Pages 1--64 from Rural Letter Carriers Benefit Plan

To become a member: For information on how to become a member of the National Rural Letter Carriers' Association, please contact the Secretary for your State Association or the membership office
of the National Rural Letter Carriers' Association.

Membership dues: Active and retired Postal Service membership dues vary by state.
Enrollment codes for this Plan: 381 High Option -Self Only
382 High Option -Self and Family

Mutual of Omaha Insurance Company, the underwriter for the RURAL CARRIER
BENEFIT PLAN has received accreditation from URAC (also known as the American Accreditation
Healthcare Commission), for Health Utilization Manage-ment Standards. See the 2002 Guide for more informa-tion
on accreditation.

For changes
in benefits see page 6. 1
1 Page 2 3

Introduction ............................................................................................................................................................................................... 4
Plain Language ......................................................................................................................................................................................... 4
Inspector General Advisory ....................................................................................................................................................................... 4
Section 1. Facts about this fee-for-service plan ...................................................................................................................................... 5
Section 2. How we change for 2002 ........................................................................................................................................................ 6
Section 3. How you get care ............................................................................................................................................................... 7-10
Identification cards ................................................................................................................................................................. 7
Where you get covered care ................................................................................................................................................. 7-8
Covered providers .............................................................................................................................................................. 7
Covered facilities ............................................................................................................................................................... 8
What you must do to get covered care ................................................................................................................................ 8-9
How to get approval for ...................................................................................................................................................... 9-10
Your hospital stay (precertification) ............................................................................................................................. 9-10
Other services .................................................................................................................................................................. 10
Section 4. Your costs for covered services ......................................................................................................................................... 11-14
Copayments ..................................................................................................................................................................... 11
Deductible ......................................................................................................................................................................... 11
Coinsurance ...................................................................................................................................................................... 11
Differences between our allowance and the bill ......................................................................................................... 11-12
Your catastrophic protection out-of-pocket maximum .......................................................................................................... 12
When government facilities bill us ....................................................................................................................................... 12
If we overpay you ................................................................................................................................................................. 12
When you are age 65 or over and you do not have Medicare .............................................................................................. 13
When you have Medicare ...................................................................................................................................................... 14
Section 5. Benefits ............................................................................................................................................................................. 15-43
Overview ............................................................................................................................................................................... 15
(a) Medical services and supplies provided by physicians and other health care professionals ..................................... 16-23
(b) Surgical and anesthesia services provided by physicians and other health care professionals .................................. 24-27
(c) Services provided by a hospital or other facility, and ambulance services ................................................................ 28-30
(d) Emergency services/ accidents ........................................................................................................................................ 31
(e) Mental health and substance abuse benefits ............................................................................................................... 32-36
(f) Prescription drug benefits ........................................................................................................................................... 37-39
(g) Special features ............................................................................................................................................................... 40
Flexible benefits option Kidney dialysis benefit Centers of excellence for transplants/ special surgery
24 hour nurse line Routine eye exam benefit Travel benefit/ overseas services
Cancer treatment benefit

Table of Contents

2002 Rural Carrier Benefit Plan 2 Table of Contents 2
2 Page 3 4

2002 Rural Carrier Benefit Plan 3 Table of Contents
(h) Dental benefits ........................................................................................................................................................ 41-42
(i) Non-FEHB benefits available to Plan members ........................................................................................................... 43
Section 6. General exclusions things we don't cover ...................................................................................................................... 44
Section 7. Filing a claim for covered services ............................................................................................................................... 45-46
Section 8. The disputed claims process .......................................................................................................................................... 47-48
Section 9. Coordinating benefits with other coverage .................................................................................................................... 49-53
When you have other health coverage ................................................................................................................................ 49
Original Medicare .......................................................................................................................................................... 49-51
Medicare managed care plan ............................................................................................................................................... 52
TRICARE/ Workers Compensation/ Medicaid ................................................................................................................ 52-53
When other Government agencies are responsible for your care ........................................................................................ 53
When others are responsible for injuries ............................................................................................................................. 53
Section 10. Definitions of terms we use in this brochure ................................................................................................................. 54-55
Section 11. FEHB facts ..................................................................................................................................................................... 56-58
Coverage information ..................................................................................................................................................... 56-57
No pre-existing condition limitation .............................................................................................................................. 56
Where you get information about enrolling in the FEHB Program .............................................................................. 56
Types of coverage available for you and your family ................................................................................................... 56
When benefits and premiums start ................................................................................................................................ 56
Your medical and claims records are confidential ......................................................................................................... 57
When you retire .............................................................................................................................................................. 57
When you lose benefits ................................................................................................................................................. 57-58
When FEHB coverage ends ........................................................................................................................................... 57
Spouse equity coverage ................................................................................................................................................. 57
Temporary Continuation of Coverage (TCC) ................................................................................................................ 57
Converting to individual coverage ................................................................................................................................. 58
Getting a Certificate of Group Health Plan Coverage ................................................................................................... 58
Long term care insurance is coming later in 2002 ................................................................................................................................. 59
INDEX..................................................................................................................................................................................................... 60
Summary of High Option benefits ..................................................................................................................................................... 61-62
Rates .......................................................................................................................................................................................... Back cover 3
3 Page 4 5
2002 Rural Carrier Benefit Plan 4 Introduction/ Plain Language/ Advisory
Introduction
Rural Carrier Benefit Plan 1630 Duke Street, First Floor
Alexandria, VA 22314-3466
This brochure describes the benefits of the Rural Carrier Benefit Plan under our contract (CS 1073) 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.
If you are enrolled in this Plan, you are 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, 2002, unless those benefits are also shown in this brochure.
OPM negotiates benefits and rates with each plan annually. Benefit changes are effective January 1, 2002, and changes are summarized on page 6. Rates are shown at the end of this brochure.

Plain Language
Teams of Government and health plans' staff worked on all FEHB brochures to make them responsive, accessible, and understandable to the public. For instance,

Except for necessary technical terms, we use common words. "You" means the enrollee or family member; "we" means the Rural Carrier Benefit Plan.
We limit acronyms to ones you know. FEHB is the Federal Employees Health Benefits Program. OPM is the Office of Personnel Management. If we use others, we tell you what they mean first.
Our brochure and other FEHB plans' brochures have the same format and similar descriptions to help you compare plans.
If you have comments or suggestions about how to improve the structure of 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. You may also write to OPM at the Office of
Personnel Management, Office of Insurance Planning and Evaluation Division, 1900 E Street, NW, Washington, DC 20415-3650.

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 misrepresented 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 1-800/ 638-8432 and explain the situation.

If we do not resolve the issue, call or write
THE HEALTH CARE FRAUD HOTLINE 202/ 418-3300

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. 4
4 Page 5 6
2002 Rural Carrier Benefit Plan 5 Section 1
Section 1. Facts about this fee-for-service plan
This Plan is a fee-for-service (FFS) plan. You can choose your own physicians, hospitals, and other health care providers.

We reimburse you or your provider for your covered services, usually based on a percentage of the amount we allow. The type and extent of covered services, and the amount we allow, may be different from other plans. Read brochures carefully.

We also have Preferred Provider Organizations (PPO):
Our fee-for-service plan offers services through a PPO. When you use our PPO providers, you will receive covered services at reduced cost. Contact us at 1-800/ 638-8432 or the Mutual of Omaha website, www.mutualofomaha.com for the names of PPO providers and to
verify their continued participation. You can also go to our web page, which you can reach through the FEHB web site, www.opm.gov/ insure. Do not call OPM or your agency for our provider directory.

The non-PPO benefits are the standard benefits of this Plan. PPO benefits apply only when you use a PPO provider. Provider networks may be more extensive in some areas than others. We cannot guarantee the availability of every specialty in all areas. If no PPO
provider is available, or you do not use a PPO provider, the standard non-PPO benefits apply. When you use a PPO hospital, keep in mind that the health care professionals who provide services to you in the hospital, such as radiologists, emergency room physicians,
anesthesiologists, and pathologists, may not all be preferred providers. If they are not, we will pay them as non-PPO providers. The Plan has PPO networks in all states except for Hawaii, Vermont and Wyoming.

How we pay providers
We generally reimburse participating providers according to an agreed-upon fee schedule and we do not offer additional financial incentives based on care provided or not provided to you. Our standard provider agreements do not contain any incentives to restrict a
provider's ability to communicate with or advise you of any appropriate treatment options. In addition, we have no compensation agreement, ownership, or other influential interests that are likely to affect provider advice or treatment decisions.

Your Rights
OPM requires that all FEHB Plans to provide certain information to their FEHB members. You may get information about us, our networks, our providers, and facilities. OPM's FEHB website (www.opm.gov/insure) lists the specific types of information that we
must make available to you. Some of the required information is listed below.
Years in existence
Profit status
If you want more information about us, call 1-800/ 638-8432 or write to Rural Carrier Benefit Plan, 1630 Duke Street, First Floor, Alexandria, VA 22314-3466. You may also contact us by fax at 1-703/ 684-9627 or visit our website at www. nrlca. org 5
5 Page 6 7
2002 Rural Carrier Benefit Plan 6 Section 2
Section 2. How we change for 2002
Do not rely on these change descriptions; this page 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
We changed the address for sending disputed claims to OPM. (Section 8)
The following four states have been added to the list of medically underserved states for 2002: Georgia, Montana, North Dakota and Texas. Louisiana has been removed from the list of medically underserved states for 2002.

Changes to this Plan
Your share of the non-Postal premium will increase by 18.4% for Self Only or 17.1% for Self and Family.
We clarified the brochure to better explain that the non-PPO benefits are the standard benefits of this Plan, that PPO benefits apply only when you use a PPO provider, and that when no PPO provider is available, non-PPO benefits apply.

We no longer limit total blood cholesterol tests to certain age groups (Section 5( a)).
We now cover certain intestinal transplants (Section 5( b)).
We changed speech therapy benefits by removing the requirement that services must be required to restore functional speech (Section 5( a)).

We clarified the Family planning and Infertility benefits by providing more examples of covered and not covered benefits (Section 5( a)).
We clarified Surgical procedures to show that we cover a comprehensive range of services, such as operative procedures (Section 5( b)).
We increased the Plan's calendar year deductible from $250 per person ($ 500 per family) to $350 per person ($ 700 per family).
We changed the deductible for a stay in a non-PPO hospital from $200 for the first admission each calendar year to $200 for each hospital admission.

We increased the out-of-pocket (catastrophic protection) limits for the Plan from $2,000 per person, $2,500 per family for PPO services to $2,500 per person, $3,000 per family. For non-PPO services, we increased the limits from $2,500 per person, $3,000 per
family to $3,000 per person, $3,500 per family.
We now provide benefits for one routine mammogram each calendar year for women beginning at age 35.
We now pay for up to 90 visits each calendar year for speech therapy, physical therapy and occupational therapy combined.
We changed what you pay for physical therapy provided by a PPO physician in his/ her office from $15 per visit to 15% of the Plan allowance after the calendar year deductible ($ 350).

We removed the five-day limit for initial and follow-up care under our Accidental injury benefit.
We changed our Accidental dental injury benefit. We removed the time limits for care as long as you remain covered by the Plan. We now pay for care that you receive for an accidental dental injury just like any other illness at the same coinsurance levels with

no deductible.
We changed our smoking cessation benefit to pay for office visits and prescription drugs the same as for any other illness. There is no limit on the number of office visits or the cost of prescription drugs for smoking cessation. 6
6 Page 7 8
2002 Rural Carrier Benefit Plan 7 Section 3
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 fill 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
confirmation (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 1-800/ 638-8432.

Where you get covered care You can get care from any "covered provider" or "covered facility." How much we pay and you pay depends on the type of covered provider or facility you use. If you use our
preferred providers, you will pay less.
Covered providers We consider the following to be covered providers when they perform services within the scope of their license or certification:

Physician: A doctor of medicine (M. D.), osteopathy (D. O.), dental surgery (D. D. S.), medical dentistry (D. M. D.), podiatric medicine (D. P. M.), chiropractic (D. C.), and
optometry (O. D.), when acting within the scope of his/ her license or certification.
Qualified Clinical Psychologist: An individual who has earned either a Doctoral or Masters Clinical Degree in psychology or an allied discipline and who is licensed or

certified in the state where services are performed. This presumes a licensed individual has demonstrated to the satisfaction of state licensing officials that he/ she by virtue of
academic and clinical experience is qualified to provide psychological services in that state.

Nurse Midwife: A person who is certified by the American College of Nurse Midwives or is licensed or certified as a nurse midwife in states requiring licensure or certification.
Nurse Practitioner/ Clinical Specialist: A person who: 1) has an active R. N. license in the United States; 2) has a baccalaureate or higher degree in nursing; and 3) is licensed
or certified as a nurse practitioner or clinical nurse specialist in states requiring licensure or certification.

Clinical Social Worker: A social worker who: 1) has a master's or doctoral degree in social work; 2) has at least two years of clinical social work practice; and 3) in states
requiring licensure, certification, or registration, is licensed, certified, or registered as a social worker where the services are rendered.

Nursing School Administered Clinic: A clinic that is: 1) licensed or certified in the state where the services are performed; and 2) provides ambulatory care in an
outpatient setting primarily in rural or inner-city areas where there is a shortage of physicians. Services billed for by these clinics are considered outpatient 'office'
services rather than facility charges.
Physician Assistant: A person who is licensed, registered, or certified in the state where services are performed.

