, and supplies)
° Vision services (testing, treatment, and supplies)
° Foot care
° Orthopedic and prosthetic devices
° Durable medical equipment (DME)
° Home health services
° Alternative treatments
° Educational classes and programs

° Organ/ tissue transplants
° Anesthesia

° Extended care benefits/ skilled nursing care
facility benefits
° Hospice care
° Ambulance

° Ambulance 11
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Section 12 2001 Preferred Care
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Section 5( a). Medical services and supplies provided by physicians and
other health care professionals

Here are some important things to keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure and are payable only when we determine they are medically
necessary.

° Plan physicians must provide or arrange your care.
° We have no deductible.
° Be sure to read Section 4, Your costs for covered services for valuable information about
how cost sharing works. Also read Section 9 about coordinating benefits with other
coverage, including with Medicare.

Diagnostic and treatment services You Pay
Professional services of physicians
° In physician's office

° In an urgent care center Nothing
° During a hospital stay
° In a skilled nursing facility
° Initial examination of a newborn child covered under a family contract

° Office medical consultations $10 per visit
° Second surgical opinions

° At home $10 per visit

Lab, X-ray and other diagnostic tests You Pay
° X-rays $10 per visit
° Cat Scans/ MRI
° Ultrasound

Section 5( a)

Benefit Description
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$10 per visit (no primary care
physician copay for children
under the age of 2) 12
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2001 Preferred Care 13 Section
Laboratory tests, such as: Nothing
° Blood tests
° Urinalysis
° Non-routine pap tests
° Pathology
° Non-routine Mammograms
° Electrocardiogram and EEG

Preventive care, adult You Pay
Routine screenings, such as: Nothing
° Complete Blood Count
° Total Blood Cholesterol -once every five years, ages 20 through 75
° Colorectal Cancer Screening, including
°° Ê ÊFecal occult blood test
°° Sigmoidoscopy, screening -every five years starting at age 50 Nothing
° Prostate Specific Antigen (PSA test) Nothing
° Two gynecological visits per year Nothing
° Routine pap test (annually) Nothing

Routine mammogram -covered for women age 35 and older, as follows: Nothing
° From age 35 through 39, one during this five year period
° From age 40 through 64, one every calendar year
° At age 65 and older, one every two consecutive calendar years

Not covered: Physical exams required for obtaining or continuing All charges
employment or insurance, attending schools or camp, or travel.

Routine Immunizations, limited to: $10 per visit
° Tetanus-diphtheria (Td) booster -once every 10 years, ages 19 and
over (except as provided for under Childhood immunizations)

° Influenza/ Pneumococcal vaccines, annually, age 65 and over or as
recommended

Lab, X-ray and other diagnostic tests (Continued) You Pay

Section 5( a) 13
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Section 14 2001 Preferred Care Section 5( a)
° Childhood immunizations recommended by the American Academy Nothing
of Pediatrics

° Examinations, such as:
°° Eye exams to determine the need for vision correction. $10 per visit

°° Ê ÊEar exams as part of a well-child care visit through age 18 to Nothing
determine the need for hearing correction.

°° Examinations done on the day of immunizations (through age 18) Nothing
° Well-child care charges for routine examinations, immunizations and Nothing
care (through age 18)

Maternity care You Pay
Complete maternity (obstetrical) care, such as: Nothing
° Prenatal care
° Delivery
° Postnatal care
Note: Here are some things to keep in mind:
° You do not need to precertify your normal delivery.
° You may remain in the hospital up to 48 hours after a regular delivery
and 96 hours after a cesarean delivery. We will extend your inpatient
stay if medically necessary.

° We cover routine nursery care of the newborn child during the covered
portion of the mother's maternity stay. We will cover other care of an
infant who requires non-routine treatment only if we cover the infant
under a Self and Family enrollment.

° We pay hospitalization and surgeon services (delivery) the same as for
illness and injury. See Hospital benefits (Section 5c) and Surgery
benefits (Section 5b).

Not covered: Routine sonograms to determine fetal age, size or sex All charges

Family planning You Pay
° Voluntary sterilization $10 per visit
° Injectable contraceptive drugs
° Intrauterine devices (IUDs)

Not covered: reversal of voluntary surgical sterilization, genetic counseling All charges

Preventive care, children You Pay 14
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2001 Preferred Care 15 Section
Infertility services You Pay
Diagnosis and treatment of infertility, such as:
° Artificial insemination:
°° intravaginal insemination (IVI)
°° intracervical insemination (ICI)
°° intrauterine insemination (IUI)
° Fertility drugs

Not covered: All charges
° Assisted reproductive technology (ART) procedures, such as:
°° in vitro fertilization
°° embryo transfer and GIFT
° Services and supplies related to excluded ART procedures
° Cost of donor sperm

Allergy care You Pay
Testing and treatment $10 per visit
Allergy injection

Allergy serum Nothing
Not covered: provocative food testing and sublingual allergy desensitization All charges.

Treatment therapies You pay
° Chemotherapy and radiation therapy. $10 per visit
Note: High dose chemotherapy in association with autologous bone
marrow transplants is limited to those transplants listed under
Organ/ Tissue Transplants on page 22.

° Respiratory and inhalation therapy
° Dialysis -Hemodialysis and peritoneal dialysis
° Intravenous (IV)/ Infusion Therapy -Home IV and antibiotic therapy
° Growth hormone therapy (GHT)
Note: We will only cover GHT when your physician pre-approves the
treatment. Your physician will submit information that establishes that the
GHT is medically necessary. Your physician must authorize GHT before
you begin treatment. If your physician does not pre-approve or if we
determine GHT is not medically necessary, we will not cover the GHT or
related services and supplies.

$10 per visit if the drug must
be administered by a physician.
All drugs that can be self-administered
are covered under
the prescription drug benefit
and are subject to the prescrip-tion
drug benefit copays.

Section 5( a) 15
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Section 16 2001 Preferred Care
Rehabilitative therapies You pay
Physical therapy, occupational therapy and speech therapy Ð
° 60 visits per condition for the services of each of the following:
°° qualified physical therapists;
°° speech therapists; and
°° occupational therapists.
Note: We only cover therapy to restore bodily function or speech when
there has been a total or partial loss of bodily function or functional
speech due to illness or injury.

° Cardiac rehabilitation following a heart transplant, bypass surgery or
a myocardial infarction, is provided for up to 36 visits.

Not covered: All charges
° long-term rehabilitative therapy
° exercise programs

Hearing services (testing, treatment, and supplies) You Pay
° Hearing aids for children through age 18. The balance after we pay
$600, every 3 years.

° Hearing screenings as part of a well-child care visit through age 18. Nothing
Not covered: All charges
° all other hearing testing
° hearing aids for adults over age 18.

Vision services (testing, treatment, and supplies) You pay
° One pair of eyeglasses or contact lenses to correct impairment directly 20% of Plan allowance.
caused by accidental ocular injury or intraocular surgery (such as for
cataracts).

° One pair of prescription eyeglasses (frames and lenses) or prescription
daily-wear contact lenses, per member once every year at plan
providers. Children under age 12 may obtain eyewear as required by
prescription change of at least .5 diopter.

° Annual eye refraction, including lens prescriptions. $10 per visit
Not covered: All charges
° Radial keratotomy and other refractive surgery.
° Eye exercises and orthoptics.

The remaining cost after a
discount of 20% -60% and a
credit of $60.

Section 5( a)

Nothing for inpatient therapy;
$10 per outpatient therapy visit 16
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2001 Preferred Care 17 Section
Foot care You Pay
Routine foot care when you are under active treatment for a metabolic $10 per visit
or peripheral vascular disease, such as diabetes.

See orthopedic and prosthetic devices for information on podiatric
shoe inserts.

