522 Health Insurance Plans Available


Reference Note:

For more material about the information in 522, see:

522.1 Types of Participating Plans

522.11 Fee-for-Service Plans with a Preferred Provider Organization

Nationwide plans are available to all eligible Postal Service employees no matter where they reside. Employees may use medical providers of choice; however, medical providers who have contracted with the PPO network or health plan may offer discounted charges. Plans will either pay medical providers directly or reimburse employees for covered services after claims are filed. The amount the plan pays may depend on whether the provider has a participation agreement with the PPO network or health plan.

522.12 Fee-for-Service PPO Only Plans

PPO Only plans provide medical services only through medical providers who have contracts with the plan. With few exceptions, there is no medical coverage if employees or their family members receive care from providers not contracted with the plan.

522.13 Fee-for-Service Employee Organization Plans

Employee organization plans are sponsored by an employee organization or union and are available only to employees who are, or who become members of the particular sponsoring organization. Generally, these plans provide benefits by cash reimbursement to either the employee or, at the employee’s request, directly to doctors and hospitals. Information concerning membership is obtained from the local representative or directly from the headquarters office of the employee organization or union.

522.14 Health Maintenance Organization and Point-of-Service Plans

Health Maintenance Organization (HMO) and Point-of-Service (POS) plans are available to employees in certain geographic localities only. These plans are either:

  1. A group-practice plan that provides benefits in the form of medical services by teams of doctors and technicians practicing in their own medical centers;
  2. An individual-practice plan that provides direct payments to doctors with whom the plan has an agreement; or
  3. A mixed model plan that is a combination of a group practice and an individual practice plan.

These plans also provide hospital benefits. The enrollment area for each plan is stated in its brochure.

522.15 High Deductible and Consumer-Driven Health Plans

High Deductible Health Plans (HDHPs) provide comprehensive coverage with higher annual deductibles and annual out-of-pocket limits than other insurance plans. HDHPs can have first-dollar coverage (no deductible) for preventive care. HDHPs offered by the FEHB Program establish and partially fund Health Savings Accounts (HSAs) for all eligible enrollees and provide comparable Health Reimbursement Arrangements (HRAs) for enrollees who are not eligible for HSAs.

With Consumer-Driven Health Plans, eligible in-network preventive care is covered in full and employees use their designated health care funds for any other covered care. If employees use up their health care funds, traditional medical coverage begins after their deductibles are satisfied.

522.2 Description of Participating Plans

Each plan has a brochure that fully describes the benefits, maximums, limitations, exclusions, and other provisions of the respective plan.