Licensed Professional Counselor or Master's Level Counselor: A person who is licensed, registered, or certified in the state where services are performed.
For the purposes of the FEHB brochure, the term "physician" includes all of these providers when the services are performed within the scope of their license or
certification.
Medically underserved areas. Note: We cover any licensed medical practitioner for any covered service performed within the scope of that license in states OPM determines are
"medically underserved." For 2002, the states are: Alabama, Georgia, Idaho, Kentucky, Mississippi, Missouri, Montana, New Mexico, North Dakota, South Carolina, South
Dakota, Texas, Utah, and Wyoming. 7
7 Page 8 9
2002 Rural Carrier Benefit Plan 8 Section 3
Covered facilities Covered facilities include:
Birthing Center: A licensed facility that is equipped and operated solely to provide prenatal care, to perform uncomplicated spontaneous deliveries, and to provide
immediate post-partum care.
Hospice: A public or private agency or organization that:
Administers and provides hospice care; and
Meets one of the following requirements:
Is licensed or certified as a hospice by the State in which it is located;
Is certified (or is qualified and could be certified) to participate as a hospice under Medicare;

Is accredited as a hospice by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO); or
Meets the standards established by the National Hospice Organization.
Hospital:
An institution that is accredited as a hospital under the hospital accreditation program of the JCAHO; or

Any other institution that is operated pursuant to law, under the supervision of a staff of doctors and with 24-hour-a-day nursing service, and that is primarily
engaged in providing:
General inpatient care and treatment of sick and injured persons through medical, diagnostic, and major surgical facilities, all of which facilities must

be provided on it premises or under its control; or
Specialized inpatient medical care and treatment of sick or injured persons through medical and diagnostic facilities (including x-ray and laboratory) on its

premises, under its control, or through a written agreement with a hospital (as defined above) or with a specialized provider of those facilities.

In no event shall the term hospital include a convalescent nursing home or institution or part thereof that:
Is used principally as a convalescent facility, rest facility, nursing facility, or facility for the aged;
Furnishes primarily domiciliary or custodial care, including training in the routines of daily living; or
Is operated as a school.
Skilled Nursing Facility: An institution or that part of an institution that provides convalescent skilled nursing care 24 hours a day and is certified (or is qualified and
could be certified) as a skilled nursing facility under Medicare.

What you must do to It depends on the kind of care you want to receive. You can go to any provider you want, get covered care but we must approve some care in advance.
Transitional care: Specialty care: If you have a chronic or disabling condition and
lose access to your specialist because we drop out of the Federal Employees Health Benefits (FEHB) Program and you enroll in another FEHB Plan, or

lose access to your PPO specialist because we terminate our contract with your specialist for other than cause 8
8 Page 9 10
2002 Rural Carrier Benefit Plan 9 Section 3
you may be able to continue seeing your specialist and receiving any PPO benefits 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 and
any PPO benefits continue until the end of your postpartum care, even if it is beyond the 90 days.

Hospital care: We pay for covered services from the effective date of your enrollment. However, if you are in the hospital when your enrollment in our Plan begins, call our customer service
department immediately at 1-800/ 638-8432.
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 92nd day after you become a member of this Plan, whichever happens first.
These provisions apply only to the benefits of the hospitalized person.

How to Get Approval for
Your hospital stay Precertification is the process by which -prior to your inpatient hospital admission -we evaluate the medical necessity of your proposed stay and the number of days
required to treat your condition. Unless we are misled by the information given to us, we won't change our decision on medical necessity.

In most cases, your physician or hospital will take care of precertification. Because you are still responsible for ensuring that we are asked to precertify your care, you should
always ask your physician or hospital whether they have contacted us.
Warning: We will reduce our benefits for the inpatient hospital stay by $500 if no one contacts us for precertification. If the stay is not medically necessary, we will not pay any benefits.

How to precertify an admission: You, your representative, your physician, or your hospital must call us at 1-800/ 228-0286 at least seven days before admission.
If you have an emergency admission due to a condition that you reasonably believe puts your life in danger or could cause serious damage to bodily function, you, your
representative, the physician, or the hospital must telephone us within two business days following the day of the emergency admission, even if you have been discharged
from the hospital.
Provide the following information:
Enrollee's name and Plan identification number;
Patient's name, birth date, and phone number;
Reason for hospitalization, proposed treatment, or surgery;
Name and phone number of admitting physician;
Name of hospital or facility; and
Number of planned days of the hospital stay. 9
9 Page 10 11
2002 Rural Carrier Benefit Plan 10 Section 3
We will then tell your physician and/ or hospital the number of approved inpatient days and we will send written confirmation of our decision to you, your physician,
and the hospital.
Maternity care You do not need to precertify a maternity admission for a routine delivery. However, if your medical condition requires you to stay more than 48 hours after a vaginal delivery or
96 hours after a cesarean section, then your physician or the hospital must contact us for precertification of additional days. Further, if your baby stays after you are discharged,
then your physician or the hospital must contact us for precertification of additional days for your baby.

If your hospital stay If your hospital stay including for maternity care needs to be extended, you, your needs to be extended: representative, your physician or the hospital must ask us to approve the additional days.

What happens when you When we precertified the admission but you remained in the hospital beyond the do not follow the number of days we approved and did not get the additional days precertified, then:
precertification rules for the part of the admission that was medically necessary, we will pay inpatient
benefits, but
for the part of the admission that was not medically necessary, we will pay only medical services and supplies otherwise payable on an outpatient basis and will
not pay inpatient benefits.

If no one contacted us, we will decide whether the hospital stay was medically necessary.

If we determine that the stay was medically necessary, we will pay the inpatient charges, less the $500 penalty.
If we determine that it was not medically necessary for you to be an inpatient, we will not pay inpatient hospital benefits. We will only pay for any covered
medical supplies and services that are otherwise payable on an outpatient basis.

If we denied the precertification request, we will not pay inpatient hospital benefits. We will only pay for any covered medical supplies and services that are otherwise
payable on an outpatient basis.

Exceptions: You do not need precertification in these cases:
You are admitted to a hospital outside the United States.
You have another group health insurance policy that is the primary payer for the hospital stay.

Your Medicare Part A is the primary payer for the hospital stay. Note: If you exhaust your Medicare hospital benefits and do not want to use your Medicare
lifetime reserve days, then we will become the primary payer and you do need precertification.

Other services Some services require a referral, precertification, or prior authorization.
Home health care
Hospice care
Skilled nursing care
Outpatient mental health and substance abuse care 10
10 Page 11 12
2002 Rural Carrier Benefit Plan 11 Section 4
Section 4. Your costs for covered services
This is what you will pay out-of-pocket for your covered care:

Copayments A copayment is a fixed amount of money you pay to the provider, facility, pharmacy, etc. when you receive services.

Example: When you see your PPO physician you pay a copayment of $15 per visit and when you go in the hospital, you pay $200 per admission.

Deductible A deductible is a fixed amount of covered expenses you must incur for certain covered services and supplies before we start paying benefits for them. Copayments do not count
toward any deductible.
The calendar year deductible is $350 per person under High Option. Under a family enrollment, the deductible is satisfied for all family members when the combined

covered expenses applied to the calendar year deductible for family members reach $700 under High Option.

We also have separate deductibles for: hospital stays$ 200 per admission; dental care$ 50 per person each calendar year.
Note: If you change plans during open season, you do not have to start a new deductible under your old plan between January 1 and the effective date of your new plan. If you
change plans at another time during the year, you must begin a new deductible under your new plan.

Coinsurance Coinsurance is the percentage of our allowance that you must pay for your care. Coinsurance doesn't begin until you meet your deductible.
Example: You pay 25% of our allowance for office visits under our non-PPO benefit.
Note: If your provider routinely waives (does not require you to pay) your copayments, deductibles, or coinsurance, the provider is misstating the fee and may be violating the

law. In this case, when we calculate our share, we will reduce the provider's fee by the amount waived.

For example, if your physician ordinarily charges $100 for a service but routinely waives your 25% coinsurance, the actual charge is $75. We will pay $56.25 (75% of the actual
charge of $75).

Differences between Our "Plan allowance" is the amount we use to calculate our payment for covered services. our allowance and Fee-for-service plans arrive at their allowances in different ways, so their allowances
the bill vary. For more information about how we determine our Plan allowance, see the definition of Plan allowance in Section 10.

Often, the provider's bill is more than a fee-for-service plan's allowance. Whether or not you have to pay the difference between our allowance and the bill will depend on the
provider you use.
PPO providers agree to limit what they will bill you. Because of that, when you use a preferred provider, your share of covered charges consists only of your

deductible and coinsurance or copayment. Here is an example about coinsurance: You see a PPO physician who charges $150, but our allowance is $100. If you have
met your deductible, you are only responsible for your coinsurance. That is, you pay just 10% of our $100 allowance ($ 10). Because of the agreement, your PPO
physician will not bill you for the $50 difference between our allowance and his bill. 11
11 Page 12 13
2002 Rural Carrier Benefit Plan 12 Section 4
Non-PPO providers, on the other hand, have no agreement to limit what they will bill you. When you use a non-PPO provider, you will pay your deductible and
coinsurance plus any difference between our allowance and charges on the bill. Here is an example: You see a non-PPO physician who charges $150 and our
allowance is again $100. Because you've met your deductible, you are responsible for your coinsurance, so you pay 25% of our $100 allowance ($ 25). Plus, because
there is no agreement between the non-PPO physician and us, he can bill you for the $50 difference between our allowance and his bill.

The following table illustrates the examples of how much you have to pay out-of-pocket for services from a PPO physician vs. a non-PPO physician. The table uses our
example of a service for which the physician charges $150 and our allowance is $100. The table shows the amount you pay if you have met your calendar year deductible.

EXAMPLE PPO physician Non-PPO physician
Physician's charge $150 $150
Our allowance We set it at: 100 We set it at: 100
We pay 85% of our allowance: 85 75% of our allowance: 75
You owe: Coinsurance 10% of our allowance: 15 25% of our allowance: 25

+Difference up to charge? No: 0 Yes: 50
TOTAL YOU PAY $15 $75

Your catastrophic protection For those benefits where coinsurance or deductibles applies, we pay 100% of the Plan out-of-pocket maximum for allowance for the rest of the calendar year after your expenses total to:
deductibles, coinsurance, and copayments $2,500 per person or $3,000 per family when you use PPO providers/ facilities, or
$3,000 per person or $3,500 per family when you use PPO and non-PPO providers/ facilities combined.

Your out-of-pocket maximum does not include the following:
Copayments,
Expenses for prescription medications you order from our mail order drug program,
Expenses for dental care,
Expenses in excess of our allowances or maximum benefit limits,
Expenses for a stay in a skilled nursing facility,
Any amount you pay for failing to get approval for a hospital stay or the continuation of a hospital stay,

Any amount you pay for failing to get approval for outpatient mental health/ substance abuse care,
Any amount you pay for not following an approved mental health/ substance abuse treatment plan, and
Expenses you pay for services, supplies and drugs not covered by us.
When government facilities Facilities of the Department of Veterans Affairs, the Department of Defense, and the bill us Indian Health Service are entitled to seek reimbursement from us for certain services and
supplies they provide to you or a family member. They may not seek more than their governing laws allow.

If we overpay you We will make diligent efforts to recover benefit payments we made in error but in good faith. We may reduce subsequent benefit payments to offset overpayments. 12
12 Page 13 14
2002 Rural Carrier Benefit Plan 13 Section 4
When you are age 65 or over and you do not have Medicare
Under the FEHB law, we must limit our payments for those benefits you would be entitled to if you had Medicare. And, your physician and hospital must follow Medicare rules and cannot bill you for more than they could bill you if you had Medicare. The

following chart has more information about the limits.

If you
are age 65 or over, and
do not have Medicare Part A, Part B, or both; and
have this Plan as an annuitant or as a former spouse, or as a family member of an annuitant or former spouse; and
are not employed in a position that gives FEHB coverage. (Your employing office can tell you if this applies.)

Then, for your inpatient hospital care,
the law requires us to base our payment on an amount the "equivalent Medicare amount" set by Medicare's rules for what Medicare would pay, not on the actual charge;

you are responsible for your applicable deductibles, coinsurance, or copayments you owe under this Plan;
you are not responsible for any charges greater than the equivalent Medicare amount; we will show that amount on the explanation of benefits (EOB) form that we send you; and

the law prohibits a hospital from collecting more than the Medicare equivalent amount.

And, for your physician care, the law requires us to base our payment and your coinsurance on
an amount set by Medicare and called the "Medicare approved amount," or
the actual charge if it is lower than the Medicare approved amount.