Not covered: All charges
° Cutting, trimming or removal of corns, calluses, or the free edge of
toenails, and similar routine treatment of conditions of the foot, except
as stated above

° Treatment of weak, strained or flat feet or bunions or spurs; and of
any instability, imbalance or subluxation of the foot (unless the
treatment is by open cutting surgery)

Orthopedic and prosthetic devices You pay
° Custom made shoe inserts (1 pair every 3 years) The balance after we pay $250.
° Internal prosthetic devices, such as artificial joints, pacemakers, Nothing
cochlear implants, and surgically implanted breast implant following
mastectomy. Note: See 5( b) for coverage of the surgery to insert
the device

° Orthotic devices 20% of plan allowance.
° Artificial limbs and eyes; stump hose
° Externally worn breast prostheses and surgical bras, including
necessary replacements, following a mastectomy

° Corrective orthopedic appliances for non-dental treatment of
temporomandibular joint (TMJ) pain dysfunction syndrome.

° Orthopedic devices, such as braces.

Not covered: All charges
° arch supports
° heel pads and heel cups
° lumbosacral supports
° corsets, trusses, elastic stockings, support hose, and other supportive
devices

Section 5( a) 17
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Section 18 2001 Preferred Care Section 5( a)
Durable medical equipment (DME) You pay
Rental or purchase, at our option, including repair and adjustment, of 20% of plan allowance.
durable medical equipment prescribed by your Plan physician, such as
oxygen and dialysis equipment. Under this benefit, we also cover:

° hospital beds;
° wheelchairs;
° crutches;
° walkers;
° blood glucose monitors; and
° insulin pumps.

Not covered: All charges
° Motorized wheel chairs, unless medically necessary
° Air conditioners, dehumidifiers, humidifiers
° Breast pumps
° Electric hospital bed (unless medically necessary)
° Hypo-allergenic bedding
° Visual aids (e. g., CCTV, magnifying glasses)
° Environmental control units, such as control units to turn on a
television or air conditioner, etc.

° Augmentative communication devices, including speech machines.

Home health services You Pay
° Home health care ordered by a Plan physician and provided by a Nothing
registered nurse (R. N.), licensed practical nurse (L. P. N.), licensed
vocational nurse (L. V. N.), or home health aide.

° Services include oxygen therapy, intravenous therapy, and medications.

Not covered: All charges.
° nursing care requested by, or for the convenience of, the patient or
the patient's family;

° nursing care primarily for hygiene, feeding, exercising, moving the
patient, homemaking, companionship or giving oral medication. 18
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2001 Preferred Care 19 Section
Alternative treatments You Pay
° Chiropractic Care $10 per visit.
° Acupuncture (up to 10 visits annually) 50% of plan allowance.
Not covered: All charges
° naturopathic services
° hypnotherapy

Educational classes and programs You Pay
° Diabetes self-management $10 per visit.

Section 5( a) 19
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Section 20 2001 Preferred Care Section 5( b)
You Pay Benefit Description
Section 5( b). Surgical and anesthesia services provided by physicians
and other health care professionals

° The amounts listed below are for the charges billed by a physician or other health care
professional for your surgical care. Any costs associated with the facility charge (i. e.
hospital, surgical center, etc.) are covered in Section 5 (c).

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Surgical procedures You Pay
° Treatment of fractures, including casting
° Normal pre-and post-operative care by the surgeon
° Correction of amblyopia and strabismus
° Endoscopy procedure
° Biopsy procedure
° Removal of tumors and cysts
° Correction of congenital anomalies (see reconstructive surgery)
° Surgical treatment of morbid obesity Ð a condition in which an
individual weighs 100 pounds or 100% over his or her normal weight
according to current underwriting standards; eligible members must
be age 18 or over.

° Insertion of internal prosthetic devices. See 5( a) Ð Orthopedic braces
and prosthetic devices for device coverage information.

° Voluntary sterilization $10 per visit
° Surgically implanted contraceptives
° Treatment of burns

Not covered: All charges
° Reversal of voluntary sterilization
° Routine treatment of conditions of the foot; see Foot care.

$10 per office visit; nothing
for inpatient hospital
procedures. 20
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2001 Preferred Care 21 Section
Reconstructive surgery You Pay
° Surgery to correct a functional defect
° Surgery to correct a condition caused by injury or illness if:
°° the condition produced a major effect on the member's appearance and
°° the condition can reasonably be expected to be corrected by
such surgery

° Surgery to correct a condition that existed at or from birth and is a
significant deviation from the common form or norm. Examples of
congenital anomalies are: protruding ear deformities; cleft lip; cleft
palate; birth marks; webbed fingers; and webbed toes.

° All stages of breast reconstruction surgery following a mastectomy, Nothing
such as:

°° surgery to produce a symmetrical appearance on the other breast;
°° treatment of any physical complications, such as lymphoedema;
°° breast prostheses and surgical bras and replacements (see Prosthetic
devices)

Note: If you need to have a mastectomy, you may choose to have this
procedure performed on an inpatient basis and remain in the hospital up
to 48 hours after the procedure.

Not covered: All charges
° Cosmetic surgery -any surgical procedure (or any portion of a
procedure) performed primarily to improve physical appearance through
change in bodily form, except repair of accidental injury

° Surgeries related to sex transformation

Oral and maxillofacial surgery You Pay
Oral surgical procedures, limited to:
° Reduction of fractures of the jaws or facial bones;
° Surgical correction of cleft lip, cleft palate or severe functional
malocclusion;

° Removal of stones from salivary ducts;
° Excision of leukoplakia or malignancies;
° Excision of cysts and incision of abscesses when done as independent
procedures; and

° Other surgical procedures that do not involve the teeth or their
supporting structures.

Not covered: All charges
° Oral implants and transplants
° Procedures that involve the teeth or their supporting structures (such
as the periodontal membrane, gingiva, and alveolar bone)

Section 5( b)

Nothing for inpatient surgery;
$10 per outpatient surgery

Nothing for inpatient surgery;
$10 per outpatient surgery 21
21 Page 22 23
Section 22 2001 Preferred Care Section 5 (b)
Organ/ tissue transplants You Pay
Limited to: Nothing
° Cornea
° Heart
° Heart/ lung
° Kidney
° Kidney/ Pancreas
° Liver
° Lung: Single -Double
° Pancreas
° Allogeneic bone marrow transplants
° Autologous bone marrow transplants (autologous stem cell and
peripheral stem cell support) for the following conditions: acute
lymphocytic or non-lymphocytic leukemia; advanced Hodgkin's
lymphoma; advanced non-Hodgkin's lymphoma; advanced
neuroblastoma; breast cancer; multiple myeloma; epithelial ovarian
cancer; testicular, mediastinal, and ovarian cancers.

Limited Benefits Ð Treatment for breast cancer, multiple myeloma, and
epithelial ovarian cancer may be provided in an NCI-or NIH-approved
clinical trial at a Plan-designated center of excellence and if approved by
the Plan's medical director in accordance with the Plan's protocols.

Note: We cover related medical and hospital expenses of the donor when
we cover the recipient.

Not covered: All charges
° Donor screening tests and donor search expenses, except those
performed for the actual donor

° Implants of artificial organs
° Transplants not listed as covered

Anesthesia You Pay
Professional services provided in -Nothing
° Hospital (inpatient)
° Hospital (outpatient department)
° Ambulatory surgical center
° Office

Section 5 (b) Section 5( b) Section 5( b) 22
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2001 Preferred Care 23 Section
You Pay Benefit Description
Section 5( c). Services provided by a hospital or other facility,
and ambulance services

° Plan physicians must provide or arrange your care and you must be hospitalized in a
Plan facility.

