Entry in tables	Explanation
Personal Profile Questionnaire
Premium Type	This entry indicates your premium category. Premiums are not the same for GS, Postal, FDIC, and several other types of eligible employees. GS part-time employees pay part of the employer share of the premium. Annuitants pay the same before-tax premiums as GS employees, but do not get the approximately one third premium cost reduction ("premium conversion") tax shelter available to almost all employees.
Premium Conversion	A "Yes" means that your employee share is paid in pre-tax dollars; on average that results in a saving of about one third because you are not taxed on the amount you spend.
Family Size	Health costs vary with family size; we take this into account in rating plans. We do not have ratings for families larger than 5 (or for Medicare beneficiaries with covered children) but ratings for families of 5 or Medicare couples are good approximations.
Restricted Plans	Only if you are employed by an intelligence agency or the Defense Department are you likely to be eligible for enrollment in the two plans open only to workers (or annuitants) of those agencies. Similarly, only rural postal carriers (or annuitants) and annuitants who live in Panama can enroll in those two plans. See plan brochures for specific details.
Age	Health costs vary even more by age than by family size. We use age below 55, from 55 to 64, and 65 or above, in rating plans.
Medicare Status	When Medicare is primary and you have both Parts A and B, you can save a significant amount in reduced cost-sharing. However, you do not usually save more than about half the premium cost of Medicare.
Expected Health Care Use	We present ratings by average, low, or high expected health care use. Unless you are quite sure that your health care situation is unusual, we strongly recommend selecting "average." However, if you are in unusually good health and expect no more than an annual checkup, a dental visit, and a few prescriptions, you can select "low." If you expect a major operation in a hospital, we suggest selecting "high."
Zip Code Location	The FEHBP has both national plans and plans that serve only particular states or cities. You can choose the Zip code where you either live or work. If you live outside a plan's official enrollment area, in most cases you can still join if you are willing to travel that far for routine health care. We use the service area zip codes provided by the Office of Personnel Management. You should always consult the plan brochure to confirm service area.
Your Summary Rankings
Plan Code	This is a code assigned by OPM, unique to each plan in each geographic area. Use it to be sure you have the right plan and to enroll. Codes ending in a "1" or a "4" are for individuals, and in a "2" or a "5" for families, e.g., AB1 is a self only plan and AB2 a family plan.
Plan Name	This is the name of the plan. In some cases, we abbreviate the name to make our tables clearer.
Plan Type	Health Maintenance Organizations, or HMOs, are almost all Local plans. A few of these allow you to use providers outside the plan's network. This is called "Point-of-Service" (POS) and we label the few that provide this option as HMO-POS. Consumer Driven and High Deductible Plans offer a health savings account coupled with a high deductible and we label these CDHP or HDHP. These may be national or local plans. Almost all of the national plans offer both preferred provider benefits (PPO) and, if you use non-preferred providers, fee-for-service benefits (FEE). We present our cost comparisons for these national plans based on using preferred providers (PPO). All but one of the national plans gives you a better rate with affiliated providers, but allows you to go out of network should you choose to do so. We encourage you to read our Advice & Explanations section to gain a further understanding of how these plan types work and which may best meet your needs.
Published Premium ($)	This shows the premium you pay, even if you have no health care bills. If you indicate you are enrolled in Medicare Part B, it includes the Medicare premium. It does not reflect the tax-preferred discount you receive (approximately one third) if you participate in "premium conversion."
Yearly Cost if Health Care Use and Bills are None ($0)	This shows the yearly cost to you of the premium and dues, after tax savings through “premium conversion,” and savings from any applicable “health savings account.” This can be a negative number, meaning an actual savings to you, because your health savings account in HDHP or CDHP plans can be larger than your after-tax premium.
Yearly Cost for Self Only if Health Care Use and Bills are Low ($1,000)	This shows how much you are likely to pay for a few doctor visits (one of which is an annual checkup), minor dental services, and a few prescriptions. It is based on estimated costs of $1,000 for these services. Of course, it includes the premium and any dues.
Yearly Cost for Couples/Families if Health Care Use and Bills are Low ($2,500)	This shows how much you are likely to pay for a number of doctor visits (one of which is an annual checkup), minor dental services, and modest prescription drug spending. It is based on estimated costs of $2,500 for these services. Of course, it includes the premium and any dues.
Yearly Cost for Self Only Retiree or Annuitant if Health Care Use and Bills are Low ($2,500)	This shows how much you are likely to pay for a number of doctor visits (one of which is an annual checkup), minor dental services, and modest prescription drug spending. It is based on estimated costs of $2,500 for these services. Of course, it includes the premium and any dues.