If your physician Then you are responsible for
Participates with Medicare or accepts your deductibles, coinsurance, and copayments; Medicare assignment for the claim and is

a member of our PPO network,
Participates with Medicare and is not in your deductibles, coinsurance, copayments, our PPO network, and any balance up to the Medicare approved amount;

Does not participate with Medicare, your deductibles, coinsurance, copayments, and any balance up to 115% of the Medicare approved amount

It is generally to your financial advantage to use a physician who participates with Medicare. Such physicians are permitted to collect only up to the Medicare approved amount.
Our explanation of benefits (EOB) form will tell you how much the physician or hospital can collect from you. If your physician or hospital tries to collect more than allowed by law, ask the physician or hospital to reduce the charges. If you have paid more
than allowed, ask for a refund. If you need further assistance, call us. 13
13 Page 14 15
2002 Rural Carrier Benefit Plan 14 Section 4
When you have the Original We limit our payment to an amount that supplements the benefits that Medicare would Medicare Plan (Part A, Part B, pay under Medicare Part A (Hospital insurance) and Medicare Part B (Medical
or both) insurance), regardless of whether Medicare pays. Note: We pay our regular benefits for emergency services to an institutional provider, such as a hospital, that does not
participate with Medicare and is not reimbursed by Medicare.

If you are covered by Medicare Part B and it is primary, your out-of-pocket costs for services that both Medicare Part B and we cover depend on whether your physician
accepts Medicare assignment for the claim.
If your physician accepts Medicare assignment, then you pay nothing for covered charges.

If your physician does not accept Medicare assignment, then you pay the difference between our payment combined with Medicare's payment and the charge.

Note: The physician who does not accept Medicare assignment may not bill you for more than 115% of the amount Medicare bases its payment on, called the "limiting
charge." The Medicare Summary Notice (MSN) that Medicare will send you will have more information about the limiting charge. If your physician tries to collect more than
allowed by law, ask the physician to reduce the charges. If the physician does not, report the physician to your Medicare carrier who sent you the MSN form. Call us if
you need further assistance.

When you have a Medicare A physician may ask you to sign a private contract agreeing that you can be billed Private Contract with a physician directly for services Medicare ordinarily covers. Should you sign an agreement,
Medicare will not pay any portion of the charges, and we will not increase our payment. We will still limit our payment to the amount we would have paid after
Medicare's payment.
Please see Section 9, Coordinating benefits with other coverage, for more information about how we coordinate benefits with Medicare. 14
14 Page 15 16
2002 Rural Carrier Benefit Plan 15 Section 5
Section 5. Benefits OVERVIEW
(See page 6 for how our benefits changed this year and pages 61-62 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 1-800/ 638-8432 or at our website at www.nrlca. org

(a) Medical services and supplies provided by physicians and other health care professionals .................................................... 16-23
Diagnostic and treatment services Speech therapy Lab, X-ray, and other diagnostic tests Hearing services (testing, treatment, and supplies)

Preventive care, adult Vision services (testing, treatment, and supplies) Preventive care, children Foot care
Maternity care Orthopedic and prosthetic devices Family planning Durable medical equipment (DME)
Infertility services Home health services Allergy care Chiropractic
Treatment therapies Alternative treatments Physical and occupational therapy Educational classes and programs

(b) Surgical and anesthesia services provided by physicians and other health care professionals ................................................ 24-27
Surgical procedures Organ/ tissue transplants Reconstructive surgery Anesthesia

Oral and maxillofacial surgery

(c) Services provided by a hospital or other facility, and ambulance services................................................................................. 28-30
Inpatient hospital Hospice care Outpatient hospital or ambulatory surgical center Ambulance

Extended care benefits/ Skilled nursing care facility benefits

(d) Emergency services/ Accidents .......................................................................................................................................................... 31
Accidental injury Ambulance

(e) Mental health and substance abuse benefits ............................................................................................................................... 32-36
(f) Prescription drug benefits ............................................................................................................................................................ 37-39
(g) Special features .................................................................................................................................................................................. 40
Flexible benefits option Kidney dialysis benefit 24 hour nurse line Routine eye exam benefit

Cancer treatment benefit Centers of excellence for transplants/ surgery Travel benefit/ overseas services
Kidney dialysis benefit
(h) Dental benefits ............................................................................................................................................................................. 41-42
(i) Non-FEHB benefits available to Plan members ............................................................................................................................... 43
SUMMARY OF BENEFITS................................................................................................................................................................ 61-62 15
15 Page 16 17
2002 Rural Carrier Benefit Plan 16 Section 5 (a)
Here are some important things you should 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.

The calendar year deductible is: $350 per person ($ 700 per family). The calendar year deductible applies to almost all benefits in this Section. We added "( No deductible)" to
show when the calendar year deductible does not apply.
The non-PPO benefits are the standard benefits of this plan. PPO benefits apply only when you use a PPO provider. When no PPO provider is available, non-PPO benefits apply.

Be sure to read Section 4, Your costs for covered services for valuable information about how cost sharing works, with special sections for members who are age 65 or over. Also
read Section 9 about coordinating benefits with other coverage, including with Medicare.

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Section 5 (a). Medical services and supplies provided by physicians and other health care professionals

Benefit Description You pay After the calendar year deductible
NOTE: The calendar year deductible applies to almost all benefits in this Section. We say "( No deductible)" when it does not apply.
Diagnostic and treatment services
Professional services of physicians (not including surgery)
In a physician's office
In an urgent care center
Office medical consultations
Second surgical opinion
One routine physical exam per person each calendar year

Note: We pay for surgery services by a physician under Surgical services Section 5( b).

Professional services of physicians (not including surgery)
During a hospital stay
In a skilled nursing facility
Initial examination of a newborn child covered under a family enrollment
At home
Note: We pay for surgery services by a physician under Surgical services Section 5( b).

PPO: 15% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount

PPO: $15 copayment (No deductible)
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount 16
16 Page 17 18
2002 Rural Carrier Benefit Plan 17 Section 5 (a)
Lab, X-ray and other diagnostic tests You pay
Tests, such as:
Blood tests
Urinalysis
Non-routine pap tests
Pathology
X-rays
Non-routine Mammograms
CAT Scans/ MRI
Ultrasound
Electrocardiogram and EEG

Note: We consider lab, x-ray and other diagnostic tests you receive in a physician's office during an office visit under Diagnostic and treatment

services on page 16.

Preventive care, adult
Routine screenings, limited to:
Sigmoidoscopy, screening -every five years starting at age 50
Annual coverage of one fecal occult blood test for members age 40 and older.

Prostate Specific Antigen (PSA test) -one annually for men age 40 and older.
Chlamydial infection
One routine pap test per calendar year
Routine mammogram -one annually for women age 35 and older

Not covered: All charges.
Adult immunizations

Preventive care, children
Childhood immunizations recommended by the American Academy of Pediatrics for dependent children under age 22.

Note: Associated charged for office visits and other services are considered under Diagnostic and treatment services on page 16.

PPO: 15% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount
Note: If your PPO provider uses a non-PPO lab or radiologist, we will pay
non-PPO benefits for any lab and X-ray charges.

PPO: 15% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount

PPO: Nothing (No deductible)
Non-PPO: Nothing up to Plan allowance then any difference between our allowance
and the billed amount (No deductible) 17
17 Page 18 19
2002 Rural Carrier Benefit Plan 18 Section 5 (a)
Maternity care You pay
Complete maternity (obstetrical) care, such as:
Delivery

Note: Here are some things to keep in mind:
You do not need to precertify your normal delivery; see page 10 for other circumstances, such as extended stays for you or your baby.

You may remain in the hospital up to 48 hours after a regular delivery and 96 hours after a cesarean delivery. We will cover an extended stay,
if medically necessary, but you, your representative, your physician or your hospital must precertify.

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 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: All charges.
Procedures, services, drugs, and 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 and supplies related to treatment of impotency.
Family planning
A broad range of voluntary family planning services, including:
Voluntary sterilization
Surgical implant of contraceptive drugs (such as Norplant)
Injection of contraceptive drugs (such as Depo provera)
Fitting, inserting or removing intrauterine devices (such as diaphragms or IUDs)

Note: We cover contraceptive drugs and devices under Prescription drug benefits, Section 5( f).

Not Covered: All charges.
Reversal of voluntary surgical sterilization
Genetic counseling

PPO: 15% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount
Note: If your child is not covered under a Self and Family enrollment, you pay
all of your child's charges after your discharge from the hospital.

PPO: $15 copayment for non-surgical services.
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount for non-surgical services
Note: We cover surgical procedures under Surgical services in Section 5( b). 18
18 Page 19 20
2002 Rural Carrier Benefit Plan 19 Section 5 (a)
PPO: 15% of the Plan allowance up to $5,000 then all charges
Non-PPO: 25% of the Plan allowance up to $5,000 and any difference between our
allowance and the billed amount

Infertility services You pay
Diagnosis and treatment of infertility, except as shown in Not covered below.
Initial diagnostic tests and procedures done only to identify the cause of infertility.

Fertility drugs, hormone therapy and related services
Medical or surgical procedures done to create or enhance fertility

Note: The Plan will pay up to $5,000 per person per lifetime for covered infertility services, including prescription drugs.

Not covered: All charges.
Infertility services after voluntary sterilization
Assisted reproductive technology (ART) procedures, such as:
artificial insemination
in vitro fertilization
embryo transfer and GIFT
intravaginal insemination (IVI)
intracervical insemination (ICI)
intrauterine insemination (IUI)

Services and supplies related to ART procedures.
Cost of donor sperm
Cost of donor egg

Allergy care
Testing and treatment, including materials (such as allergy serum) PPO: 15% of the Plan allowance, if not done along with an office visit

Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount
Note: The allergy services are included in the office visit copayment if performed
during an office visit with a PPO provider
Allergy injection PPO: $15 copayment each (No deductible)

Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount
Not covered: All charges.
RAST tests
Food tests
End point titration techniques
Sublingual allergy desensitization 19
19 Page 20 21
2002 Rural Carrier Benefit Plan 20 Section 5 (a)
Treatment therapies You pay
Chemotherapy and radiation therapy
Note: High dose chemotherapy in association with autologous bone marrow transplants is limited to those transplants listed on pages 26 and 27.

Note: The Plan pays for services, supplies and tests rendered for the direct treatment of cancer under Special Features, Section 5( g)

Dialysis -Hemodialysis and peritoneal dialysis
Note: The Plan pays for services, supplies, and testing for kidney (renal) dialysis under Special Features, Section 5( g).

Intravenous (IV)/ Infusion Therapy -Home IV and antibiotic therapy
Respiratory and inhalation therapies
Growth Hormone Therapy (GHT)
Note: Growth hormone is covered under Prescription drug benefits in Section 5( f).

Physical, occupational and speech therapies
Physical therapy, speech therapy and occupational therapy
90 total combined visits per calendar year for all three listed therapies provided by:

qualified physical therapists;
qualified physicians;
speech therapists; and
occupational therapists.

Note: We only cover physical, speech and occupational therapy when a physician:

1) orders the care;
2) identifies the specific professional skills the patient requires and the medical necessity for skilled services; and

3) indicates the length of time the services are needed.
Not covered: All charges.
long-term rehabilitative therapy
exercise programs

Hearing services (testing, treatment, and supplies)
Testing only when necessary because of accidental injury or illness PPO: 15% of the Plan allowance

Non-PPO: 25% of the Plan allowance and any difference between our allowance and the
billed amount
Not covered: All charges.
Hearing testing when hearing loss is not caused by an accidental injury or illness

Hearing aids, testing and examinations for them

PPO: 15% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount

PPO: 15% of the Plan allowance Non-PPO: 25% of the Plan allowance and
any difference between our allowance and the billed amount

Note: If your physician provides physical and/ or occupational therapy in his/ her
office, the coinsurance above will apply for those services. 20
20 Page 21 22
2002 Rural Carrier Benefit Plan 21 Section 5 (a)
Vision services (testing, treatment, and supplies) You pay
One pair of eyeglasses or contact lenses to correct a change in sight caused directly by an accidental eye injury or intraocular surgery (such as for

cataracts), within one year of the injury or surgery
Note: See Special Features, Section 5 (g), for our benefit for routine eye examinations.

Not covered: All charges.
Eyeglasses or contact lenses
Eye exercises and orthoptics
Refractive eye surgery and related services

Foot care
Routine foot care when you are under active treatment for a metabolic or PPO: 15% of the Plan allowance peripheral vascular disease, such as diabetes.

Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount
Not covered: All charges.
Treatment or removal of corns and calluses, or trimming of toenails
Orthopedic shoes, orthotics, and other devices to support the feet

Orthopedic and prosthetic devices
Artificial limbs and eyes; stump hose
Externally worn breast prostheses and surgical bras, including necessary replacements following a mastectomy.

Internal prosthetic devices, such as artificial joints, pacemakers, cochlear implants, and surgically implanted breast implant following mastectomy.

Note: See Section 5( b) for coverage of the surgery to insert the device.
Not covered: All charges.
Orthopedic and corrective shoes
Arch supports
Foot orthotics
Heel pads and heel cups
Corsets, trusses
Elastic stockings, TED hose and Jobst stockings, unless we determine
that they are medically necessary

PPO: 15% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount

PPO: 15% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount 21
21 Page 22 23
2002 Rural Carrier Benefit Plan 22 Section 5 (a)
Durable medical equipment (DME) You pay
Durable medical equipment (DME) is equipment and supplies that:
Are prescribed by your attending physician (i. e., the physician who is treating your illness or injury);

Are medically necessary;
Are primarily and customarily used only for a medical purpose;
Are generally useful only to a person with an illness or injury;
Are designed for prolonged use; and
Serve a specific therapeutic purpose in the treatment of an illness or injury.

We cover rental or purchase, at our option, including repair and adjustment, of durable medical equipment, such as oxygen and dialysis equipment.
Under this benefit, we also cover:
Hospital beds;
Wheelchairs;
Crutches; and
Walkers.