° We have no deductible.
° Be sure to read Section 4, Your costs for covered services for valuable information about
how cost sharing works. Also read Section 9 about coordinating benefits with other
coverage, including with Medicare.

° The amounts listed below are for the charges billed by the facility (i. e., hospital or
surgical center) or ambulance service for your surgery or care. Any costs associated with
the professional charge (i. e., physicians, etc.) are covered in Section 5( a) or (b).

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Inpatient hospital You Pay
Room and board, such as Nothing
° ward, semiprivate, or intensive care accommodations
° general nursing care; and
° meals and special diets.

NOTE: If you want a private room when it is not medically necessary,
you pay the additional charge above the semiprivate room rate.

Other hospital services and supplies, such as: Nothing
° Operating, recovery, maternity, and other treatment rooms
° Prescribed drugs and medicines
° Diagnostic laboratory tests and X-rays
° Administration of blood and blood products
° Blood or blood plasma, if not donated or replaced
° Dressings, splints, casts, and sterile tray services
° Medical supplies and equipment, including oxygen
° Anesthetics, including nurse anesthetist services
° Medical supplies, appliances, medical equipment, and any covered
items billed by a hospital for use at home.

Not covered: All charges.
° Custodial care
° Non-covered facilities
° Personal comfort items, such as telephone, television, barber services,
guest meals and beds

° Private nursing care

Section 5( c) 23
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Section 24 2001 Preferred Care
Outpatient hospital or ambulatory surgical center You Pay
° Operating, recovery, and other treatment rooms Nothing
° Prescribed drugs and medicines
° Diagnostic laboratory tests, X-rays, and pathology services
° Administration of blood, blood plasma, and other biologicals
° Blood and blood plasma, if not donated or replaced
° Pre-surgical testing
° Dressings, casts, and sterile tray services
° Medical supplies, including oxygen
° Anesthetics and anesthesia service

NOTE: We cover hospital services and supplies related to dental
procedures when necessitated by a non-dental physical impairment.
We do not cover the dental procedures.

Extended care benefits/ skilled nursing care facility benefits You pay
Skilled nursing facility (SNF): 120 days per calendar year. Nothing
Covered services include:
° Bed, board, and general nursing care.
° Drugs, biologicals, supplies, and equipment.

Not covered: custodial care All charges

Hospice care You Pay
Care for terminally ill patients (life expectancy of 6 months or less). Nothing
° Covered services include dietary counseling, home health aid,
occupational therapy, speech therapy, and skilled nursing.

° Drugs and medical supplies.

Not covered: Independent nursing, homemaker services All charges

Ambulance You Pay
° Local professional ambulance service when medically appropriate Nothing

Section 5( c) 24
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2001 Preferred Care 25 Section
What is a medical emergency?
A medical emergency is the sudden and unexpected onset of a condition or an injury that you believe endan-gers
your life or could result in serious injury or disability, and requires immediate medical or surgical care.
Some problems are emergencies because, if not treated promptly, they might become more serious; examples
include deep cuts and broken bones. Others are emergencies because they are potentially life-threatening,
such as heart attacks, strokes, poisonings, gunshot wounds, or sudden inability to breathe. There are many
other acute conditions that we may determine are medical emergencies -what they all have in common is the
need for quick action.

What to do in case of emergency:
Emergencies within our service area: Emergency services must be provided or authorized by a plan
physician unless time or circumstances make it impossible. You or a family member must contact your
primary care physician within 48 hours, or as soon as reasonably possible if your care was not pre-approved.
It is your responsibility to ensure that your doctor is notified in a timely manner.

If you are hospitalized in a non-plan facility and Plan physicians determine that care can be better provided in
a Plan hospital, you would be transferred when medically feasible. Any follow up care must be pre-approved
by the Plan or provided by Plan providers.

Emergencies outside of our service area: Emergency services must be provided or authorized by a plan
physician unless time or circumstances make it impossible. You or a family member must contact your
primary care physician within 48 hours or as soon as reasonably possible if your care was not pre-approved.
It is your responsibility to ensure that your doctor is notified in a timely manner.

If a Plan doctor determines that care can be better provided in a Plan hospital, you would be transferred when
medically feasible. Any follow up care must be pre-approved by the Plan or provided by Plan providers.

Section 5( d). Emergency services/ accidents
Here are some important things to keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure.

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Section 5( d) 25
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Section 26 2001 Preferred Care
You Pay Benefit Description
Emergency within our service area You Pay
° Emergency care at a doctor's office $10
° Emergency care at an urgent care center $25
° Emergency care as an outpatient at a hospital, $50 (waived if admitted)
including doctors' services

Not covered: Elective care or non-emergency care All charges

Emergency outside our service area You Pay
° Emergency care at a doctor's office $10
° Emergency care at an urgent care center $25
° Emergency care as an outpatient at a hospital, including $50 (waived if admitted)
doctors' services

Not covered: All charges
° Elective care or non-emergency care
° Emergency care provided outside the service area if the need for
care could have been foreseen before leaving the service area

° Medical and hospital costs resulting from a normal full-term delivery
of a baby outside the service area.

Ambulance You Pay
Professional ambulance service when medically appropriate. Nothing
See 5 (c) for non-emergency service.

Not covered: Air ambulance, unless determined to be medically All charges
necessary and approved by our medical director.

Section 5( d) 26
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2001 Preferred Care 27 Section
You Pay Benefit Description
Section 5( e). Mental Health and Substance Abuse Benefits
Parity
Beginning in 2001, all FEHB plans' mental health and substance abuse benefits will
achieve "parity" with other benefits. This means that we will provide mental health and
substance abuse benefits differently than in the past.

When you get our approval for services and follow a treatment plan we approve, cost-sharing
and limitations for Plan mental health and substance abuse benefits will be no
greater than for similar benefits for other illnesses and conditions.

Here are some important things to keep in mind about these benefits:
° All benefits are subject to the definitions, limitations, and exclusions in this brochure.
° We have no deductible.
° Be sure to read Section 4, Your costs for covered services for valuable information about
how cost sharing works. Also, read Section 9 about coordinating benefits with other
coverage, including with Medicare.

° YOU MUST GET PREAUTHORIZATION OF THESE SERVICES. See the
instructions after the benefits description below.

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Mental health and substance abuse benefits You Pay
Diagnostic and treatment services recommended by a Plan provider and
contained in a treatment plan that we approve. The treatment plan may
include services, drugs, and supplies described elsewhere in this brochure.

Note: Plan benefits are payable only when we determine the care is
clinically appropriate to treat your condition and only when you receive
the care as part of a treatment plan that we approve.

° Professional services, including individual or group therapy by $10 per visit
providers such as psychiatrists, psychologists, or clinical social workers

° Medication management

° Diagnostic tests Nothing
° Services provided by a hospital or other facility Nothing
° Services in approved alternative care settings such as partial
hospitalization, full-day hospitalization, and facility based intensive
outpatient treatment

Not covered: Services we have not approved. All charges
Note: OPM will base its review of disputes about treatment plans on the
treatment plan's clinical appropriateness. OPM will generally not order
us to pay or provide one clinically appropriate treatment plan in favor
of another.

Your cost sharing
responsibilities are no
greater than for other
illness or conditions.

Section 5( e) 27
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Section 28 2001 Preferred Care
Preauthorization To be eligible to receive these benefits you must follow your treatment plan and all the following authorization processes:
For mental health treatment, you or your primary care physician are required
to contact Preferred Care's Behavioral Health Services Unit and speak with a
mental health specialist who will ask basic information about your mental
health history to determine the need for a referral for outpatient care. For
inpatient care, your primary care physician makes a referral to Preferred
Care's Preauthorization Department for inpatient hospitalization or partial
hospitalization (day treatment).

