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Section 5(h). Special features |
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| Special 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. If we identify a less costly alternative, we may ask you to sign an alternative benefits agreement that will include all of the following terms. Until you sign and return the agreement, regular contract benefits will continue.
- Alternative benefits will be made available for a limited time period and are subject to our ongoing review. You must cooperate with the review process.
- 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 except as expressly provided in the agreement, we may withdraw it at any time and resume regular contract benefits.
- If you sign an agreement, we will provide the agreed-upon alternative benefits for the stated time period (unless circumstances change). You may request an extension of the time period, but regular benefits will resume if we do not approve your request.
- Our decision to offer or withdraw alternative benefits is not subject to OPM review under the disputed claims process.
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| Travel benefit/services overseas |
For covered services rendered by a hospital or by a doctor outside the United States and Puerto Rico, the Plan will pay eligible charges at PPO benefit levels, limited to the Plans allowance established for the Washington, D.C. Metropolitan area. The member is responsible for the difference between the Plans allowance and the providers charge. See page 63, Section 7. Filing a claim for covered services.
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| Services for deaf and hearing impaired |
SAMBA has a TDD line for the hearing-impaired: 301/984-4155 (TDD equipment is needed).
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| Online Resources |
Visit our web site at www.SambaPlans.com to view your claim history, order prescription refills and have access to many health resources, such as:
- a Hospital Quality Ratings Guide and Treatment Cost Estimator tool,
- an electronic Health Library to obtain information about a specific disease or medical condition,
- a Health Assessment to help you determine what medical conditions you are at risk for due to personal habits, family history, etc. and what to do to reduce the chances of getting these conditions,
- preventive care tips, and
- tools to quit smoking, lose weight and live a healthier life.
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| Healthy Rewards Program |
SAMBA members can participate in the CIGNA/CareAllies Healthy Rewards Program. This Program provides access to discounts on treatments and items not covered under the Plan. For example, you could obtain discounts as high as 25% - 50% on services such as Lasik surgery, cosmetic items, massage therapy, and fitness memberships.
Visit www.SambaPlans.com for more information.
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