U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

This is a general description of the plan changes. This page is not an official statement of benefits. For that, go to the Benefits descriptions in the Plan Brochure. Also, we edited and clarified language throughout the brochure; any language change not shown here is a clarification that does not change benefits.

• Enrollment Code 2U. Your share of the non-Postal premium will decrease by 4.2% for Self Only and decrease by 7.3% for Self and Family.

• Enrollment Code 2X. Your share of the non-Postal premium will increase by 0.3% for Self Only and increase by 3.1% for Self and Family.

• Enrollment Code 6J. Your share of the non-Postal premium will increase by 17.0% for Self Only and increase by 4.2% for Self and Family.

• Enrollment Code 7D. Your share of the non-Postal premium will increase by 1.0% for Self Only and decrease by 2.3% for Self and Family.

• Enrollment Code 8J. Your share of the non-Postal premium will decrease by 5.6% for Self Only and decrease by 5.6% for Self and Family.

• Enrollment Code JC. Your share of the non-Postal premium will increase by 22.0% for Self Only and increase by 45.4% for Self and Family.

• Enrollment Code P3. Your share of the non-Postal premium will increase by 1.3% for Self Only and decrease by 2.2% for Self and Family.

• Enrollment Code RD. Your share of the non-Postal premium will increase by 7.9% for Self Only and decrease by 0.4% for Self and Family.

• Enrollment Code UB. Your share of the non-Postal premium will increase by 3.0% for Self Only and decrease by 6.6% for Self and Family.

• Enrollment Code WQ. Your share of the non-Postal premium will increase by 10.6% for Self Only and increase by 10.6% for Self and Family.

• We now charge a copay for allergy injections, whether you receive them from a doctor or nurse. Your injections will be subject to a $20 copay for each visit to a primary care physician, or a $25 copay for each visit to a specialist. (Section 5(a))

• We are reducing coverage of artificial insemination to 3 cycles per lifetime. (Section 5(a))

• We now cover autologous tandem transplants for ovarian cancers, as well as for testicular cancers. (Section 5(b))

• We reduced a portion of our Service Area for 2004. If you are in enrollment Code 6J (Nashville, TN), and live or work in the following counties: Hickman, Humphreys, Lawrence, Lincoln, Marshall, Maury, Perry, and Wayne, you must select another FEHB plan during Open Season to continue to receive full benefits. If you do not select another FEHB plan during Open Season, you will be covered only for emergency services received outside the Service Area. (See page 13)

• We reduced a portion of our Service Area for 2004. If you are in Enrollment Code 2X (San Diego, CA area only), and live or work in the following town in Riverside county: Moreno Valley, you must select another FEHB plan during Open Season to continue to receive full benefits. If you do not select another FEHB plan during Open Season, you will be covered only for emergency services received outside the Service Area. (See page 11)

• We added the following to the Service Area in the State of Tennessee: Montgomery county in the Nashville area (Enrollment Code 6J). (See page 13)

• We added the following to the Service Area in the State of California: the city of San Diego and the counties of San Diego and San Luis Obispo (Enrollment Code 2X). (See page 11)

• We added a new Service Area in the State of Nevada: the city of Las Vegas and the entire county of Clark; and a portion of Nye county as defined by the town of Pahrump (Enrollment Code Y1). (See page 12)

• We added a new Service Area in the State of Pennsylvania: the city of Pittsburgh and the entire counties of Allegheny, Armstrong, Beaver, Blair, Butler, Cambria, Clarion, Fayette, Greene, Lawrence, Somerset, Washington, and Westmoreland (Enrollment Code YE). (See page 13)

• We added a new Service Area in the State of Oklahoma serving Oklahoma City and Tulsa, and various surrounding full and partial counties (Enrollment Code SL). (See page 13 for a detailed description of the Service Area)

• We added a new Service Area in the State of Texas serving Austin and San Antonio, and various surrounding full and partial counties (Enrollment Code P1). (See page 14 for a detailed description of the Service Area)

• We added a new Service Area in the State of Texas serving Dallas/Fort Worth and Houston, and various surrounding full and partial counties (Enrollment Code PU). (See page 14 for a detailed description of the Service Area)

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Special Notice 1. Members in Enrollment Code 6J (Nashville, TN): We reduced a portion of our Service Area for 2004. If you are in enrollment Code 6J and live or work in the following counties: Hickman, Humphreys, Lawrence, Lincoln, Marshall, Maury, Perry, and Wayne, you must select another FEHB plan during Open Season to continue to receive full benefits. If you do not select another FEHB plan during Open Season, you will be covered only for emergency services received outside the Service Area

. Special Notice 2. Members in Enrollment Code 2X (San Diego, CA area only): We reduced a portion of our Service Area for 2004. If you are in enrollment Code 2X and live or work in the following town in Riverside county: Moreno Valley, you must select another FEHB plan during Open Season to continue to receive full benefits. If you do not select another FEHB plan during Open Season, you will be covered only for emergency services received outside the Service Area.