Also included are:
Take-home items from the hospital; and
Medical supplies, appliances, medical equipment, and any covered items billed by a hospital for use at home (Note: calendar year deductible

applies.)

Home health services
If home health services are precertified, 90 visits per calendar year up to a maximum plan payment of $80 per visit when:

A registered nurse (R. N.), licensed practical nurse (L. P. N.) or licensed vocational nurse (L. V. N.) provides the services;
A qualified physical therapist provides services in the home
The attending physician orders the care;
The physician identifies the specific professional skills required by the patient and the medical necessity for skilled services; and

The physician indicates the length of time the services are needed.
If home health services are not precertified, 40 visits per calendar year up to a maximum plan payment of $40 per visit.

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

Home care primarily for personal assistance that does not include a medical component and is not diagnostic, therapeutic, or rehabilitative

Custodial care as defined by the Plan

PPO: 15% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount

PPO: (No deductible); all charges after we pay $80 per visit
Non-PPO: (No deductible); all charges after we pay $80 per visit

PPO: (No deductible); all charges after we pay $40 per visit
Non-PPO: (No deductible); all charges after we pay $40 per visit 22
22 Page 23 24
2002 Rural Carrier Benefit Plan 23 Section 5 (a)
PPO: 15% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount

PPO: $15 copayment (No deductible)
Non-PPO: 25% of the Plan allowance and any difference between our
allowance and the billed amount.
25% of the Plan allowance

PPO: 15% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount
PPO: Nothing
Non-PPO: Nothing

Chiropractic You pay
Manipulation of the spine and extremities
Related procedures such as ultrasound, electrical muscle stimulation, vibratory therapy, and cold pack application

Alternative treatments
The Plan has no benefit for this type of care. All charges.
Note: Benefits of certain alternative treatment providers may be covered in medically underserved areas; see page 7.

Not covered: All charges.
Naturopathic services
Acupuncture

Educational classes and programs
Coverage is limited to:
Smoking Cessation
(a) office visits no limit

(b) Prescription drugs covered under prescription drug benefit (see Prescription drug benefits Section 5( f))

(c) Individual or group counseling, up to $100 for one program every 12 months. Over-the-counter (OTC) drugs for smoking cessation are part
of the individual/ group counseling $100 maximum per program.

Education and management programs for:
Diabetes
Asthma, including pediatric asthma
Osteoarthritis
Congestive heart failure (CHF)

Note: The diabetes, asthma and arthritis education programs are provided through Caremark, our prescription benefit management company. For
information on the education programs for diabetes, asthma and arthritis call toll-free 1-800/ 227-3728.

The congestive heart failure education program is provided through Healthy directions. For information on the education program for congestive heart
failure, call toll-free 1-800/ 228-0286. 23
23 Page 24 25
2002 Rural Carrier Benefit Plan 24 Section 5 (b)
Here are some important things you should 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.

The calendar year deductible is: $350 per person ($ 700 per family). The calendar year deductible applies to almost all benefits in this Section. We added (" No deductible") to
show when the calendar year deductible does not apply.
The non-PPO benefits are the standard benefits of this Plan. PPO benefits apply only when you use a PPO provider. When no PPO provider is available, non-PPO benefits apply.

Be sure to read Section 4, Your costs for covered services for valuable information about how cost sharing works, with special sections for members who are age 65 or over. Also
read Section 9 about coordinating benefits with other coverage, including with Medicare.
The amounts listed below are for the charges billed by a physician or other health care professional for your surgical care. Look in Section 5( c) for charges associated with the
facility (i. e. hospital, surgical center, etc.).
YOU MUST GET PRECERTIFICATION OF SOME SURGICAL PROCEDURES. Please refer to the precertification information shown in Section 3 to be sure which
services require precertification.

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Section 5 (b). Surgical and anesthesia services provided by physicians and other health care professionals

Benefit Description You pay After the calendar year deductible
NOTE: The calendar year deductible applies to almost all benefits in this Section. We say (" No deductible") when it does not apply.
Surgical procedures
A comprehensive range of services, such as:
Operative procedures, including delivery of a newborn and circumcision
Treatment of fractures, including casting
Endoscopy procedures
Biopsy procedures
Removal of tumors and cysts
Correction of congenital anomalies (see Reconstructive surgery)
Surgical treatment of morbid obesity 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 Section 5( a) -Orthopedic and prosthetic devices for device coverage information

Voluntary sterilization, Norplant (a surgically implanted contraceptive), and intrauterine devices (IUDs)
Treatment of burns
Assistant surgeons we cover up to 20% of our allowance for the surgeon's charge

Surgical procedures continued on next page

PPO: 10% of the Plan allowance (No deductible)
Non-PPO: 15% of the Plan allowance and any difference between our allowance and
the billed amount (No deductible) 24
24 Page 25 26
2002 Rural Carrier Benefit Plan 25 Section 5 (b)
Surgical procedures (continued) You pay
When multiple or bilateral surgical procedures performed during the same operative session add time or complexity to patient care, our benefits are:

For the primary procedure:
PPO: 90% of the Plan allowance or
Non-PPO: 85% of the reasonable and customary charge

For the secondary procedure( s):
PPO: 90% of one-half of the Plan allowance or
Non-PPO: 85% of one-half of the reasonable and customary charge

Note: Multiple or bilateral surgical procedures performed through the same incision are "incidental" to the primary surgery. That is, the procedure would
not add time or complexity to patient care. We do not pay extra for incidental procedures.

Not covered: All charges.
Reversal of voluntary surgical sterilization.
All refractive eye surgeries and similar services.
Dental appliances, study models, splints, and other devices or service
related to the treatment of TMJ dysfunction.

Treatment or removal of corns and calluses, or trimming of toenails.
Mutually exclusive procedures surgical procedures that are not generally
performed on one patient on the same day.

Reconstructive surgery
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 the 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; and webbed fingers and toes.

All stages of breast reconstruction surgery following a mastectomy, such as:
surgery to produce a symmetrical appearance on the other breast;
treatment of any physical complications, such as lymphedemas;
breast prostheses; and surgical bras and replacements (see Prosthetic devices, Section 5( a) for coverage)

Note: If you need a mastectomy, you may choose to have the 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 and reconstruction of a breast following mastectomy

Surgeries related to sex transformation or sexual dysfunction

PPO: 10% of the Plan allowance for the primary procedure and 10% of one-half
of the Plan allowance for the secondary procedure( s). (No deductible)

Non-PPO: 15% of the Plan allowance for the primary procedure and 15% of
one-half of the Plan allowance for the secondary procedure( s); and any difference
between our payment and the billed amount. (No deductible)

PPO: 10% of the Plan allowance (No deductible)
Non-PPO: 15% of the Plan allowance and any difference between our allowance and
the billed amount (No deductible) 25
25 Page 26 27
2002 Rural Carrier Benefit Plan 26 Section 5 (b)
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 pathological tori, tumors, and premalignant and malignant lesions

Dental surgical biopsy
Excision of cysts and incision of abscesses when done as independent procedures

Surgical correction of temporomandibular joint (TMJ) dysfunction
Extraction of impacted (unerupted) teeth
Frenectomy and frenotomy not as a result of orthodontic care
Pre-and post-operative medical examinations

Note: For extraction of impacted (unerupted) teeth, anesthesia is a covered benefit, but any pre or post-operative medical exams are not covered.

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)

Organ/ tissue transplants
Limited to:
Cornea
Heart
Heart/ lung
Kidney
Kidney/ Pancreas
Liver
Lung: Single only for the following end-stage pulmonary diseases: pulmonary fibrosis, primary pulmonary hypertension, or emphysema

Double lung only for patients with cystic fibrosis
Pancreas (when condition is not treatable by insulin use)
Intestinal transplants (small intestine) and the small intestine with the liver or small intestine with multiple organs such as the liver, stomach,

and pancreas for irreversible intestinal failure
Bone marrow transplants and stem cell support for:
Allogeneic bone marrow transplants
Autologous bone marrow transplants (autologous stem cell support)

Organ/ tissue transplants continued on next page

PPO: 10% of the Plan allowance (No deductible)
Non-PPO: 15% of the Plan allowance and any difference between our allowance and
the billed amount (No deductible)

PPO: 10% of the Plan allowance (No deductible)
Non-PPO: 15% of the Plan allowance and any difference between our allowance and the
billed amount (No deductible) 26
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2002 Rural Carrier Benefit Plan 27 Section 5 (b)
Organ/ tissue transplants (continued) You pay
Autologous peripheral stem cell support for:
Acute lymphocytic or non-lymphocytic leukemia
Advanced Hodgkin's lymphoma
Advanced non-Hodgkin's lymphoma
Advanced neuroblastoma
Testicular, mediastinal, retroperitoneal, and ovarian germ cell tumors
Epithelial ovarian cancer
Breast cancer
Multiple myeloma

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

Note: Mutual of Omaha has special arrangements with 15 transplant facilities to provide services for tissue and organ transplants its Medical Specialty
Network. The network was designed to give you an opportunity to access providers that demonstrate high quality medical care for transplant patients.
For a list of facilities included in the Medical Specialty Network, call Customer Service at 1-800/ 638-8432, consult a provider directory, or visit
Mutual of Omaha's website at www. mutualofomaha. com
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 above

Anesthesia
Professional services provided in:
Hospital (inpatient)

Professional services provided in:
Hospital outpatient department
Skilled nursing facility
Ambulatory surgical center
Office

PPO: 15% of the Plan allowance (No deductible)
Non-PPO: 15% of the Plan allowance and any difference between our allowance and the
billed amount (No deductible)
Note: If your PPO provider uses a non-PPO anesthesiologist, we will pay non-PPO
benefits for any anesthesia charges.
PPO: 15% of the Plan allowance (No deductible)

Non-PPO: 15% of the Plan allowance and any difference between our allowance and the
billed amount (No deductible)
Note: If your PPO provider uses a non-PPO anesthesiologist, we will pay non-PPO
benefits for any anesthesia charges.

PPO: 10% of the Plan allowance (No deductible)
Non-PPO: 15% of the Plan allowance and any difference between our allowance and
the billed amount (No deductible) 27
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2002 Rural Carrier Benefit Plan 28 Section 5 (c)
Here are some important things you should 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.

Unlike Sections 5( a) and 5( b), in this Section 5( c) the calendar year deductible applies to only a few benefits. In that case, we added "( calendar year deductible applies)". The
calendar year deductible is: $350 per person ($ 700 per family)
The non-PPO benefits are the standard benefits of this Plan. PPO benefits apply only when you use a PPO provider. When no PPO provider is available, non-PPO benefits apply.

Be sure to read Section 4, Your costs for covered services for valuable information about how cost sharing works, with special sections for members who are age 65 or over. 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 in Sections 5( a) or (b).
YOU MUST GET PRECERTIFICATION OF HOSPITAL STAYS; FAILURE TO DO SO WILL RESULT IN A MINIMUM $500 PENALTY. Please refer to the
precertification information shown in Section 3 to be sure which services require precertification.

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Section 5 (c). Services provided by a hospital or other facility, and ambulance services

Benefit Description You pay
NOTE: The calendar year deductible applies ONLY when we say below: "( calendar year deductible applies)".
Inpatient hospital
Room and board, such as
Ward, semiprivate, or intensive care accommodations;
General nursing care; and
Meals and special diets.

NOTE: We only cover a private room when you must be isolated to prevent contagion. Otherwise, we will pay the hospital's average charge for
semiprivate accommodations. If the hospital only has private rooms, we base our payment on the average semiprivate rate of the most comparable hospital
in the area.
NOTE: When the non-PPO hospital bills a flat rate, we prorate the charges to determine how to pay them, as follows: 30% room and board and 70%
other charges.
Inpatient hospital continued on next page

PPO: Nothing
Non-PPO: $200 per admission
Note: If you use a PPO provider and a PPO facility, we may still pay non-PPO benefits if
you receive treatment from a radiologist, pathologist, or anesthesiologist who is not a
PPO provider. 28
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2002 Rural Carrier Benefit Plan 29 Section 5 (c)
PPO: Nothing
Non-PPO: 20% of charges

PPO: Nothing (no deductible)
Non-PPO: Nothing (No deductible) up to our allowance, then all charges.

Inpatient hospital (continued) You pay
Other hospital services and supplies, such as:
Operating, recovery, maternity, and other treatment rooms
Prescribed drugs and medicines
Diagnostic laboratory tests and X-rays
Blood or blood plasma, if not donated or replaced
Dressings, splints, casts, and sterile tray services

Note: Take-home medical supplies, equipment, orthopedic and prosthetic devices are covered under Section 5( a)

Note: We base payment on whether the facility or a health care professional bills for the services or supplies. For example, when the anesthesiologist bills,
we pay Anesthesia benefits. If preadmission testing is performed in the hospital as inpatient then we pay pre-admission tests at the same coinsurance
rate as inpatient miscellaneous charges.
Not covered: All charges.
Any part of a hospital admission that is not medically necessary (see
definition), such as when you do not need acute hospital inpatient (overnight) care, but could receive care in some other setting without

adversely affecting your condition or the quality of your medical care.
Note: In this event, we pay benefits for services and supplies other than room and board and in-hospital physician care at the level they would have

been covered if provided in an alternative setting
Custodial care (see definition) even when in a hospital
Non-covered facilities, such as nursing homes, rest homes, convalescent
homes, facilities for the aged, and schools

Personal comfort items, such as telephone, television, radio, newspapers,
air conditioner, beauty and barber services, guest meals and beds

Private nursing care during a hospital stay

Outpatient hospital or ambulatory surgical center
Operating, recovery, and other treatment rooms
Prescribed drugs and medicines (not take home drugs)
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

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.
Note: We base payment on whether the facility or a health care professional bills for the services or supplies. For example, when the physician bills for
surgery, we pay Surgery benefits. 29
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2002 Rural Carrier Benefit Plan 30 Section 5 (c)
Extended care benefits/ Skilled nursing care facility benefits You pay
Skilled nursing facility (SNF): If the stay is precertified, we pay 100% of the reasonable and customary charges for the initial 60 days confinement

in a calendar year, when the services are medically necessary.
If the stay is not precertified, we pay 80% of the reasonable and customary charges for the initial 30 days confinement in a calendar year, when the
services are medically necessary.