For chemical dependency treatment, you are required to contact the Preferred
Care Behavioral Health Services Unit and speak with an intake coordinator
who will ask basic information about your chemical dependency history to
determine the need for an assessment. If an assessment is appropriate, an
appointment for you will be arranged with an independent Preferred Care
Chemical Dependency Assessor. Once the assessment is completed, a clinical
quality coordinator will contact you to make specific recommendations for
treatment, and will arrange inpatient or outpatient services as needed.

The Behavioral Health Services Unit telephone number is (716) 327-2477 or
(800) 836-1430 ext. 477. For the names of plan providers or a provider
directory, contact a Preferred Care Customer Care Center representative at
(716) 325-3113 or (800) 950-3224 or visit our website at www. preferredcare. org.

Special transitional benefit If a mental health or substance abuse professional provider is treating you under our plan as of January 1, 2001, you will be eligible for continued
coverage with your provider for up to 90 days under the following condition:
° If your mental health or substance abuse professional provider with whom
you are currently in treatment leaves the plan at our request for other than
cause.

If this condition applies to you, we will allow you reasonable time to transfer
your care to a Plan mental health or substance abuse professional provider.
During the transitional period, you may continue to see your treating provider
and will not pay any more out-of-pocket than you did in the year 2000 for
services. This transitional period will begin with our notice to you of the
change in coverage and will end 90 days after you receive our notice. If we
write to you before October 1, 2000, the 90-day period ends before January 1
and this transitional benefit does not apply.

Limitation We may limit your benefits if you do not follow your treatment plan.

Section 5( e) 28
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2001 Preferred Care 29 Section Section 5( f)
Section 5( f). Prescription drug benefits
Here are some important things to keep in mind about these benefits:
° We cover prescribed drugs and medications, as described in the chart beginning on the
next page.

° All benefits are subject to the definitions, limitations and exclusions in this brochure
and are payable only when we determine they are medically necessary.

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There are important features you should be aware of. These include:
° Who can write your prescription. A licensed Plan physician must write the prescription.
° Where you can obtain them. You may fill the prescription at a Plan pharmacy, a non-network pharmacy, or by
mail for maintenance medications.

° We use a formulary. A formulary is a list of selected FDA approved prescription medications. Use of a
formulary helps control out of pocket costs. The Preferred Care formulary is an open, clinically comprehensive
guide that was developed by a nationally recognized independent group of clinicians.

° These are the dispensing limitations. You may purchase up to a 90 day supply at a Plan pharmacy and are
required to pay a copayment for each 30-day supply you purchase. The amount you pay is based upon a three-tier
copayment structure. The tiers determine the amount you pay for each 30-day supply purchased. The three
tiers are categorized as: Generic Drugs; Preferred Brand Name Drugs; and Non-Preferred Brand Name Drugs.

You may also purchase certain medications for up to a 90-day supply through the mail order pharmacy. You are
required to pay a copayment for each 90 day supply purchased through the mail order pharmacy. The amount
you pay for medications purchased through the mail order pharmacy is also based on the three tier copayment
structure. The tiers are categorized as: Generic Drugs; Preferred Brand Name Drugs; and Non-Preferred Brand
Name Drugs. You may obtain a list of the medications covered through the mail order program by contacting a
Customer Care representative at (716) 325-3113 or (800) 950-3224.

° When you have to file a claim. If you use a non-plan pharmacy or do not present your identification card at a
plan pharmacy, you are required to submit a claim.

(Prescription drug benefits begin on the next page) 29
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Section 30 2001 Preferred Care
You Pay Benefit Description
Covered medications and supplies You Pay
We cover the following medications and supplies prescribed by a Plan physi-cian
and obtained from a Plan pharmacy or through our mail order program:

° Drugs and medicines that by Federal law of the United States require a
physician's prescription for their purchase, except as excluded below

° Disposable needles and syringes for the administration of covered
medications

° Drugs for sexual dysfunction have dispensing limits. Contact us
for details.

° Contraceptive drugs
° Drugs for infertility treatment after a medical condition has been
corrected are limited to 4 cycles per pregnancy. Pergonal/ Metrodin
and other FDA approved drugs, only after unsuccessful treatment with
Clomifen and only when very specific clinical indications are met.
The coverage is limited to, but not exceeding, four (4) treatment cycles
per pregnancy. This benefit requires an approval referral for each cycle.
If no pregnancy has occurred after completion of four cycles of
Gonadotropic drugs, all fertility drug benefits are exhausted.

Diabetic Drugs & Supplies:
° Insulin and oral agents
° Supplies, including disposable needles and syringes

° Diabetes education (see Educational classes and programs, page 19) $10 per session.
° Diabetic medical equipment $10 per unit.
Here are some things to keep in mind about our prescription drug program:
° A generic equivalent will be dispensed if it is available, unless your
physician specifically requires a name brand. If you receive a name
brand drug when a Federally-approved generic drug is available, and
your physician has not specified Dispense as Written for the name brand
drug, you have to pay the difference in cost between the name brand
drug and the generic, in addition to the brand name copay.

° We administer an open formulary. If your physician believes a name brand
product is necessary or there is no generic available, your physician may
prescribe a name brand drug from a formulary list. This list of name brand
drugs is a preferred list of drugs that we selected to meet patient needs at a
lower cost. To order a prescription drug brochure, call (716) 325-3113.

Not covered: All Charges
° Drugs and supplies for cosmetic purposes
° Vitamins and nutritional supplements that can be purchased without
a prescription.

° Nonprescription medicines
° Drugs to enhance athletic performance

At a Plan Pharmacy
(for each 30 day supply)
$10 per generic prescription.
$20 per preferred brand name
prescription.
$35 per non-preferred brand
name prescription.

At Mail Order Pharmacy
(for each 90 day supply)
$20 per generic prescription.
$40 per preferred brand name
prescription.
$70 per non-preferred brand
name prescription.

Note: If there is no generic
equivalent available, you will still
have to pay the brand name copay.

$10 for each 30-day supply at
a Plan pharmacy.
$10 for each 90-day supply
from the mail order pharmacy.

Section 5( f) 30
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2001 Preferred Care 31 Section Section 5( g)
Section 5( g). Special Features
Feature Description

Flexible benefits option Under the flexible benefits option, we determine the most effective way
to provide services.

° We may identify medically appropriate alternatives to traditional care
and coordinate other benefits as a less costly alternative benefit.

° Alternative benefits are subject to our ongoing review.
° By approving an alternative benefit, we cannot guarantee you will get
it in the future.

° The decision to offer an alternative benefit is solely ours, and we may
withdraw it at any time and resume regular contract benefits.

° Our decision to offer or withdraw alternative benefits is not subject to
OPM review under the disputed claims process.

Services for deaf and ° If you have a speech or hearing impairment and have TTY/ TDD
hearing impaired equipment, you may contact us at (716) 325-2629.

Travel benefits/ services ° Urgent and emergency care only.
overseas 31
31 Page 32 33
Section 32 2001 Preferred Care
Section 5( h). Dental Benefits
Here are some important things to keep in mind about these benefits:
° Please remember that all benefits are subject to the definitions, limitations, and
exclusions in this brochure and are payable only when we determine they are medically
necessary.

Accidental injury benefit
We cover restorative services and supplies necessary to promptly repair (but not replace) sound natural teeth.
The need for these services must result from an accidental injury. Benefits are provided only for a course of
treatment that has begun within 12 months of the injury. You pay $10 per visit.

Dental Benefits
Hospitalization for certain dental procedures is covered when a Plan doctor determines there is a need for
hospitalization for reasons totally unrelated to the dental procedure; the Plan will cover the hospitalization,
but not the cost of the professional dental services. Conditions for which hospitalization would be covered
include hemophilia and heart disease. The need for anesthesia, by itself is not such a condition.

