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UnitedHealthCare Insurance，Inc。
如果您已加入此计划，则有权获得此手册中所述的好处。如果您参加了自我加一个或自我和家庭保险，则每个合格的家庭成员也有权获得这些好处。If you are a Postal Service annuitant and you are eligible for Medicare Part D, or a covered Medicare Part D-eligible family member of a Postal Service annuitant, your prescription drug benefits are provided under our Medicare Part D Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP) unless you choose to opt in to the UnitedHealthcare Retiree Advantage plan which includes Part D prescriptions drugs.您无权根据FEHB计划获得的福利权，除非此PSHB计划手册中也显示了这些福利。
2024 FEHB计划绩效评估程序手册
Definitions of Terms We Use in This Brochure .....................................................................................................175 Index ..........................................................................................................................................................................................184 Summary of Benefits for the Aetna HealthFund CDHP Plan - 2025 ................................................................................................................................................................................................................. 189
2025
共同保险 ................................................................................................................................................................................27 共付额 ................................................................................................................................................................................27 费用分摊 ................................................................................................................................................................................27 自付额 ................................................................................................................................................................................27 如果您的提供商定期免除您的费用 .............................................................................................................................................28 豁免 ................................................................................................................................................................................28 我们的补贴和账单之间的差异 .............................................................................................................................................28 您的自付额、共同保险和共付额的灾难保护最高自付额 .............................................................................................................30 结转 ................................................................................................................................................................................30 如果我们多付了您 ................................................................................................................................................................31 当政府机构向我们开具账单时 ......................................................................................................................................31 关于意外账单的重要通知 - 了解您的权利 .............................................................................................................................31 第 5 节。Elevate Plus 和 Elevate Option 福利...........................................................................................................32 Elevate Plus 和 Elevate 概述 ......................................................................................................................................34 计划成员可享受的非 PSHB 福利 ......................................................................................................................................114 第 6 节。一般排除条款 - 我们不承保的服务、药品和用品 .............................................................................................115 第 7 节。为承保服务提出索赔 .............................................................................................................................116 第 8 节。有争议的索赔流程 ........................................................................................................................................................................119 第 8(a) 节。联邦医疗保险 PDP EGWP 索赔争议流程 ......................................................................................................................122 第 9 节。协调联邦医疗保险和其他保险的福利 ......................................................................................................................125
农村运营商福利计划
如果您参加了该计划，您有权享受本手册中描述的福利。如果您参加了 Self Plus One 或 Self and Family 保险，则每个符合条件的家庭成员也有权享受这些福利。如果您是邮政服务年金受益人，并且您有资格享受 Medicare Part D，或者是邮政服务年金受益人的符合 Medicare Part D 资格的家庭成员，您的处方药福利将根据我们的 Medicare Part D 处方药计划 (PDP) 雇主团体豁免计划 (EGWP) 或我们的 Medicare Advantage 处方药计划 (MAPD) 提供，如果您选择参加我们专为 RCBP 成员设计的 MAPD 选项。您无权享受 FEHB 计划在 2025 年 1 月 1 日之前提供的福利，除非这些福利也在本 PSHB 计划手册中显示。
2025
如果您参加了该计划，您有权享受本手册中描述的福利。如果您参加了 Self Plus One 或 Self and Family 保险，则每个符合条件的家庭成员也有权享受这些福利。如果您是邮政服务年金受益人，并且您有资格享受 Medicare Part D，或者是邮政服务年金受益人的符合 Medicare Part D 资格的家庭成员，您的处方药福利将根据我们的 Medicare Part D 处方药计划 (PDP) 雇主团体豁免计划 (EGWP) 或我们的 Medicare Advantage 处方药计划 (MAPD) 提供，如果您选择参加我们专为 RCBP 成员设计的 MAPD 选项。您无权享受 FEHB 计划在 2025 年 1 月 1 日之前提供的福利，除非这些福利也在本 PSHB 计划手册中显示。
了解邮政服务健康福利 (PSHB) 计划
OPM 于 2024 年 5 月 24 日发布了拟议规则制定通知 (NPRM)，提议符合 Medicare 资格的个人自动加入 Medicare Part D 作为其 PSHB 计划的一部分。符合 Medicare 资格的个人将被允许选择不通过 PHSB Medicare Part D 计划自动获得处方药保险。根据此提案，如果符合 Medicare 资格的 PSHB 参与者选择退出或取消 Medicare Part D 保险，他们将无法通过其 PSHB 计划获得处方药福利，但仍可以加入单独的 Medicare Part D 计划或作为受保家庭成员获得 Medicare Part D 保险。如果个人选择退出或取消 Medicare Part D 雇主团体豁免计划 (EGWP)，他们将可以在下一个开放季节再次通过 PSHB 加入 Medicare Part D。
CL2023-20免疫覆盖范围
Definitions of Terms We Use in This Brochure .....................................................................................................198 Index ..........................................................................................................................................................................................207 Summary of Benefits for the HDHP of the Aetna HealthFund Plan - 2025 ................................................................................................................................................................................. 213 AETNA直接健康计划的福利摘要-2025 ...............................................................................................................................................................................................................................................................................................................................................................................
MHBP
我们在此手册中使用的术语的定义................................................................................................................................................................................................................................................................................................................................................... 131索引............................................................................................................................................................................................................. .................................................................... 142
HMSA 计划
费用分摊................................................................................................................................................................26 共同支付................................................................................................................................................................26 免赔额................................................................................................................................................................26 符合条件的费用................................................................................................................................................26 共同保险................................................................................................................................................................27 我们的计划津贴和账单之间的差异.............................................................................................................................27 您的灾难保护自付最高限额.............................................................................................................................27 结转.............................................................................................................................................................................28 当政府机构向我们收费时.............................................................................................................................................28 关于意外账单的重要通知 - 了解您的权利............................................................................................................28 第 5 节。高额和标准选项福利.............................................................................................................................29 第 5 节。高额和标准选项福利概述.............................................................................................................................31 第 5(a) 节。医生和其他医疗专业人士提供的医疗服务和用品......................................................................................32 第5(b)节 医生和其他医疗专业人士提供的外科和麻醉服务..............................................................................51 第5(c)节 医院或其他机构提供的服务以及救护车服务.........................................................................................................60 第5(d)节 紧急服务/事故....................................................................................................................................64 第5(e)节 精神健康和物质使用障碍福利.........................................................................................................................68 第5(f)节 处方药福利.........................................................................................................................................71 第5(f)(a)节PDP EGWP 处方药福利 ......................................................................................................................................83 第 5(g) 节。牙科福利 ......................................................................................................................................................98 第 5(h) 节。健康和其他特殊功能 ................................................................................................................................101 第 5(i) 节。服务点福利 ................................................................................................................................................104 计划成员可享受的非 PSHB 福利 ......................................................................................................................................106
最终报告：2024财政年度的高层管理挑战
Definitions of Terms We Use in This Brochure .....................................................................................................157 Index ..........................................................................................................................................................................................167 Summary of Benefits for the Blue Cross and Blue Shield Service Benefit Plan Standard Option - 2025 ........................................................................................ 169