Not covered: All charges.
Custodial care

Hospice care
Hospice is a coordinated program of maintenance and supportive care for the terminally ill prescribed by a physician and provided by a medically

supervised team under the direction of a Plan-approved independent hospice administration.

We pay up to $7,500 per lifetime for inpatient and outpatient services, if the care is precertified.
We pay up to $5,500 per lifetime for inpatient and outpatient services, if the care is not precertified.
Not covered: All charges.
Independent nursing
Homemaker services

Ambulance
Professional ambulance service to the nearest hospital equipped to handle the patient's condition

Not covered: All charges.
Ambulance transportation from the hospital to home

PPO: Nothing
Non-PPO: Nothing

PPO: 20% for the first 30 days then all charges
Non-PPO: 20% for the first 30 days, then all charges.

Nothing up to $7,500, if care is precertified. Then all charges over $7,500.
Nothing up to $5,500, if care is not precertified. Then all charges over $5,500.

PPO: 15% of the Plan allowance (Calendar year deductible applies)
Non-PPO: 25% of the Plan allowance and any difference between our allowance and
the billed amount (Calendar year deductible applies) 30
30 Page 31 32
2002 Rural Carrier Benefit Plan 31 Section 5 (d)
PPO: Nothing (No deductible) The Plan will pay up to $400.
Non-PPO: Nothing (No deductible). The Plan will pay up to $400.

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.

The calendar year deductible is: $350 per person ($ 700 per family). The calendar year deductible applies to almost all benefits in this Section. We added "( No deductible)" to
show when the calendar year deductible does not apply.
The non-PPO benefits are the standard benefits of this Plan. PPO benefits apply only when you use a PPO provider. When no PPO provider is available, non-PPO benefits apply.

Be sure to read Section 4, Your costs for covered services for valuable information about how cost sharing works, with special sections for members who are age 65 or over. Also
read Section 9 about coordinating benefits with other coverage, including with Medicare.

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Section 5 (d). Emergency services/ accidents

What is an accidental injury?
An accidental injury is a bodily injury sustained solely through violent, external, and accidental means, such as broken bones, animal bites, and poisonings.

PPO: 15% of the Plan allowance
Non-PPO: 25% of the Plan allowance and any difference between our allowance and the

billed amount

Benefit Description You pay After the calendar year deductible
NOTE: The calendar year deductible applies to almost all benefits in this Section. We say (" No deductible") when it does not apply.
Accidental injury
If you or a family member is accidentally injured, the Plan will pay 100% of reasonable and customary charges up to the maximum benefit of $400 for:

Surgery and medical care by a physician
Hospital room and board and other related services and supplies
Private duty nursing services in your home by a registered nurse (R. N.)
X-ray and laboratory tests
Drugs and medicines
Casts, splints, braces, and crutches
Surgical dressings

Note: Charges exceeding the maximum benefit ($ 400) will be considered under Sections 5( a) or 5( b).

We pay Hospital benefits if you are admitted to the hospital from the emergency room.
See page 41 for accidental dental injuries.
Ambulance
Professional ambulance service to the nearest hospital equipped to handle the patient's condition, including air ambulance when medically necessary

Note: See Section 5( c) for non-emergency service. 31
31 Page 32 33
2002 Rural Carrier Benefit Plan 32 Section 5 (e)
You may choose to get care Out-of-Network (non-PPO) or In-Network (PPO). When you receive In-Network care, you must get our approval for all services and follow a treatment plan
we approve. If you do, cost-sharing and limitations for In-Network 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.
The calendar year deductible or, for facility care, the inpatient deductible apply to almost all benefits in this Section. We added "( No deductible)" to show when a deductible does not

apply.
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 descriptions below.

In-Network mental health and substance abuse benefits are below, then Out-of-Network (Non-PPO) benefits begin on page 35.

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Section 5 (e). Mental health and substance abuse benefits

Benefit Description You pay After the calendar year deductible
NOTE: The calendar year deductible applies to almost all benefits in this Section. We say (" No deductible") when it does not apply.
In-Network benefits
All diagnostic and treatment services contained in a treatment plan that Your cost sharing responsibilities are no we approve. The treatment plan may include services, drugs, and supplies greater than for other illness or conditions.

described elsewhere in this brochure.
Note: In-Network 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. We will reduce your benefits if you do not precertify, preauthorize, get review of continuing
treatment, or follow our approved treatment plan for all levels of care.
Professional services, including individual or group therapy by providers 15% of Plan allowance (No deductible for such as psychiatrists, psychologists, or clinical social workers outpatient physician visits)

Medication management $15 copayment (No deductible)
Diagnostic tests 15% of Plan allowance
In-Network benefits continued on next page 32
32 Page 33 34
2002 Rural Carrier Benefit Plan 33 Section 5 (e)
In-Network benefits (continued) You pay
Services provided in a hospital or other facility as an inpatient Nothing (No deductible)
Services in approved alternative care settings such as: 15% of Plan allowance
Partial hospitalization includes a time-limited, ambulatory, active treatment program that:

Offers intensive clinical services that are coordinated and structured in stable surroundings; and
Provides at least 20 hours of scheduled programs in a licensed or accredited facility over at least five days per week

Intensive outpatient programs offer time-limited programs that:
Are coordinated, structured and intensively therapeutic;
Are designed to treat a variety of people with moderate to severe problems with at least one area of daily life because of a mental

health or substance abuse condition; and
Provide 3-4 hours of active treatment each day for at least 2-3 days a week

Not covered: All charges.
Services we have not approved
All charges (including room and board) for chemical aversion therapy,
conditioned reflex treatments, narcotherapy, and similar aversion
treatments

Biofeedback and milieu therapy
Counseling or therapy for educational or behavioral problems
Counseling or therapy for mental retardation or a learning disability
Counseling services for marital or family problems

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. 33
33 Page 34 35
Preauthorization To be eligible to receive these enhanced mental health and substance abuse benefits you must obtain a treatment plan and follow all of the authorization processes. These
include:
Precertification to establish the medical necessity of your stay in a hospital or other facility. Please see pages 9 and 10 for information on how to precertify your care. If
you do not precertify your stay, we will reduce our benefits by $500.
Preauthorization to establish the medical necessity for all levels of outpatient or office care by your physician or other covered provider. Please see pages 9 and 10
for information on how to preauthorize your care. If you do not preauthorize your care within two business days of the first visit, we will reduce any available benefits
by 50%.
Review of continuing treatment to establish the medical necessity of your continuing treatment for all levels of outpatient or office care. Please see pages 9 and 10, for
information on how to get review of continuing treatment. If you do not get your continuing treatment reviewed or you do not follow your treatment plan, we will
reduce any available benefits by 50%.

Network deductibles and A $350 per person ($ 700 per family) calendar year deductible applies to outpatient out-of-pocket maximums charges and inpatient and outpatient professional charges. We waive the calendar year
deductible for office visits with PPO physicians. Once you reach the combined out-of-pocket maximum (see page 12), the Plan will pay 100% of its allowance for the rest of
the calendar year.

Network limitation If you do not obtain an approved treatment plan, we will provide only Out-of-Network benefits.

How to submit Follow the normal claim procedure on page 45. Network claims

2002 Rural Carrier Benefit Plan 34 Section 5 (e)

In-Network benefits (continued) 34
34 Page 35 36
2002 Rural Carrier Benefit Plan 35 Section 5 (e)
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.

See pages 2-34 for In-Network (PPO) benefits.
Be sure to read Section 4, Your costs for covered services for valuable information about how cost sharing works, with special sections for members who are age 65 or over. Also
read Section 9 about coordinating benefits with other coverage, including with Medicare.

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Out-of-Network benefits

Benefit Description You pay After the calendar year deductible
NOTE: The calendar year deductible applies to almost all benefits in this Section. We say (" No deductible") when it does not apply.
Out-of-Network inpatient mental health benefits
We pay 100% of room and board, such as $200 per hospital admission
ward, semiprivate, or intensive care accommodations;
general nursing care; and
meals and special diets.

We pay 80% of other hospital services and supplies, such as: 20% of charges
Prescribed drugs and medicines
Diagnostic laboratory tests
Medical supplies and equipment

Services in Alternative Care Settings
Partial hospitalization includes a time-limited, ambulatory, active 25% of Plan allowance and any difference treatment program that: between our allowance and the billed amount

Offers intensive clinical services that are coordinated and structured in stable surroundings; and
Provides at least 20 hours of scheduled programs in a licensed or accredited facility over at least five days per week

Intensive outpatient programs offer time-limited programs that:
Are coordinated, structured and intensively therapeutic;
Are designed to treat a variety of people with moderate to severe problems with at least one area of daily life because of a mental health

or substance abuse condition; and
Provide 3-4 hours of active treatment each day for at least 2-3 days a week. 35
35 Page 36 37
2002 Rural Carrier Benefit Plan 36 Section 5 (e)
Inpatient/ Outpatient Mental Health/ Substance Abuse Treatment Sessions You pay
We pay for mental health/ substance abuse treatment sessions (including All charges in excess of $75 (No deductible) group sessions) up to a maximum of $75 per session. This benefit also
applies to treatment sessions billed by a hospital or provided by the hospital staff.

Note: We pay for medication management and diagnostic testing in Section 5( a).

Out of Network substance abuse benefits
We will pay up to a maximum of $5,500 for inpatient treatment in an Nothing up to $5,500, then all charges in an accredited facility or for an outpatient treatment program.

Note: This benefit is limited to two inpatient treatment programs per person per lifetime.

Not covered out-of-network: All charges.
Services we have not approved
All charges (including room and board) for chemical aversion therapy, conditioned reflex treatments, narcotherapy, and similar aversion

treatments
Biofeedback and milieu therapy
Counseling or therapy for educational or behavioral problems
Counseling or therapy for mental retardation or a learning disability
Counseling services for marital or family problems

Precertification Follow the normal procedure on pages 9 and 10 to get approval for your hospital stay, partial hospitalization, or intensive outpatient program.

Out-of-Network out-of-pocket For those benefits where coinsurance applies, we pay 100% of the Plan allowance for maximum the rest of the calendar year after your expenses (including the deductible) total to
$8,000 per person during a calendar year.

How to submit Follow the normal claim procedure on page 45. Out-of-Network claims 36
36 Page 37 38
2002 Rural Carrier Benefit Plan 37 Section 5 (f)
Here are some important things you should 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.
The calendar year deductible is: $350 per person ($ 700 per family). The calendar year deductible applies to almost all benefits in this Section. We added (" No deductible") to
show when the calendar year deductible does not apply.
Be sure to read Section 4, Your costs for covered services for valuable information about how cost sharing works, with special sections for members who are age 65 or over. Also
read Section 9 about coordinating benefits with other coverage, including with Medicare.

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Section 5 (f). Prescription drug benefits

There are important features you should be aware of. These include:
Who can write your prescription. A licensed physician must write the prescription.
Where you can obtain your prescription. You may fill your prescription at a Caremark network pharmacy, a non-network pharmacy, or through the Caremark mail order prescription program.

Caremark network pharmacy
You may fill your prescription at a Caremark network pharmacy. To find a participating pharmacy where you live, call Caremark toll-free at 1-800/ 831-4440 or on the Internet at www.rxrequest.com or as a link

through our web page at www.nrlca.org. You must show the pharmacy your Plan ID card (that includes the Caremark logo) or a Caremark prescription drug card to receive the negotiated discount price.
You pay the full discounted price for your prescription and then file a claim with us. Prescriptions you purchase at a Caremark network pharmacy without using your ID card or a Caremark drug card are
at the full regular price charged by the pharmacy.
Non-Network Pharmacy
You may fill your prescription at any non-network pharmacy. You pay the full regular price for your prescription and then file a claim with us.

Caremark mail order prescription program
You may fill your long-term prescription through the Caremark mail order prescription program. You will receive order forms and information on how to use the mail order prescription program with your Plan ID

card. To order your prescription by mail: 1) complete the Caremark order form; 2) enclose your prescription( s) and copayment( s); 3) mail your order to Caremark, P O Box 659572, San Antonio, TX
78256-9572; and 4) allow approximately two weeks for delivery. You will receive order forms for refills and future prescription orders each time you use the mail order program. You can also order refills from the
mail order program by telephone toll-free at 1-800/ 213-0879 or on the Internet at www.rxrequest.com.
These are the dispensing limitations.
You may purchase up to a 34-day supply of medication at a Caremark network pharmacy. There is no limit on the number of refills that you can buy at a Caremark network pharmacy.

