November 1, 2004

Under separate cover, you (the parent) should have received your 2005 SAMBA Health Benefit Plan brochure in the mail.  As shown in the brochure and accompanying literature, next year SAMBA will offer both a High Option and a Standard Option health plan selection.

You currently have an over age 22 child enrolled in SAMBA's Dependent Children Health Benefit Plan (DHBP).  This notice is to inform you that the 2005 DHBP health plan benefits will be equivalent to the "Standard Option" benefits as described in the 2005 SAMBA Health Benefit Plan brochure.  A brief summary of the Standard Option benefits is shown on the other side.

Please note that as a result of this change the first paragraph under the "Coverage" provision shown in the DHBP Summary Plan Description (revised January 1, 2003) has been replaced with the following paragraph:

Coverage:
The DHBP benefits, exclusions, limitations, PPO networks, and maximums are described in the SAMBA Health Benefit Plan brochure (No. RI 72-006) authorized by OPM.  The Brochure is published annually and its terms apply to charges incurred in that calendar year.  DHBP coverage generally is equivalent to self-only coverage under the SAMBA Health Benefit Plan Standard Option.  Accordingly, the current year SAMBA Health Benefit Plan brochure (No. RI 72-006) is incorporated as part of this Summary Plan Description with the exception of those references specifically addressed to Federal Health Benefits Program (FEHB) participants and "Section 8.  The disputed claim process" and "Section 11.  FEHB facts."  (Note:  The two Sections sited reference the 2003 brochure.  This language may move to another section of the brochure in future publications.)

In mid-December, two new DHBP identification cards (ID's) will be mailed to you for your child's use.  One card will carry the SAMBA and BlueCross BlueShield logos and is to be used to obtain health care services.  The second card is to be used for pharmacy services.  For security and peace of mind, we will no longer use Social Security numbers as the member ID.

Should you have any questions, please contact SAMBA at 1-800-638-6589.

Sincerely,

Walter E. Wilson   Executive DIrector