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Section 5( h) 32
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2001 Preferred Care 33 Section
The benefits on this page are not part of the FEHB contract or premium, and you cannot file an FEHB disputed
claim about them. Fees you pay for these services do not count toward FEHB out-of-pocket maximums.

HealthPerks ® from Preferred Care are courses, resources, and discounts available to all members of the Plan.
HealthPerks ® provides connections to traditional and complimentary providers, all geared to giving Plan members'
tools to make appropriate health and wellness decisions for themselves and their families. Our HealthPerks ® program
was developed to encourage appropriate participation in healthful activities focusing on preventive care to aid in
improving the health status of our members. Courses, programs and workshops cover areas such as: CPR & First Aid,
Diet & Nutrition, Smoking Cessation, Women's Issues, and Childbirth & Parenting. Discounts are provided for
purchasing health related, recreation or leisure merchandise or services from: Weight Watchers, Play It Again Sports,
Muxworthy's, G& G Fitness, Lori's Natural Foods, and Rock Ventures to name a few. Over twenty clubs provide plan
members discounted arrangements. HealthPerks ® also maintains a massage therapy panel that provides discounts on
massage services. Discounts and schedules vary by participating vendor.

New programs for 2001 include:
° 20% discount on LASIK surgery at select locations
° Safe driving and safe boating course discounts at select locations
° 20% discount on teeth whitening at participating dental providers
° 20% discount on sunglasses and safety glasses at select locations

To receive a HealthPerks ® brochure, call Preferred Care's Customer Care Center at (716) 325-3113 or toll free at
(800) 950-3224. Members with a speech or hearing impairment and access to TTY/ TDD equipment may call (716)
325-2629.

www. preferredcare. org. Preferred Care's website provides valuable health information, frequently asked questions,
HealthPerks ® offerings, physician listings, and important links to other sites that can provide you with the most up to
date information on health and wellness.

This plan offers Medicare recipients the opportunity to enroll in the Plan through Medicare. As indicated on page 40,
annuitants and former spouses with FEHB coverage may enroll in a Medicare managed care plan when one is available
in their area. They may then later enroll in the FEHB Program. Most Federal annuitants have Medicare Part A. Contact
your retirement system for information on dropping your FEHB enrollment and changing to a Medicare managed care
plan. Contact us at (716) 327-2480 or toll free at (800) 665-7924 for information on the Medicare managed care plan
and the cost of that enrollment.

Section 5( i). Non-FEHB benefits available to Plan members

Section 5( i) 33
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Section 34 2001 Preferred Care
Section 6. General exclusions Ð things we don't cover
The exclusions in this section apply to all benefits. Although we may list a specific service as a benefit, we will not
cover it unless your Plan doctor determines it is medically necessary to prevent, diagnose, or treat your illness,
disease, injury, or condition.

We do not cover the following:
° Care by non-Plan providers except for authorized referrals or emergencies (see Emergency Benefits);
° Services, drugs, or supplies you receive while you are not enrolled in this Plan;
° Services, drugs, or supplies that are not medically necessary;
° Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric
practice;

° Experimental or investigational procedures, treatments, drugs or devices;
° Services, drugs, or supplies related to abortions, except when the life of the mother would be endangered if the
fetus were carried to term or when the pregnancy is the result of an act of rape or incest;

° Services, drugs, or supplies related to sex transformations;
° Services, drugs, or supplies you receive from a provider or facility barred from the FEHB Program; or
° Services that would normally be provided without charge.

Section 6 34
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2001 Preferred Care 35 Section Section 6
Section 7. Filing a claim for covered services
When you receive services from Plan physicians, receive services at Plan hospitals and facilities, or obtain your
prescription drugs at Plan pharmacies, you will not have to file claims. Just present your identification card and pay
your copayment or coinsurance.

You will only need to file a claim when you receive emergency services from non-plan providers. Sometimes these
providers bill us directly. Check with the provider. If you need to file the claim, here is the process:

Medical and hospital In most cases, providers and facilities file claims for you. Physicians must benefits file on the form HCFA-1500, Health Insurance Claim Form. Facilities will
file on the UB-92 form. For claims questions and assistance, call us at
(716) 325-3113.

When you must file a claim Ð such as for out-of-area care Ð submit it on the
HCFA-1500 or a claim form that includes the information shown below. Bills
and receipts should be itemized and show:

° Covered member's name and ID number;
° Name and address of physician or facility that provided the service or supply;
° Dates you received the services or supplies;
° Diagnosis;
° Type of each service or supply;
° The charge for each service or supply;
° A copy of the explanation of benefits, payments, or denial from any
primary payer Ð such as the Medicare Summary Notice (MSN); and

° Receipts, if you paid for your services.

Submit your claims to:
Preferred Care, 259 Monroe Avenue, Rochester, New York, 14607

Prescription drugs Submit your claims to:
Paid Prescriptions, Inc., P. O. Box 702, Parsippany, New Jersey, 07054

Deadline for filing your Send us all of the documents for your claim as soon as possible. You must claim submit the claim by December 31 of the year after the year you received the
service, unless timely filing was prevented by administrative operations of
Government or legal incapacity, provided the claim was submitted as soon as
reasonably possible.

When we need more Please reply promptly when we ask for additional information. We may delay information processing or deny your claim if you do not respond.

Section 7 35
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Section 36 2001 Preferred Care
Section 8. The disputed claims process
Follow this Federal Employees Health Benefits Program disputed claims process if you disagree with our decision on
your claim or request for services, drugs, or supplies -including a request for preauthorization:

Step Description
Ask us in writing to reconsider our initial decision. You must:
(a) Write to us within 6 months from the date of our decision; and
(b) Send your request to us at: 259 Monroe Avenue, Rochester, N. Y. 14607; and
(c) Include a statement about why you believe our initial decision was wrong, based on specific benefit
provisions in this brochure; and

(d) Include copies of documents that support your claim, such as physicians' letters, operative reports, bills,
medical records, and explanation of benefits (EOB) forms.

We have 30 days from the date we receive your request to:
(a) Pay the claim (or arrange for the health care provider to give you the care); or
(b) Write to you and maintain our denial Ð go to step 4; or
(c) Ask you or your provider for more information. If we ask your provider, we will send you a copy of our
request Ð go to step 3.

You or your provider must send the information so that we receive it within 60 days of our request. We will
then decide within 30 more days.

If we do not receive the information within 60 days, we will decide within 30 days of the date the information
was due. We will base our decision on the information we already have.

We will write to you with our decision.

If you do not agree with our decision, you may ask OPM to review it.
You must write to OPM within:
° 90 days after the date of our letter upholding our initial decision; or
° 120 days after you first wrote to us Ð if we did not answer that request in some way within 30 days; or
° 120 days after we asked for additional information.

Write to OPM at: Office of Personnel Management, Office of Insurance Programs, Contracts Division 3,
P. O. Box 436, Washington, D. C. 20044-0436.

Send OPM the following information:
° A statement about why you believe our decision was wrong, based on specific benefit provisions in this
brochure;

° Copies of documents that support your claim, such as physicians' letters, operative reports, bills, medical
records, and explanation of benefits (EOB) forms;

° Copies of all letters you sent to us about the claim;
° Copies of all letters we sent to you about the claim; and
° Your daytime phone number and the best time to call.

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2001 Preferred Care 37 Section
Note: If you want OPM to review different claims, you must clearly identify which documents apply to
which claim.

Note: You are the only person who has a right to file a disputed claim with OPM. Parties acting as your
representative, such as medical providers, must provide a copy of your specific written consent with the
review request.

Note: The above deadlines may be extended if you show that you were unable to meet the deadline because of
reasons beyond your control.