There is no day supply or refill limit for medications that you buy at a non-network pharmacy.
A generic equivalent will be dispensed if it is available, unless your physician specifically requires a brand name.

You may purchase up to a 90-day supply of a medication through the Caremark mail order prescription program. If you request a refill before you use 75% of the medication (based on your physician's written
directions for taking the medication), Caremark will return the refill request to you. Caremark follows generally accepted pharmacy standards when filling your prescriptions. These include Federal and state

Prescription drug benefits continued on next page 37
37 Page 38 39
2002 Rural Carrier Benefit Plan 38 Section 5 (f)
pharmacy regulations, the professional judgment of the pharmacist, and the usage recommendations of the drug manufacturer as approved by the U. S. Food and Drug Administration (FDA). If a Federally approved
generic drug is available, Caremark will substitute for a brand name drug unless your physician specifies that it is medically necessary that you receive the brand name drug. Certain types of prescription medications are
not available through the mail order program such as:
Specially mixed (compounded) capsules and suppositories
Vaccines
Frozen medications
Dental products
Most medical devices
Infertility drugs

Caremark will fill prescriptions for medications designated as Class II, III, IV, and V controlled substances by the FDA. However, Federal or state law may limit the supply of these medications to less than 90 days.
We have an open formulary for our mail order prescription program. If your physician believes a brand name drug is necessary or there is no generic available, your physician may prescribe a brand name drug
from a formulary list. This list of brand name drugs is a preferred (not required) list of drugs that we selected to meet patient needs. To request a prescription drug formulary list, call Caremark toll-free at
1-800/ 831-4440.
If you have Medicare Part B, we do not waive your deductible or coinsurance for prescription drugs and supplies that you buy at a Caremark network pharmacy or at a non-network pharmacy. However, your

copyment is reduced for prescriptions that you order through the Caremark mail order prescription program.

Why use generic drugs? Generic drugs offer a safe and economic way to meet your prescription drug needs. The generic name of a drug is its chemical name; the name brand is the name under which the manufacturer advertises
and sells a drug. Under federal law, generic and name brand drugs must meet the same standards for safety, purity, strength, and effectiveness. Generic drugs contain the same active ingredients and are equivalent in strength and
dosage to the original brand name product. All manufacturing and marketing of a generic drug is conducted following strict guidelines established by the U. S. Food and Drug Administration (FDA). No prescription drug can
be sold in the U. S. without FDA approval. The manufacturing facilities of all drug companies, whether they make generic or brand name drugs, must pass stringent, regular inspections by the FDA. There is no difference between
the standards set for drug companies that make brand name or generic medications. Many drug companies that make brand name drugs also make generic drugs. A generic prescription costs you and us less than a name brand
prescription.

When you have to file a claim. Follow the normal claim procedure on page 45. There is no special claim form to fill out for your prescription drug expenses.
Prescription drug benefits begin on next page 38
38 Page 39 40
2002 Rural Carrier Benefit Plan 39 Section 5 (f)
Section 5 (f). Prescription drug benefits (continued)
Benefit Description You pay After the calendar year deductible
NOTE: The calendar year deductible applies to almost all benefits in this Section. We say "No deductible" when it does not apply.
Covered medications and supplies
When you enroll in the Plan, you will receive a description of our Network Retail: 25% of cost prescription drug program, a combined prescription drug/ Plan identification

card, a mail order form/ patient profile and a pre-addressed reply envelope Network Retail with Medicare Part B: for the mail-order prescription program. 25% of cost

You may purchase the following medications and supplies prescribed by a physician from either a pharmacy or by mail:
Drugs and medicines (including those prescribed during a non-covered hospital stay or in a non-covered facility) that require a physician's
prescription by Federal law of the United States except those listed as Not covered below.

Insulin
Needles and syringes for the administration of covered medications
Contraceptive drugs and devices

Not covered: All charges.
Drugs and supplies for cosmetic purposes
Drugs to treat impotence and sexual dysfunction
Vitamins, nutrients and food supplements even if a physician prescribes or
administers them

Nonprescription (over-the-counter) medicines

Non-Network Retail: 25% of cost
Non-Network Retail with Medicare Part B: 25% of cost

Network Mail Order: $13 generic/$ 18 brand name (No deductible)
Network Mail Order with Medicare Part B: $3 generic/$ 6 brand name (No
deductible)
Note: If there is no generic equivalent drug available, you will still have to pay the brand
name copayment. 39
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2002 Rural Carrier Benefit Plan 40 Section 5 (g)
Section 5 (g). Special features
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.
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.

24 hour nurse line For any of your health concerns, 24 hours a day, 7 days a week, you may call Optum NurseLine toll-free at 1-877/ 610-9822 and talk with a registered nurse who will discuss
treatment options and answer your health questions and concerns. This service is also available on the Internet at www. healthforums. com.

Services for deaf and No benefit hearing impaired

Cancer treatment benefit We will pay 100% of the Plan allowance for services and supplies normally covered by the Plan for treatment of an illness diagnosed as cancer. The service or supply must
be for the treatment of a malignancy. A diagnosis secondary to cancer is not covered under this benefit.

Kidney (renal) dialysis We will pay 100% of the Plan allowance for services, supplies and testing for kidney benefit (renal) dialysis. This benefit applies to inpatient and outpatient kidney dialysis.

Routine eye exam benefit We will pay up to $45 per person for one routine eye exam each calendar year. Note: The itemized bill must show that you had a routine eye exam to qualify for this
benefit.
Reciprocity benefit No benefit
High risk pregnancies No benefit
Centers of excellence for Mutual of Omaha has special arrangements with 15 facilities to provide services for transplants/ heart surgery/ etc tissue and organ transplants its Medical Specialty Network. The network is designed
to give you an opportunity to access providers that demonstrate high quality medical care for transplant patients. For a list of facilities included in the Medical Specialty
Network, call Customer Service at 1-800/ 638-8432, consult a PPO directory, or visit Mutual of Omaha's website at www. mutualofomaha. com

Travel benefit/ services In case of a medical problem while traveling in a foreign country or more than 100 overseas miles from home, you can call toll-free at 1-877/ 715-2596 for a referral to an English-speaking
physician, clinic or hospital. This service is available 24 hours a day, 7 days a week anywhere in the world. 40
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2002 Rural Carrier Benefit Plan 41 Section 5 (h)
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.

The dental deductible is: $50 per person. The dental deductible applies to almost all benefits in this Section. We added (" No deductible") to show when the dental deductible does not
apply.
Be sure to read Section 4, Your costs for covered services for valuable information about how cost sharing works, with special sections for members who are age 65 or over. Also
read Section 9 about coordinating benefits with other coverage.
Note: We cover a hospital stay for dental procedures only when a non-dental physical impairment exists which makes hospitalization necessary to safeguard the health of the patient.
We cover the dental procedure under Dental benefits listed below.

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Section 5 (h). Dental benefits

Dental benefits continued on next page
Accidental injury benefit You pay
The Plan will pay reasonable and customary charges for the treatment or repair (including root canal therapy and crowns) of an accidental injury

to sound natural teeth (not from biting or chewing), provided the accident occurs while covered by the FEHB Program, and the treatment or repair
is completed while covered by the Plan.
Note: We may request dental records, including x-rays, to verify the condition of your teeth before the accidental injury. Charges covered for

dental accidents cannot be considered under Dental Benefits.

Dental benefits Class A Schedule

Service We pay You pay (scheduled allowance)
The plan pays actual charges for up to two visits per All charges that exceed the Plan's person per calendar year up to the scheduled Plan scheduled allowance for the
allowance (No deductible) service
Oral exam $12.50
Prophylaxis, adult $22.00
Prophylaxis, child (thru age 14) $15.00 with fluoride treatment $24.00

Space maintainer $88.00
Complete X-ray series $34.00
Panoramic X-ray $34.00
Single film X-ray $ 5.50
Each additional X-ray film (up to 7) $ 4.00
Bitewings -2 films $ 9.00
Bitewings -4 films $14.00

PPO: 10% of the Plan allowance (No deductible)
Non-PPO: 15% of the Plan allowance and any difference between our allowance and the
billed amount (No deductible) 41
41 Page 42 43
Dental benefits Class B Schedule
Service We pay You pay (scheduled allowance)
After a deductible of $50 per person during the All charges that exceed the Plan's calendar year, the Plan pays actual charges up to the allowance for the service.
scheduled allowance for each service. There is no annual limit on the amount of services you receive.

Restorations 1 surface deciduous $ 12.50
2 surface deciduous $ 18.50 3 surface deciduous $ 23.50
1 surface permanent $ 14.00 2 surface permanent $ 20.50
3 or more surface permanent $ 26.50 Gold restoration $103.50

Extractions Single tooth $ 16.00
Each additional tooth $ 15.00 Pulp capping-direct $ 9.50
Pulpotomy-vital $ 21.00
Root canal therapy This includes the actual root canal treatment and
ay retreatments One root $106.00
Two roots $126.00 Three or more roots $170.00

Periodontics Gingival curettage (per quadrant) $ 26.50
Crowns/ abutments Resin and Resin with metal $120.00
Porcelain $113.50 Porcelain with gold $120.00
Gold (full cast and 3/ 4 cast) $120.00 Prefabricated resin and stainless steel $ 21.50

Pontics Porcelain and Porcelain with gold $120.00
Dentures Complete upper or lower $126.00
Partial without bar $138.00 Partial with bar $157.00
Repairs (dentures and partials) $ 14.00 Denture relining $ 40.50

2002 Rural Carrier Benefit Plan 42 Section 5 (h)
When this schedule lists a type of dental care, but does not list a particular dental procedure under that type of care, we will determine the maximum allowance for that procedure. 42
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2002 Rural Carrier Benefit Plan 43 Section 5 (i)
Section 5 (i). Non-FEHB benefits available to Plan members
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 deductibles or out-of-pocket maximums.

Long term care insurance Long term care is open to NRLCA members, their spouse, parents and parents-in-law under age 80. Premium rates are based on your age at the time of approval for coverage. Please consult the separate
descriptive pamphlet for detailed information.
Covers skilled nursing, intermediate nursing and custodial care in a nursing home, skilled nursing facility, or assisted living home; $100 per day benefit

Covers outpatient care for home health care, adult day care and respite care; $50 per day benefit Includes return of premium feature
Includes inflation protection option
Long term disability income insurance The Rural Letter Carrier Long Term Disability (RLCLTD) Income Plan protects an individual from being unable to work and earn a paycheck because of an illness or injury. The RLCLTD
Plan is available to active regular rural letter carriers that are members of the NRLCA. Premium rates are based on your age and benefit level selected. Please consult the separate descriptive pamphlet for detailed information.

Two benefit levels with a waiting period Replacement of 50% or 60% of your basic pay tax-free
Benefits payable to age 65 Premiums payable through payroll allotment

Supplemental dental insurance The NRLCA Dental Plan is available to all NRLCA members. The Plan features a schedule of benefits for a variety of dental care services. Premium rates are based on geographic regions across the
country and are guaranteed for three years from the time of initial enrollment in the Plan. The Plan allows members to use any licensed dentist with improved benefits if you use one of more than 45,000 preferred dental offices throughout
the country. Benefits include:
Diagnostic and Preventive Care Oral Surgery

Restorative Care Endodontic Care (Root Canals)
Periodontic Care (Gum Disease) Prosthodontic Care (Crowns and Dentures)

Please consult the separate descriptive pamphlet for detailed information.
Term life insurance The NRLCA Life Insurance Plan is available to actively employed members of the NRLCA under age 60. Premium rates are based on your age at time of approval for coverage and at each renewal date. Please
consult the separate descriptive pamphlet for detailed information.
Provides up to $200,000 of term life insurance coverage in $25,000 multiples Provides up to $40,000 accidental death and dismemberment coverage

Family life insurance coverage up to $10,000 Living Care benefit for terminally ill enrollees

Vision and Hearing Insurance The NRLCA Vision and Hearing Plan is available to all members of the NRLCA. There are two levels of coverage: Standard and Superior. Please see the separate pamphlet for complete information.
Provides discounts on frames, lenses, and contact lenses at participating providers Provides discounts on laser eye surgery at TLC Vision Centers and See Clearly Vision Centers
Provides discounts on hearing aids at Beltone Hearing Centers, free hearing exam and an extended warranty on the hearing aid.

For further information on any of the above benefits, contact the NRLCA Insurance Department at:
NRLCA Group Insurance Department 1630 Duke Street, First Floor
Alexandria, VA 22314-3466 1-703/ 684-5552

Benefits on this page are not part of the FEHB contract 43
43 Page 44 45
2002 Rural Carrier Benefit Plan 44 Section 6
Section 6. General exclusions 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 we determine it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or condition.

