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Do not rely only on these change descriptions; this Section is not an official statement of benefits. For that, go to Section 5 Benefits. Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits. Program-wide changes • In Section 3, under Covered providers, Illinois has been added to the list of medically underserved areas for 2009. Changes to both our High and Standard Options • Coverage of routine mammograms for women age 65 and older has been increased from one every two consecutive calendar years to one every calendar year. See page 24. • Benefits for skilled nursing care facilities are no longer available. See page 44. • Benefits for foot orthotics and arch supports are no longer available. See page 30. • Fertility drugs are no longer covered. See page 56. • Coverage has been increased to 100% for routine adult immunizations endorsed by the Centers for Disease Control and Prevention (CDC). See page 24. • The non-PPO benefits for Orthopedic and prosthetic devices has been reduced from 70% to 50% of the Plan allowance. See page 30. • PPO benefits will be paid for services rendered by a non-PPO assistant surgeon when treatment is received in a PPO facility. See pages 35 and 43. Changes to our High Option only • Your share of the non-Postal premium will decrease for Self Only and Self and Family. See page 86 • Benefits for home health aide services are no longer available. See page 32. • Benefits are now provided for screenings, testing, diagnostic evaluations, and treatment by licensed hearing professionals (including hearing aids) for adults under the Plan's Hearing services (testing, treatment, and supplies) benefit. See page 28. • The prescription drug copayment amounts under Section 5(f). Prescription drug benefits have increased as follows: Non-Medicare members at Retail - preferred drugs have increased from $25 to $30 per prescription and non-preferred drugs have increased from $40 to $45 per prescription; Non-Medicare members at Mail Order - preferred drugs have increased from $45 to $50 per prescription and non-preferred drugs have increased from $60 to $65 per prescription; Medicare members at Retail - all copays remain the same; Medicare members at Mail Order - generic drugs have increased from $5 to $10 per prescription, preferred drugs have increased from $20 to $30 per prescription and non-preferred drugs have increased from $35 to $50 per prescription. See page 55. Changes to our Standard Option only • Your share of the non-Postal premium will increase for Self Only and Self and Family. See page 86. • PPO benefits for Other inpatient hospital services and supplies have been reduced from 100% to 85% of the Plan allowance. See page 43. • The catastrophic protection out-of-pocket maximum will no longer include out-of-pocket expenses for deductibles and copayments. See page 15. • Benefits for the diagnosis and treatment of infertility have been reduced from $5,000 per person, per lifetime to $2,500 per person, per lifetime. See page 26. • The calendar year deductible has been increased from $250 to $300 per person and from $500 to $600 per family for all benefit categories. • The calendar year deductible for mental health and substance abuse benefits has been increased from $250 to $300 per person and from $500 to $600 per family. • Benefits for the first hearing aid and testing when necessitated by an accidental injury are no longer available. See page 29. • A catastrophic out-of-pocket limit of $5,000 per person, per calendar year has been added to the Prescription drug benefits for both retail and mail order drugs combined. See page 26. • The prescription drug copayment amounts under Section 5(f). Prescription drug benefits have changed as follows: Retail preferred drugs have changed from $30 to 25% coinsurance ($30 minimum/$60 maximum) per prescription and non-preferred drugs have changed from $45 to 35% coinsurance ($45 minimum/$90 maximum) per prescription; Mail Order preferred drugs have changed from 25% coinsurance ($45 minimum/$80 maximum) to 25% coinsurance ($50 minimum/$100 maximum) per prescription and non-preferred drugs have changed from 25% coinsurance ($60 minimum/$100 maximum) to 35% coinsurance ($65 minimum/$120 maximum) per prescription. The generic copayments will remain unchanged. See page 55. Other Changes • Open enrollment in the SAMBA Health Benefit Plan has been extended to include all Federal employees and annuitants who are eligible to enroll in the Federal Employees Health Benefits Program (FEHB). • Please note the SAMBA Health Benefit Plan brochure number has changed to RI 71-015. Clarifications • A definition for sound natural tooth has been added to this brochure. See Section 10. Definitions of terms we use in this brochure on page 75. • Dental implants are now specifically excluded under Section 5(g). Dental benefits. See page 58. • The Plan's extended prescription drug dispensing limitations have been updated to indicate that the Plan will authorize up to a 90-day supply of medication(s) if you should be called to active military duty and a 30-day supply in the event of a national emergency. See Section 5(f). Prescription drug benefits on page 53. • Diagnostic tests and medication management are now specifically listed as covered expenses under Out-of-Network benefits in Section 5(e). Mental health and substance abuse benefits. See page 50. • Emergency room physician care is now specifically listed as a covered expense under Diagnostic and treatment services in Section 5(a). Medical services and supplies provided by physicians and other health care professionals. See page 22. • The three benefit levels for prescription drugs purchased through the retail pharmacy and mail order programs under Section 5(f). Prescription drug benefits have been further defined as follows. Level I: generic drugs; Level II: formulary or preferred name brand drugs; and Level III: non-formulary or non-preferred name brand drugs. See page 52. • Telephone and on-line medical consultations are now specifically excluded. See Section 6, General exclusions -- things we don't cover on page 26.
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