OPM will review your disputed claim request and will use the information it collects from you and us to
decide whether our decision is correct. OPM will send you a final decision within 60 days. There are no
other administrative appeals.

If you do not agree with OPM's decision, your only recourse is to sue. If you decide to sue, you must file the
suit against OPM in Federal court by December 31 of the third year after the year in which you received the
disputed services, drugs, or supplies. This is the only deadline that may not be extended.

OPM may disclose the information it collects during the review process to support their disputed claim
decision. This information will become part of the court record.

You may not sue until you have completed the disputed claims process. Further, Federal law governs your
lawsuit, benefits, and payment of benefits. The Federal court will base its review on the record that was
before OPM when OPM decided to uphold or overturn our decision. You may recover only the amount of
benefits in dispute.

NOTE: If you have a serious or life threatening condition (one that may cause permanent loss of bodily
functions or death if not treated as soon as possible), and

(a) We haven't responded yet to your initial request for care or preauthorization/ prior approval, then call us at
(716) 325-3113 and we will expedite our review; or

(b) We denied your initial request for care or preauthorization/ prior approval, then:
°° If we expedite our review and maintain our denial, we will inform OPM so that they can give your
claim expedited treatment too, or

°° You can call OPM's Health Benefits Contracts Division 3 at 202/ 606-0755 between 8 a. m. and 5
p. m. eastern time.

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Section 38 2001 Preferred Care
Section 9. Coordinating benefits with other coverage
When you have other You must tell us if you are covered or a family member is covered under health coverage another group health plan or have automobile insurance that pays health care
expenses without regard to fault. This is called "double coverage."
When you have double coverage, one plan normally pays its benefits in full as
the primary payer and the other plan pays a reduced benefit as the secondary
payer. We, like other insurers, determine which coverage is primary according
to the National Association of Insurance Commissioners' guidelines.

When we are the primary payer, we will pay the benefits described in this
brochure.

When we are the secondary payer, we will determine our allowance. After the
primary plan pays, we will pay whatever is left up to the plan allowance or our
regular benefit, whichever is less. We will not pay more than our allowance. If
we are the secondary payer, we may be entitled to receive payment from your
primary plan.

° What is Medicare? Medicare is a Health Insurance Program for:
°° People 65 years of age and older.
°° Some people with disabilities, under 65 years of age.
°° People with End-Stage Renal Disease (permanent kidney failure requiring
dialysis or a transplant).

Medicare has two parts:
°° Part A (Hospital Insurance). Most people do not have to pay for Part A.
°° Part B (Medical Insurance). Most people pay monthly for Part B.
If you are eligible for Medicare, you may have choices in how you get your
health care. The information in the next few pages shows how we coordinate
benefits with Medicare, depending on the type of Medicare plan you have.

° The Original The Original Medicare Plan is available everywhere in the United States. It is
Medicare Plan the way most people get their Medicare Part A and Part B benefits. You may
go to any doctor, specialist, or hospital that accepts Medicare. Medicare pays
its share and you pay your share. Some things are not covered under Original
Medicare, like prescription drugs.

When you are enrolled in this Plan and Original Medicare, you still need to
follow the rules in this brochure for us to cover your care. You must use our
providers.

When Medicare is the primary payer, we will waive some of your out of
pocket costs, such as copays and coinsurance.

(Primary Payer Chart appears on next page.)

Section 9 38
38 Page 39 40
2001 Preferred Care 39 Section
The following chart illustrates whether Original Medicare or this Plan should be the primary payer for you according
to your employment status and other factors determined by Medicare. It is critical that you tell us if you or a covered
family member has Medicare coverage so we can administer these requirements correctly.

Primary Payer Chart
Then the primary payer is . . .
Original Medicare This Plan
A. When either you Ñ or your covered spouse Ñ are age 65 or over and ...

Section 9
1 Are an active employee with the Federal government (including when
you or a family member are eligible for Medicare solely because of a 3
disability),

2) Are an annuitant, 3
3) Are a reemployed annuitant with the Federal government when
a) The position is excluded from FEHB 3
b) Or, the position is not excluded from FEHB
Ask your employing office which of these applies to you. 3

4) Are a Federal judge who retired under title 28, U. S. C., or a Tax Court
judge who retired under Section 7447 of title 26, U. S. C. (or if your 3
covered spouse is this type of judge),

5) Are enrolled in Part B only, regardless of your employment status, 3 3
(for Part B (for other
services) services)

6) Are a former Federal employee receiving Workers' Compensation and 3
the Office of Workers' Compensation Programs has determined that (except for claims
you are unable to return to duty, related to Workers'
Compensation.)

B. When you Ð or a covered family member Ð have Medicare based
on end stage renal disease (ESRD) and...

1) Are within the first 30 months of eligibility to receive Part A benefits 3
solely because of ESRD,

2) Have completed the 30-month ESRD coordination period and are still 3
eligible for Medicare due to ESRD,

3) Become eligible for Medicare due to ESRD after Medicare became 3
primary for you under another provision,

C. When you or a covered family member have FEHB and...
1) Are eligible for Medicare based on disability,
a) And are an annuitant 3
b) And are an active employee 3 39
39 Page 40 41
Section 40 2001 Preferred Care
Claims process
° When we are the primary payer, we process the claim first.
° When Original Medicare is the primary payer, Medicare processes your
claim first. In many cases, your claims will be coordinated automatically
and we will pay the balance of covered charges. To find out if you need to
do something about filing your claims, call us at (716) 325-3113 or visit
our website at www. preferredcare. org.

° Medicare managed If you are eligible for Medicare, you may choose to enroll in a Medicare
care plan managed care plan. To learn more about enrolling in a Medicare managed
care plan, contact Medicare at 1-800-MEDICARE (1-800-633-4227) or at
www. medicare. gov. If you enroll in a Medicare managed care plan, the
following options are available to you:

This Plan and another Plan's Medicare managed care plan: You may
enroll in another plan's Medicare managed care plan and also remain enrolled
in our FEHB plan. We will still provide benefits when your Medicare man-aged
care plan is primary, even out of the managed care plan's network and/ or
service area (if you use our Plan providers). We will waive our copayments,
and/ or coinsurance when we are the secondary payer. You are required to use
Plan providers.

Suspended FEHB coverage and a Medicare managed care plan: If you are
an annuitant or former spouse, you can suspend your FEHB coverage to enroll
in a Medicare managed care plan, eliminating your FEHB premium. (OPM
does not contribute to your Medicare managed care plan premium). For
information on suspending your FEHB enrollment, contact your retirement
office. If you later want to re-enroll in the FEHB Program, generally you may
do so only at the next open season unless you involuntarily lose coverage or
move out of the Medicare managed care service area.

° Enrollment in Note: If you choose not to enroll in Medicare Part B, you can still be covered
Medicare Part B under the FEHB Program. We cannot require you to enroll in Medicare.

TRICARE TRICARE is the health care program for eligible dependents of military persons, and retirees of the military. TRICARE includes the CHAMPUS program. If both
TRICARE and this Plan cover you, they pay first. See your TRICARE
Health Benefits Advisor if you have questions about TRICARE coverage.

Workers' Compensation We do not cover services that:
° you need because of a workplace-related disease or injury that the Office
of Workers' Compensation Programs (OWCP) or a similar Federal or State
agency determines they must provide; or

° OWCP or a similar agency pays for through a third party injury settlement
or other similar proceeding that is based on a claim you filed under OWCP
or similar laws.

Once OWCP or similar agency pays its maximum benefits for your treatment,
we will cover your benefits. You must use our providers.