We do not cover the following:
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, sexual dysfunction or impotence;
Services, drugs, or supplies you receive from a provider or facility barred from the FEHB Program;
Services, drugs or supplies when no charge would be made if you had no health insurance coverage;
Services, drugs, or supplies you receive without charge while in active military service; or required for illness or injury you sustain on or after the effective date of enrollment (1) as a result of an act of war within the United States, its territories, or

possessions; or (2) during combat;
Services, drugs, or supplies you receive from immediate relatives or household members, such as spouse, parents, child, brother or sister by blood, marriage, or adoption;

Services or supplies you receive at a facility not covered under the Plan, except that medically necessary prescription drugs are covered;
Charges for services and supplies that are not reasonable and customary;
Any part of a provider's fee or charge that you would ordinarily pay but is waived by the provider. If a provider routinely waives (does not require you to pay) a deductible or coinsurance, we will calculate the actual provider fee or charge by

reducing the fee or charge by the amount waived;
Charges that you or us has no legal obligation to pay, such as: excess charges for an annuitant age 65 or older who is not covered by Medicare Part A and/ or B (see page 13), doctor charges exceeding the amount specified by the Department of

Health and Human Services when benefits are payable under Medicare (limiting charge) or State premium taxes however applied;

Custodial care;
Acupuncture;
Preventive medical care and services, except those provided under Preventive care adult and Preventive care children in Section 5( a);

Weight control or any treatment of obesity except surgery for morbid obesity (ileojejunal, balloon or gastric shunt procedures);
Private duty nursing care that you receive during a hospital stay
Any services you receive related to a learning disability;
Chelation therapy, except for acute arsenic, gold, mercury or lead poisoning;
Breast implants (except after mastectomy), injections of silicone or other substances, and all related charges;
Nonmedical services such as social services and recreational, educational, visual, and speech therapy (except as provided in Section 5( a));

Hearing aids and examinations for them;
Eyeglasses and contact lenses (except as covered in Section 5( a));
Non-surgical treatment of temporomandibular joint (TMJ) dysfunction including dental appliances, study models, splints and other devices; or

Services, drugs and supplies for cosmetic purposes
Charges for completion of reports or forms
Telephone consultations, conferences, or treatment
Biofeedback and milieu therapy

Note: Exclusions that are primarily identified with a single benefit category are listed along with that benefit category, but may apply to other categories. 44
44 Page 45 46
2002 Rural Carrier Benefit Plan 45 Section 7
Section 7. Filing a claim for covered services
How to claim benefits To obtain claim forms or other claims filing advice or answers about our benefits, contact us at 1-800/ 638-8432.

In most cases, providers and facilities file claims for you. Your physician must file on the form HCFA-1500, Health Insurance Claim Form. Your facility will file on the
UB-92 form. For claims questions and assistance, call us at 1-800/ 638-8432.
When you must file a claim such as for overseas claims or when another group health plan is primary submit it on the HCFA-1500 or a claim form that includes
the information shown below. Send your claims to:
Rural Carrier Benefit Plan P. O. Box 668329

Charlotte, NC 28266-8329

Bills and receipts should be itemized and show:
Name of patient and relationship to enrollee;
Plan identification number of the enrollee;
Name and address of person or firm providing the service or supply;
Dates that services or supplies were furnished;
Diagnosis;
Type of each service or supply; and
The charge for each service or supply.

Note: Canceled checks, cash register receipts, or balance due statements are not acceptable substitutes for itemized bills.

In addition:
You must send a copy of the explanation of benefits (EOB) from any primary payer (such as the Medicare Summary Notice (MSN)) with your claim.

Bills for home nursing care must show that the nurse is a registered or licensed practical nurse.
Claims for rental or purchase of durable medical equipment; private duty nursing; and physical, occupational, and speech therapy require a written statement from the
physician specifying the medical necessity for the service or supply and the length of time needed.

Claims for prescription drugs and supplies that are not ordered through the Mail Order Prescription Drug Program must include receipts that have the patient's name, the
prescription number, name of drug or supply, prescribing physician's name, date, charge, and pharmacy name. The pharmacist must sign any computer printout or
pharmacy ledger. 45
45 Page 46 47
2002 Rural Carrier Benefit Plan 46 Section 7
Records Keep a separate record of the medical expenses of each covered family member as deductibles and maximum allowances apply separately to each person. Save copies of
all medical bills, including those you accumulate to satisfy a deductible. In most instances they will serve as evidence of your claim. We will not provide duplicate or
year-end statements. .

Deadline for filing your claim Send us all of the documents for your claim as soon as possible. You must submit the claim no more than two years after you receive 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. Once we pay benefits, there is a
three-year limitation on reissuing uncashed checks.

Overseas claims Follow the same procedures when submitting claims for overseas (foreign) services as you would when submitting claims for stateside services. Claims for overseas services
should include an English translation. Charges should be converted to U. S. dollars using the exchange rate applicable at the time the expense was incurred. We will
provide translation and currency conversion services for claims for overseas (foreign) services.

When we need more information Please reply promptly when we ask for additional information. We may delay processing or deny your claim if you do not respond. 46
46 Page 47 48
2002 Rural Carrier Benefit Plan 47 Section 8
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/ prior approval:

Step Description
1 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: Rural Carrier Benefit Plan, P. O. Box 668329, Charlotte, NC 28266-8432 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.

2 We have 30 days from the date we receive your request to: (a) Pay the claim (or, if applicable, arrange for the health care provider to give you the care); or
(b) Write to you and maintain our denial 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 go to step 3.

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.
4 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 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 2, 1900 E Street, NW, Washington, DC 20415-3620

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. 47
47 Page 48 49
2002 Rural Carrier Benefit Plan 48 Section 8
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 include 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.

5 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.
6 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 or from the year in which you were denied precertification or prior approval. 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 1-800-638-8432 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 2 at 202/ 606-3818 between 8 a. m. and 5 p. m. Eastern Time.

Disputed claims process (continued) 48
48 Page 49 50
2002 Rural Carrier Benefit Plan 49 Section 9
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 another health coverage 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 what is left of our allowance, up to our regular benefit. We will
not pay more than our allowance.

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. If you or your spouse worked for at least 10 years in Medicare-covered employment, you

should be able to qualify for premium-free Part A insurance. (Someone who was a Federal employee on January 1, 1983 or since automatically qualifies.) Otherwise, if
you are age 65 or older, you may be able to buy it. Contact 1-800-MEDICARE (1-800/ 633-4227) for more information

Part B (Medical Insurance). Most people pay monthly for Part B. Generally, Part B premiums are withheld from your monthly Social Security check or your retirement
check.
If you are eligible for Medicare, you may have choices in how you get your health care. Medicare managed care plan is the term used to describe the various health plan
choices available to Medicare beneficiaries. The information in the next few pages shows how we coordinate benefits with Medicare, depending on the type of Medicare
managed care plan you have. .

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

When you are enrolled in Original Medicare along with this Plan, you still need to follow the rules in this brochure for us to cover your care except you do not need to
get a hospital stay approved when Medicare pays first. 49
49 Page 50 51
2002 Rural Carrier Benefit Plan 50 Section 9
Claims process when you have the Original Medicare Plan You probably will never have to file a claim form when you have both our Plan and the Original
Medicare Plan
When we are the primary payer, we process the claim first.
When Original Medicare is the primary payer, Medicare processes your claim first. In most cases, your claims will be coordinated automatically and we will pay the
balance of covered charges. You will not need to do anything. To find out if you need to do something about filing your claims, call us at 1-800/ 638-8432.

We waive some costs when you have the Original Medicare Plan -When Original Medicare is the primary payer, we will waive some out-of-pocket costs, as follows:
Medical services and supplies provided by physicians and other health care professionals. If you are enrolled in Medicare Part B, we will waive our $350
calendar year deductible and pay the $100 Part B deductible for you.
NOTE: We do not waive the $350 calendar year deductible for prescription drug expenses when the medication is purchased at a pharmacy.

Services and supplies provided in a hospital or other covered facility. If you are enrolled in Medicare Part A, we will waive our $200 hospital deductible and pay the
Part A deductible for you. 50
50 Page 51 52
2002 Rural Carrier Benefit Plan 51 Section 9
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 A. When either you or your covered spouse are age 65 or over and

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

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

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 covered spouse 3

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 the 3 Office of Workers' Compensation Programs has determined that you are unable (except for claims

to return to duty, related to Workers' Compensation.)

B. When you or a covered family member have Medicare based on end stage renal disease (ESRD) and
1) Are within the first 30 months of eligibility to receive Part A benefits solely because of ESRD 3
2) Have completed the 30-month ESRD coordination period and are still eligible for Medicare due to ESRD, 3
3) Become eligible for Medicare due to ESRD after Medicare became primary for you under another provision, 3

C. When you or a covered family member have FEHB and
1) Are eligible for Medicare based on disability, and
a) Are an annuitant, or ................................................................................................. 3
b) Are an active employee ........................................................................................... 3
c) Are a former spouse of an annuitant........................................................................ 3
d) Are a former spouse of an active employee ........................................................... 3 51
51 Page 52 53
2002 Rural Carrier Benefit Plan 52 Section 9
Medicare managed care plan If you are eligible for Medicare, you may choose to enroll in and get your Medicare benefits from another type of Medicare+ Choice plan a Medicare managed care plan.
These are health care choices (like HMOs) in some areas of the country. In most Medicare managed care plans, you can only go to doctors, specialists, or hospitals that
are part of the plan. Medicare managed care plans provide all the benefits that Original Medicare covers. Some cover extras, like prescription drugs. 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 managed care plan is primary, even out of the managed care plan's network and/ or service area, but we will not
waive any of our copayments, coinsurance, or deductibles. If you enroll in a Medicare managed care plan, tell us. We will need to know whether you are in the Original
Medicare Plan or in a Medicare managed care plan so we can correctly coordinate benefits with Medicare.

Suspended FEHB coverage to enroll in 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 plan's service area.

Private Contract with your physician A physician may ask you to sign a private contract agreeing that you can be billed directly for services ordinarily covered by Original Medicare. Should you sign an
agreement, Medicare will not pay any portion of the charges, and we will not increase our payment. We will still limit our payment to the amount we would have paid after
Original Medicare's payment.

If you do not enroll in Medicare If you do not have one or both Parts of Medicare, you can still be covered under the Part A or Part B FEHB Program. We will not require you to enroll in Medicare Part B and, if you can't
get premium-free Part A, we will not ask you to enroll in it.

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, we pay first. See your TRICARE Health Benefits Advisor if you have questions about TRICARE coverage. 52
52 Page 53 54
2002 Rural Carrier Benefit Plan 53 Section 9
Workers' Compensation We do not cover services that:
you need because of a workplace-related illness 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 care.

Medicaid When you have this Plan and Medicaid, we pay first.
When other Government agencies We do not cover services and supplies when a local, State, or Federal Government are responsible for your care agency directly or indirectly pays for them.

When others are responsible When you receive money to compensate you for medical or hospital care for injuries for 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 at 1-800/ 638-8432 for our subrogation
procedures. 53
53 Page 54 55
2002 Rural Carrier Benefit Plan 54 Section 10
Section 10. Definitions of terms we use in this brochure
Acupuncture The technique of passing long thin needles through the skin into specific external body locations to relieve pain, to produce regional anesthesia, or for other therapeutic
purposes.

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.

Chiropractic A system of therapy that attributes disease to abnormal function of the nervous system and attempts to restore normal function by manipulation of the spinal column and other
body structures.

Copayment A copayment is a fixed amount of money you pay when you receive covered services. See page 11.

Coinsurance Coinsurance is the percentage of our allowance that you must pay for your care. You may also be responsible for additional amounts. See page 11.
Covered services Services we provide benefits for, as described in this brochure.
Custodial care Treatment or services, no matter who recommends them or where you receive them, which a person without medical skills can provide safely and reasonably. In addition,
treatment and services designed mainly to help the patient with daily living activities. These include:

personal care like help in: walking; getting in and out of bed; bathing; eating (by spoon, gastostomy or tube); exercising; dressing
homemaking services, like preparing meals or special diets
moving the patient
acting as a companion or sitter
supervising the taking of medication that can usually be self-administered; or
treatment or services that anyone can perform with minimal training like recording temperature, pulse and respirations or administering and monitoring a feeding

system.
We determine what treatments or services are custodial care.

Deductible A deductible is a fixed amount of covered expenses you must incur for certain covered services and supplies before we start paying benefits for those services. See page 11.

Experimental / A drug, device or biological product is experimental or investigational if the drug, investigational services device or biological product cannot be lawfully marketed without the approval of the
U. S. Food and Drug Administration (FDA) and approval for marketing has not been given at the time it is furnished to you. Approval means all forms of acceptance by the
FDA.
A medical treatment or procedure, or a drug, device or biological product is experimental or investigational if:

reliable evidence shows that it is the subject of on-going phase I, II or III clinical trials or under study to determine its maximum tolerated dose, its toxicity, its safety,
its efficacy, or its efficacy as compared with the standard means of treatment or diagnosis; or 54
54 Page 55 56
2001 Rural Carrier Benefit Plan 55 Section 10
reliable evidence shows that the consensus of opinion among experts regarding the drug, device, or biological product or medical treatment or procedure is that further
studies or clinical trials are necessary to determine its maximum tolerated dose, its toxicity, its safety, its efficacy or its efficacy as compared with the standard means
of treatment or diagnosis.
Reliable evidence shall mean only published reports and articles in the authoritative medical and scientific literature; the written protocol or protocols used by the treating
facility or the protocol( s) of another facility studying substantially the same drug, device or medical treatment or procedure; or the written informed consent used by the
treating facility or by another facility studying substantially the same drug, device or medical treatment or procedure.

