Coventry Health Care www.chcde.com 1-800-833-7423 2013 A Health Maintenance Organization (high and standard option) with a high deductible health plan option Serving: All of Maryland IMPORTANT Enrollment in this Plan is limited. You must live or work in the • Rates: Back Cover State of Maryland. See page 12 for requirements • Changes for 2013: Page 13 • Summary of benefits: Page 125 Maryland: IG1 High Option – Self Only IG2 High Option – Self and Family IG4 Standard Option – Self Only IG5 Standard Option – Self and Family GZ1 HDHP Option – Self Only GZ2 HDHP Option – Self and Family RI 73-836 Important Notice from Coventry Health Care About Our Prescription Drug Coverage and Medicare OPM has determined that the Coventry Health Care prescription drug coverage is, on average, comparable to Medicare Part D prescription drug coverage; thus you do not need to enroll in Medicare Part D and pay extra for prescription drug benefits. If you decide to enroll in Medicare Part D later, you will not have to pay a penalty for late enrollment as long as you keep your FEHB coverage. However, if you choose to enroll in Medicare Part D, you can keep your FEHB coverage and will coordinate benefits with Medicare. Remember: If you are an annuitant and you cancel your FEHB coverage, you may not re-enroll in the FEHB Program. Please be advised If you lose or drop your FEHB coverage and go 63 days or longer without prescription drug coverage that’s as least as good as Medicare’s prescription drug coverage, your monthly premium will go up a least 1% per month for every month that you did not have that coverage. For example, if you go 19 months without Medicare Part D prescription drug coverage, your premium will always be at least 19 percent higher than what many other people pay. You’ll have to pay this higher premium as long as you have Medicare prescription drug coverage. In addition, you may have to wait until the Annual Coordinated Election Period (October 15th through December 7th) to enroll in Medicare Part D. Medicare’s Low Income Benefits For people with limited income and resources, extra help paying for a Medicare prescription drug plan is available. Information regarding this program is available through the Social Security Administration (SSA) online at www. socialsecurity.gov, or call the SSA at 1-800-772-1213 (TTY 1-800-325-0778). You can get more information about Medicare prescription drug plans and the coverage offered in your area from these places: • Visit www.medicare.gov for personalized help. • Call 1-800-MEDICARE (1-800-633-4227), (TTY 1-877-486-2048). Table of Contents Table of Contents ..........................................................................................................................................................................1 Introduction ...................................................................................................................................................................................3 Plain Language ..............................................................................................................................................................................3 Stop Health Care Fraud! ...............................................................................................................................................................3 Preventing Medical Mistakes ........................................................................................................................................................4 FEHB Facts ...................................................................................................................................................................................7 Coverage information .........................................................................................................................................................7 • No pre-existing condition limitation ...............................................................................................................................7 • Where you can get information about enrolling in the FEHB Program .........................................................................7 • Types of coverage available for you and your family ....................................................................................................7 • Family member coverage ...............................................................................................................................................8 • Children’s Equity Act .....................................................................................................................................................8 • When benefits and premiums start .................................................................................................................................9 • When you retire ..............................................................................................................................................................9 When you lose benefits .......................................................................................................................................................8 • When FEHB coverage ends ............................................................................................................................................9 • Upon divorce ..................................................................................................................................................................9 • Temporary Continuation of Coverage (TCC) ...............................................................................................................10 • Converting to individual coverage ...............................................................................................................................10 • Getting a Certificate of Group Health Plan Coverage ..................................................................................................10 Section 1. How this plan works ...................................................................................................................................................11 General features of our High and Standard Options .........................................................................................................11 How we pay providers ......................................................................................................................................................11 General features of our High Deductible Health Plan ......................................................................................................11 Your rights .........................................................................................................................................................................12 Your medical and claims records are confidential ............................................................................................................12 Service Area ......................................................................................................................................................................12 Section 2. Changes for 2013 .......................................................................................................................................................13 Changes to this Plan ..........................................................................................................................................................13 Section 3. How you get care .......................................................................................................................................................14 Identification cards ............................................................................................................................................................14 Where you get covered care ..............................................................................................................................................14 • Network providers and facilities ...................................................................................................................................14 • Out-of-network providers and facilities .......................................................................................................................15 What you must do to get covered care ..............................................................................................................................15 • Primary care ..................................................................................................................................................................15 • Specialty care ................................................................................................................................................................15 • Hospital care .................................................................................................................................................................16 If you are hospitalized when your enrollment begins .......................................................................................................16 Other services ....................................................................................................................................................................17 • You need prior Plan approval for certain services