Section 9 40
40 Page 41 42
2001 Preferred Care 41 Section Section 9
Medicaid When you have this Plan and Medicaid, we pay first.
When other Government We do not cover services and supplies when a local, State, agencies are responsible for or Federal Government agency directly or indirectly pays for them.
your care
When others are responsible When you receive money to compensate you for medical or hospital care for for injuries injuries or illness caused by another person, you must reimburse us for any
expenses we paid. However, we will cover the cost of treatment that exceeds
the amount you received in the settlement.

If you do not seek damages you must agree to let us try. This is called
subrogation. If you need more information, contact us for our subrogation
procedures. 41
41 Page 42 43
Section 42 2001 Preferred Care Section 10
Calendar year January 1 through December 31 of the same year. For new enrollees, the calendar year begins on the effective date of their enrollment and ends on
December 31 of the same year.
Copayment A copayment is a fixed amount of money you pay when you receive covered services. See page 10.

Coinsurance Coinsurance is the percentage of our allowance that you must pay for your care. See page 10.
Covered services Care we provide benefits for, as described in this brochure.
Custodial care Care that could be provided safely and reasonably by people without profes-sional skills or training that is primarily to help the member with daily living
activities or meet personal needs.
Experimental or This Plan considers a drug, device, treatment, or procedure to be experimental investigational or investigational if it meets one or more of the following criteria:
1. It cannot be lawfully marketed without the approval of the FDA and such
approval has not been granted at the time of its use.
2. It is the subject of a current investigational new drug or device application
on file with the FDA.
3. It is being provided pursuant to a Phase I or Phase II clinical trial or as the
experimental or research arm of a clinical trial.
4. It is being provided pursuant to a written protocol which describes among
its objectives, determination of safety, efficacy, or efficacy in comparison
to conventional alternatives.
5. The predominant opinion among experts as expressed in the published peer
review literature is that further research is necessary in order to define
safety compared with conventional alternatives.
6. It is not experimental or investigational in itself, but is being used in
conjunction with a drug, device, treatment, or procedure that is experimental
or investigational.

Group health coverage Health care coverage that a member is eligible for because of employment by, membership in, or connection with, a particular organization or group that
provides payment for hospital, medical, or other health care services or
supplies.

Medically necessary Medically necessary means that the use of services and supplies required to diagnose or treat you are:
° consistent with your illness;
° safe and effective;
° not only for the convenience of you or your health
care provider; and
° the most appropriate level for your illness.

Plan allowance Plan allowance is the amount we use to determine our payment and your coinsurance for covered services.

Us/ We Us and we refer to Preferred Care.
Yo u You refers to the enrollee and each covered family member.

Section 10. Definitions of terms we use in this brochure 42
42 Page 43 44
2001 Preferred Care 43 Section Section 11
No pre-existing condition We will not refuse to cover the treatment of a condition that you had before limitation you enrolled in this Plan solely because you had the condition before you
enrolled.
Where you can get See www. opm. gov/ insure. Also, your employing or retirement office can information about enrolling answer your questions, and give you a Guide to Federal Employees Health
in the FEHB Program Benefits Plans, brochures for other plans, and other materials you need to make an informed decision about:

° When you may change your enrollment;
° How you can cover your family members;
° What happens when you transfer to another Federal agency, go on leave
without pay, enter military service, or retire;

° When your enrollment ends; and
° When the next open season for enrollment begins.
We don't determine who is eligible for coverage and, in most cases, cannot
change your enrollment status without information from your employing or
retirement office.

Types of coverage available Self Only coverage is for you alone. Self and Family coverage is for you, your for you and your family spouse, and your unmarried dependent children under age 22, including any
foster children or stepchildren your employing or retirement office authorizes
coverage for. Under certain circumstances, you may also continue coverage
for a disabled child 22 years of age or older who is incapable of self-support.

If you have a Self Only enrollment, you may change to a Self and Family
enrollment if you marry, give birth, or add a child to your family. You may
change your enrollment 31 days before to 60 days after that event. The Self
and Family enrollment begins on the first day of the pay period in which the
child is born or becomes an eligible family member. When you change to Self
and Family because you marry, the change is effective on the first day of the
pay period that begins after your employing office receives your enrollment
form; benefits will not be available to your spouse until you marry.

Your employing or retirement office will not notify you when a family
member is no longer eligible to receive health benefits, nor will we. Please
tell us immediately when you add or remove family members from your
coverage for any reason, including divorce, or when your child under age 22
marries or turns 22.

If you or one of your family members is enrolled in one FEHB plan, that
person may not be enrolled in or covered as a family member by another
FEHB plan.

When benefits and The benefits in this brochure are effective on January 1. If you are new premiums start to this Plan, your coverage and premiums begin on the first day of your first
pay period that starts on or after January 1. Annuitants' premiums begin on
January 1.

Section 11. FEHB facts 43
43 Page 44 45
Section 44 2001 Preferred Care Section 11
Your medical and claims We will keep your medical and claims information confidential. Only the records are confidential following will have access to it:
° OPM, this Plan, and subcontractors when they administer this contract;
° This Plan, and appropriate third parties, such as other insurance plans and
the Office of Workers' Compensation Programs (OWCP), when coordinat-ing
benefit payments and subrogating claims;

° Law enforcement officials when investigating and/ or prosecuting alleged
civil or criminal actions;

° OPM and the General Accounting Office when conducting audits;
° Individuals involved in bona fide medical research or education that does
not disclose your identity; or

° OPM, when reviewing a disputed claim or defending litigation about a
claim.

When you retire When you retire, you can usually stay in the FEHB Program. Generally, you must have been enrolled in the FEHB Program for the last five years of your
Federal service. If you do not meet this requirement, you may be eligible for
other forms of coverage, such as Temporary Continuation of Coverage (TCC).

When you lose benefits
° When FEHB You will receive an additional 31 days of coverage, for no additional
coverage ends premium, when:

°° Your enrollment ends, unless you cancel your enrollment, or
°° You are a family member no longer eligible for coverage.
You may be eligible for spouse equity coverage or Temporary Continuation
of Coverage.

° Spouse equity If you are divorced from a Federal employee or annuitant, you may not
coverage continue to get benefits under your former spouse's enrollment. But, you may
be eligible for your own FEHB coverage under the spouse equity law. If you
are recently divorced or are anticipating a divorce, contact your ex-spouse's
employing or retirement office to get RI 70-5, the Guide to Federal Employees
Health Benefits Plans for Temporary Continuation of Coverage and Former
Spouse Enrollees, or other information about your coverage choices.

° TCC If you leave Federal service, or if you lose coverage because you no longer
qualify as a family member, you may be eligible for Temporary Continuation
of Coverage (TCC). For example, you can receive TCC if you are not able to
continue your FEHB enrollment after you retire.

You may not elect TCC if you are fired from your Federal job due to gross
misconduct.

Get the RI 79-27, which describes TCC, and the RI 70-5, the Guide to Federal
Employees Health Benefits Plans for Temporary Continuation of Coverage
and Former Spouse Enrollees, from your employing or retirement office or
from www. opm. gov/ insure. 44
44 Page 45 46
2001 Preferred Care 45 Section Section 11
° Converting to You may convert to a non-FEHB individual policy if:
°° Your coverage under TCC or the spouse equity law ends. If you canceled
your coverage or did not pay your premium, you cannot convert;

°° You decided not to receive coverage under TCC or the spouse equity law;
or

°° You are not eligible for coverage under TCC or the spouse equity law.
If you leave Federal service, your employing office will notify you of your
right to convert. You must apply in writing to us within 31 days after you
receive this notice. However, if you are a family member who is losing
coverage, the employing or retirement office will not notify you. You must
apply in writing to us within 31 days after you are no longer eligible for
coverage.

Your benefits and rates will differ from those under the FEHB Program;
however, you will not have to answer questions about your health, and we will
not impose a waiting period or limit your coverage due to pre-existing
conditions.