Hospital admission An admission (or series of admissions separated by less than 60 days) to a hospital as an inpatient for any illness or injury. You start a new hospital stay: (1) when the
admission is for a cause unrelated to the previous admission; (2) when an employee returns to work for at least one day before the next admission; or (3) when the hospital
stays are separated by at least 60 days for a dependent or retiree.

Medical necessity Services, supplies, drugs, or equipment provided by a hospital or covered provider of the health care services that we determine:
are appropriate to diagnose or treat the patient's condition, illness or injury;
are consistent with standards of good medical practice in the United States;
are not primarily for the personal comfort or convenience of the patient, the family, or the provider;

are not a part of or associated with the scholastic education or vocational training of the patient; and
in the case of inpatient care, cannot be provided safely in an outpatient setting.
The fact that a covered provider prescribes, recommends, or approves a service, supply, drug or equipment does not, by itself, make it a medical necessity.

Plan allowance Our Plan allowance is the amount we use to determine our payment and your coinsurance for covered services. Fee-for-service plans determine their allowances in
different ways. We determine our allowance as follows:
We base our Plan allowance on reasonable and customary charges. Reasonable and customary charges are those charges that are comparable to charges made by other
providers for similar services and supplies under comparable circumstances in the same geographic area. We develop the Plan's allowances from actual claims received in each
zip code throughout the United States, as complied by the Health Insurance Association of America. We review and update the allowances twice a year (January 1
and July 1), using the 90th percentile for all charges for a medical procedure. Preferred providers accept the plan allowance as payment in full. For certain services, exceptions
may exist to this general method for determining the Plan's allowance.
For more information, see Differences between our allowance and the bill in Section 4.

Us/ We Us and we refer to the Rural Carrier Benefit Plan.
You You refers to the enrollee and each covered family member. 55
55 Page 56 57
Section 11. FEHB facts
No pre-existing condition We will not refuse to cover the treatment of a condition that you had before you limitation enrolled in this Plan solely because you had the condition before you enrolled.

Where you can get information See www. opm. gov/ insure. Also, your employing or retirement office can answer your about enrolling in the questions, and give you a Guide to Federal Employees Health Benefits Plans,
FEHB Program 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 spouse, for you and your family 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 joined this Plan during premiums start Open Season, your coverage begins on the first day of your first pay period that starts
on or after January 1. Annuitants' coverage and premiums begin on January 1. If you joined at any other time during the year, your employing office will tell you the
effective date of coverage

2002 Rural Carrier Benefit Plan 56 Section 11 56
56 Page 57 58
Your medical and claims We will keep your medical and claims information confidential. Only records are confidential the 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 coordinating 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 coverage ends You will receive an additional 31 days of coverage, for no additional 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.

Temporary Continuation If you leave Federal service, or if you lose coverage because you no longer qualify as of Coverage (TCC) 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, if you lose your Federal job, if your child turns 22 or
marries, etc.
Enrolling in TCC. 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. It explains what you have to do to enroll.

2002 Rural Carrier Benefit Plan 57 Section 11 57
57 Page 58 59
Converting to You may convert to a non-FEHB individual policy if: individual coverage
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 The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a Group Health Plan Coverage Federal law that offers limited Federal protections for health coverage availability and
continuity to people who lose employer group coverage. If you leave the FEHB Program, we will give you a Certificate of Group 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, limitations, 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.
For more information get OPM pamphlet RI 79-27, Temporary Continuation of Coverage (TCC) under the FEHB Program. See also the FEHB web site
(www.opm.gov/insure/health); refer to the "TCC and HIPAA" frequently asked questions. These highlight HIPAA rules, such as the requirement that Federal
employees must exhaust any TCC eligibility as one condition for guaranteed access to individual health coverage under HIPAA, and have information about Federal and State
agencies you can contact for more information.

2002 Rural Carrier Benefit Plan 58 Section 11 58
58 Page 59 60
Long Term Care Insurance Is Coming Later in 2002!
Many FEHB enrollees think their health plan and/ or Medicare covers long-term care. Unfortunately, they are WRONG!
How are YOU planning to pay for the future custodial or chronic care you may need? Consider buying long term care insurance.

The Office of Personnel Management (OPM) will sponsor a high-quality long term care insurance program effective in October 2002. As part of its educational effort, OPM asks you to consider these questions:
What is long term care (LTC) insurance?
It's insurance to help pay for long term care services you may need if you can't take care of yourself because of an extended illness or injury, or an age-related disease such as Alzheimer's.

LTC insurance can provide broad, flexible benefits for care in a nursing home, in an assisted living facility, in your home, adult day care, hospice care, and more. Long term care insurance can supplement care provided by family
members, reducing the burden you place on them.

I'm healthy. I won't need long term care. Or, will I?
76% of Americans believe they will never need long term care, but the facts are that about half of them will. And it's not just the old folks. About 40% of people needing long term care are under age 65. They may need chronic care due

to a serious accident, a stroke, or developing multiple sclerosis, etc.
We hope you will never need long term care, but you should have a plan just in case. LTC insurance may be vital to your financial and retirement planning.

Is long term care expensive?
Yes. A year in a nursing home can exceed $50,000 and only three 8-hour shifts a week can exceed $20,000 a year, that's before inflation!

LTC can easily exhaust your savings but LTC insurance can protect it.

But won't my FEHB plan, Medicare or Medicaid cover my long term care?
Not FEHB. Look under "Not covered" in sections 5( a) and 5( c) of your FEHB brochure. Custodial care, assisted living, or continuing home health care for activities of daily living are not covered. Limited stays in skilled nursing facilities

can be covered in some circumstances.
Medicare only covers skilled nursing home care after a hospitalization with a 100 day limit.
Medicaid covers LTC for those who meet their state's guidelines, but restricts covered services and where they can be received. LTC insurance can provide choices of care and preserve your independence.

When will I get more information?
Employees will get more information from their agencies during the late summer/ early fall of 2002.
Retirees will receive information at home.

How can I find out more about the program NOW?
A toll-free telephone number will begin in mid-2002. You can learn more about the program now at www.opm.gov/insure/ltc.

2002 Rural Carrier Benefit Plan 59 Long Term Care Insurance 59
59 Page 60 61
Index
Do not rely on this page; it is for your convenience and may not show all pages where the terms appear.

Accidental injury 31 Allergy tests 19
Allogenetic (donor) bone marrow transplant 26
Alternative treatments 5, 23 Ambulance 30, 31
Anesthesia 27 Autologous bone marrow transplant 26
Biopsies 24, 26 Birthing center 8
Blood and blood plasma 29 Breast cancer screening 17
Casts 24, 29, 31 Catastrophic protection 12
Changes for 2002 6 Chemotherapy 20
Childbirth 18, 24 Chiropractic 23
Cholesterol tests 17 Circumcision 24
Claims 45, 46, 50 Coinsurance 11, 54
Colorectal cancer screening 17 Congenital anomalies 24, 25
Contraceptive devices and drugs 18, 24, 39
Coordination of benefits 49-53 Covered charges 11, 54
Covered providers 7 Crutches 22
Deductible 11, 54 Definitions 54-55
Dental care 41-42 Diagnostic services 16-17
Disputed claims review 47-48 Donor expenses (transplants) 27
Dressings 29 Durable medical equipment 22
Educational classes and programs 23 Effective date of enrollment 7, 54
Emergency 9, 14, 31 Experimental or investigational 44, 54
Eyeglasses 21, 43, 44 Family planning 18
Fecal occult blood test 17

Flexible benefits option 40 Foot care 21
Freestanding ambulatory facilities 27, 29, 33, 35
General Exclusions 44 Hearing services 20, 43
Home health services 22 Hospice care 8, 30
Home nursing care 22 Hospital 8
Immunizations 17 Infertility 19
Inhospital physician care 16 Inpatient Hospital Benefits 28-29
Insulin 39 Laboratory and pathological services 17
Machine diagnostic tests 17 Magnetic Resonance Imaging
(MRI) 17 Mail Order Prescription Drugs 37-39
Mammograms 17 Maternity Benefits 18
Medicaid 53 Medically necessary 55
Medically underserved areas 7 Medicare 13-14, 49-52
Mental Conditions/ Substance Abuse Benefits 32-36
Neurological testing 17 Newborn care 18, 24
Non-FEHB Benefits 43 Nurse 7, 22
Licensed Practical Nurse 22 Nurse Midwife 7
Nurse Practitioner 7 Registered Nurse 22
Nursery charges 18 Nursing School Administered Clinic 7
Obstetrical care 18, 24 Occupational therapy 20
Ocular injury 21 Office visits 16, 32, 36
Oral and maxillofacial surgery 26 Orthopedic devices 21
Out-of-pocket expenses 12, 34, 36

Outpatient facility care 29, 33, 35 Overseas claims 46
Oxygen 22 Pap test 17
Physical examination 16 Physical therapy 20
Physician 7, 16, 31 Pre-admission testing 17, 34, 36
Preauthorization 34 Precertification 9-10
Preferred Provider Organization (PPO) 5 Prescription drugs 37-39
Preventive care, adult 17 Preventive care, children 17
Prostate cancer screening 17 Prosthetic devices 21, 24
Psychologist 7 Psychotherapy 33, 36
Radiation therapy 20 Renal dialysis 40
Room and board 28, 35 Second surgical opinion 16
Skilled nursing facility care 8, 10, 30 Smoking cessation 23
Social Worker 7, 32 Speech therapy 20
Splints 29 Sterilization procedures 18, 24
Subrogation 53 Substance abuse 32, 36
Surgery 24-27 Anesthesia 27
Assistant surgeon 24 Multiple procedures 25
Oral 26 Outpatient 24-27
Reconstructive 25 Syringes 39
Temporary continuation of coverage 57 Transplants 26-27
Vision services 21, 43 Well child care 16, 17
Wheelchairs 22 Workers' compensation 53
X-rays 17, 29, 41

2002 Rural Carrier Benefit Plan 60 Index 60
60 Page 61 62
2002 Rural Carrier Benefit Plan 61 Summary
Summary of benefits for the Rural Carrier Benefit Plan -2002
Do not rely on this chart alone. All benefits are subject to the definitions, 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.
Below, an asterisk (*) means the item is subject to the $350 calendar year deductible. And, after we pay, you generally pay any difference between our allowance and the billed amount if you use a Non-PPO physician or other health care professional.

Benefits You pay Page
Medical services provided by physicians: PPO: $15/ office visit

Diagnostic and treatment services provided in the office ................. Non-PPO: 25% of our allowance and any 16 difference between our allowance and the
billed amount*
Surgery................................................................................................. PPO: 10% of our allowance 24-27
Non-PPO: 15% of our allowance and any difference between our allowance and the
billed amount
Services provided by a hospital: PPO: Nothing 28-30

Inpatient .............................................................................................. Non-PPO: $200 deductible per admission; nothing for room and board; 20% of other
charges
Outpatient ............................................................................................ PPO: 15% of our allowance*; nothing for 29 a surgical facility

Non-PPO: 25% of our allowance* and any difference between our allowance and the
billed amount, any difference between our allowance and the billed amount for a
surgical facility
Emergency benefits:
Accidental injury ................................................................................ Up to $400 31
Medical emergency.............................................................................. Regular benefits 16-30

Summary of benefits continued on next page 61
61 Page 62 63
2002 Rural Carrier Benefit Plan 62 Summary
Benefits You pay Page
Mental health and substance abuse treatment PPO: Nothing 32
Inpatient ............................................................................................... Non-PPO: $200 deductible per admission; 35 nothing for room and board; 20% of other
charges. For substance abuse, charges over $5,500 per treatment program

Outpatient ................................................................................................. PPO: 15% of our allowance* (no 33 deductible on physician visits)
Non-PPO: Charges over $75 per treatment 35-36 session (no deductible). For substance
abuse, charges over $5,500 for an aftercare program (combined with
inpatient)
Prescription drugs .................................................................................... Network and Non-network Pharmacy: 37-39 25% of the cost*

Mail Order Pharmacy: $13/ generic drug; $18/ brand name drug
Mail Order With Medicare Part B: $3/ generic; $6/ brand name drug
Dental Care ............................................................................................... Any difference between our scheduled 41-42 allowance and the billed amount
Special features: Flexible benefits option; Cancer treatment benefit; Kidney dialysis benefit; 24 hour nurse 40 line, Travel assistance program; Routine eye exam benefit
Protection against catastrophic costs PPO: Nothing after $2,500/ Person 12 (your out-of-pocket maximum) ............................................................... or $3,000/ Family per calendar year

Non-PPO: Nothing after $3,000/ Person or $3,500/ Family per calendar year.
Note: Benefit maximums apply and some costs do not count toward this protection 62
62 Page 63 64
2002 Rural Carrier Benefit Plan 63 Notes
Notes 63
63 Page 64
2002 Rate Information for
Rural Carrier Benefit Plan

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 RI 70-2B; and for the 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 who are not career postal employees. Refer to the applicable
FEHB Guide.

Non-Postal Premium Postal Premium
Biweekly Monthly Biweekly

Type of Gov't Your Gov't Your USPS Your Enrollment Code Share Share Share Share Share Share

High Option Self Only 381 N/ A N/ A $212.03 $130.35 $115.52 $42.50
High Option Self and Family 382 N/ A N/ A $484.06 $213.30 $263.75 $58.11 64

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