Getting a Certificate of If you leave the FEHB Program, we will give you a Certificate of Group Group Health Plan Coverage Health Plan Coverage that indicates how long you have been enrolled with us.
You can use this certificate when getting health insurance or other health care
coverage. Your new plan must reduce or eliminate waiting periods, limita-tions,
or exclusions for health related conditions based on the information in
the certificate, as long as you enroll within 63 days of losing coverage under
this Plan.

If you have been enrolled with us for less than 12 months, but were previously
enrolled in other FEHB plans, you may also request a certificate from those
plans.

Inspector General Advisory Stop health care fraud! Fraud increases the cost of health care for everyone. If you suspect that a physician, pharmacy, or hospital has charged you for
services you did not receive, billed you twice for the same service, or misrep-resented
any information, do the following:

° Call the provider and ask for an explanation. There may be an error.
° If the provider does not resolve the matter, call us at (716) 325-3113 and
explain the situation.

° If we do not resolve the issue, call THE HEALTH CARE FRAUD
HOTLINE Ð 202/ 418-3300 or write to: The United States Office of
Personnel Management, Office of the Inspector General Fraud Hotline,
1900 E Street, NW, Room 6400, Washington, DC 20415.

Penalties for Fraud Anyone who falsifies a claim to obtain FEHB Program benefits can be
prosecuted for fraud. Also, the Inspector General may investigate anyone who
uses an ID card if the person tries to obtain services for someone who is not an
eligible family member, or is no longer enrolled in the Plan and tries to obtain
benefits. Your agency may also take administrative action against you.

° Converting
to individual
coverage 45
45 Page 46 47
Section 46 2001 Preferred Care Index
Accidental injury 32
Allergy tests 15
Alternative treatment 19
Ambulance 24, 26
Anesthesia 22
Autologous bone marrow
transplant 22
Biopsies 20
Blood and blood plasma 23, 24
Casts 23, 24
Catastrophic protection 10
Changes for 2001 7
Chemotherapy 15
Childbirth 33
Cholesterol tests 13
Claims 35, 40
Coinsurance 10
Colorectal cancer screening 13
Congenital anomalies 21
Contraceptive devices and
drugs 14, 30
Coordination of benefits 38
Covered charges 40
Crutches 18
Deductible 10
Definitions 42
Dental care 32
Diagnostic services 12
Disputed claims process 36
Donor expenses (transplants) 22
Dressings 23
Durable medical equipment
(DME) 18
Educational classes and
programs 19
Effective date of enrollment 8
Emergency Benefits 25
Experimental or investigational 42
Eyeglasses 16
Family planning 14

Index
Do not rely on this page; it is for your convenience and does not explain your benefit coverage.
Fecal occult blood test 13
General Exclusions 34
Hearing services 16
Home health services 18
Hospice care 24
Hospital 8
Immunizations 13
Infertility services 15
In hospital physician care 12
Inpatient Hospital Benefits 23
Insulin 30
Laboratory and pathology services
12, 13
Magnetic Resonance Imagings
(MRIs) 12
Mail Order Prescription
Drugs 29, 30
Mammograms 13
Maternity Benefits 14
Medicaid 41
Medically necessary 42
Medicare 38
Members 5
Mental Conditions/ Substance
Abuse Benefits 27
Newborn care 14
Non-FEHB Benefits 33
Nurse
Licensed Practical Nurse 19
Nurse Midwife 6
Registered Nurse 19
Nursery Care 14
Obstetrical care 6, 14
Occupational therapy 16
Ocular injury 16
Office visits 12
Oral and maxillofacial surgery 21
Orthopedic devices 17
Out-of-pocket maximum 10
Outpatient facility care 20, 24

Oxygen 18
Pap test 13
Physical therapy 16
Physician services 12
Precertification 9, 29
Preventive care, adult 13
Preventive care, children 14
Prescription drugs 29
Prior approval 9, 28
Prostate cancer screening 13
Prosthetic devices 17
Psychologist 27
Radiation therapy 15
Rehabilitation therapies 16
Renal dialysis 15
Room and board 23
Second surgical opinion 12
Skilled nursing facility care 12, 24
Smoking cessation 39
Speech therapy 16
Splints 23
Sterilization procedures 14
Subrogation 41
Substance abuse 27
Surgery 20
° Anesthesia 22
° Oral 21
° Outpatient 20
° Reconstructive 21
Syringes 30
Temporary continuation of
coverage 40
Transplants 22
Treatment therapies 15
Vision services 16
Well child care 14
Wheelchairs 18
Workers' compensation 40
X-rays 12 46
46 Page 47 48
2001 Preferred Care 47 Section Summary of Benefits
Summary of benefits for Preferred Care -2001
° Do not rely on this chart alone. All benefits are provided in full unless indicated and are subject to the defini-tions,
limitations, and exclusions in this brochure. On this page we summarize specific expenses we cover; for
more detail, look inside.
° If you want to enroll or change your enrollment in this Plan, be sure to put the correct enrollment code from the
cover on your enrollment form.
° We only cover services provided or arranged by Plan physicians, except in emergencies.

Benefits You Pay Page
Medical services provided by physicians: Office visit copay:
° Diagnostic and treatment services provided in the office ................ $10 primary care; $10 specialist 12

Services provided by a hospital:
° Inpatient ............................................................................................ Nothing 23
° Outpatient ......................................................................................... Nothing 24

Emergency benefits:
° In-area ............................................................................................... $50 copay (waived if admitted) 25
° Out-of-area ....................................................................................... $50 copay (waived if admitted) 25

Mental health and substance abuse treatment ......................................... Regular cost sharing 27
Prescription drugs .................................................................................... At a Plan Pharmacy 29
(for each 30 day supply)
$10 per generic prescription
$20 per preferred brand name
prescription
$35 per non-preferred brand
name prescription
At Mail Order Pharmacy
(for each 90 day supply)
$20 per generic prescription
$40 per preferred brand name
prescription
$70 per non-preferred brand
name prescription

Dental Care .............................................................................................. No benefit 32
Vision Care: 16
° Annual eye refraction, including lens prescriptions $10 per visit
° One pair of prescription eyeglasses or contact lenses The remaining cost after a discount
of 20%-60% and a credit of $60

Special features: 31
° Flexible benefits option
° Services for deaf and hearing impaired
° Travel benefits/ services overseas

Protection against catastrophic costs ....................................................... Nothing after $3,300 per person
(your out-of-pocket maximum) ........................................................ or $8,400 per family enrollment 10
................................................................................................... per year
Some costs do not count toward
this protection 47
47 Page 48
Section 48 2001 Preferred Care
Non-Postal Premium Postal Premium
Biweekly Monthly Biweekly
Type of Gov't Your Gov't Your USPS Your
Enrollment Share Share Share Share Share Share

Self Only GV1 $76.29 $25.43 $165.29 $55.10 $90.28 $11.44
Self and Family GV2 $193.52 $64.51 $419.30 $139.77 $229.00 $29.03

2001 Rate Information for
Preferred Care

Non-Postal rates apply to most non-Postal enrollees. If you are in a special enrollment category, refer to the FEHB
Guide for that category or contact the agency that maintains your health benefits enrollment.

Postal rates apply to career Postal Service employees. Most employees should refer to the FEHB Guide for United
States Postal Service Employees, RI 70-2. Different postal rates apply and special FEHB guides are published for
Postal Service Nurses and Tool & Die employees (see RI 70-2B); and for Postal Service Inspectors and Office of
Inspector General (OIG) employees (see RI 70-2IN).

Postal rates do not apply to non-career postal employees, postal retirees, or associate members of any postal
employee organization. Refer to the applicable FEHB Guide.

Code 48

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