Yearly Cost if Health Care Use and Bills are Average ($)	This is our estimate of the average annual cost to enrollees with the premium category, age, Medicare status, and family size that you selected. It includes both out-of-pocket medical, hospital, and dental costs that each plan does not reimburse, and premium and any dues. It is an average of estimated costs of years with a range of health care use both low and high, including spending levels not shown in the table. It includes only the after-tax cost of premiums if you are eligible for Premium Conversion, and reduces your cost by the amount of the health savings account in Consumer Driven and High Deductible plans.
Yearly Cost if Health Care Use and Bills are High ($25,000)	This estimate includes a major hospital visit and heavier use of outpatient services, drugs, and dental care. In most years most people do not enter the hospital, so this is a very conservative measure of potential costs. It includes the premium and any dues, and any savings from premium conversion or the health savings account in Consumer Driven and High Deductible plans.
Yearly Limit on Cost to You Excluding Dental/Most You Can Pay ($)	This is the plan's guarantee as to the most you can pay for hospital, medical, and drug costs, added to the premium cost (a for-sure expense). Our figure includes estimates for co-payments and deductibles that are not included in some plans' stated limits. However, it does not include dental costs because no plan limits these. The word “Gap” means that the plan either has no guarantee or one with so many exceptions that a meaningful amount cannot be estimated. Our figure in this column is often lower than the figure in the column for costs of $25,000 because we exclude dental costs of several thousand dollars in the Limits column. Like the other cost columns, it includes any savings from premium conversion (where premiums are deducted from your pay before taxes are deducted, saving you money) or the Health savings account available in Consumer Driven and High Deductible plans.
Overall Rating by Members (%)	This is the rating given the plan through a survey of enrollees conducted by an independent survey organization under the auspices of the National Committee for Quality Assurance (NCQA). The number shown is the percent who rated the plan 8, 9 or 10 on a scale of 0 to 10. Green (+)=Statistically better than average within plan type (HDHP/CDHP, HMO, PPO) ; Red (-)= Statistically lower than average within plan type (HDHP/CDHP, HMO, PPO).
Doctors in plan	This shows whether the doctor(s) you selected were found by CHECKBOOK the last time we looked at the health plans' online physician directory. Even when a doctor appears in a plan's directory, they may not be accepting new patients. Always call the office of a physician you wish to see to verify that they are in your plan's network and, if you are a new patient, that they are accepting new patients, before you enroll in a plan based on your desire to see a particular doctor or doctors.
Plan Contact Information (only displayed when you click the plan name)
Plan Telephone	The plan's main telephone number. Most plans have additional numbers for particular questions.
Plan Web Site	This link takes you to the plan's Web site. "None" means the plan does not have a Web site.
Enrollment Limitations	Here we indicate what restrictions, other than geographic area, may prevent you from joining a plan. This is a summary of the limitations; you will need to check the plan brochure for details if you think you may be eligible.
Cost Sharing (assuming you use preferred providers)
Savings Account ($)	For Consumer Driven and High Deductible plans with a savings account, we show the savings account contribution, because you will be able to use the savings account before reaching the deductible. These plans also exempt annual checkups and other preventive services from the deductible.
Regular Deductible ($)	This is the deductible, if any, that each person will have to pay before the plan will reimburse any medical expenses.
Extra Deductible for Hospital Stay ($)	Some plans charge a special deductible for at least the first hospital admission. If the deductible varies with the number of days in your stay, we give an average figure.
Extra Deductible for Drugs ($)	Some plans charge a special deductible before they reimburse prescription drugs.
Hospital Room and Board (%)	A few plans make you pay for a small percentage of hospital room and board charges.
Other Hospital Inpatient (%)	A few plans make you pay for a small percentage of other inpatient hospital charges.
Primary Care Doctor Visit ($ or %)	Some plans charge a percentage, most a dollar co-payment, for each visit to a preferred or affiliated provider primary care physician or provider.
Specialist Care Doctor Visit ($ or %)	Some plans charge a percentage, most a dollar co-payment, for each visit to a preferred or affiliated provider specialist physician or provider.
Prescription Drugs at Local Pharmacy -- Generic ($ or %)	Generic drugs are usually less expensive than name brand drugs still under patent. Some plans charge a percentage, most a dollar co-payment, for each prescription. In most cases, the amount specified allows a one month supply from the local pharmacy. See the plan brochure for details.
Prescription Drugs at Local Pharmacy -- Name Brand on Formulary ($ or %)	Most newer drugs are under patent and cost more. Some plans charge a percentage, most a dollar co-payment, for each prescription. In most cases the amount specified allows a one month supply from the local pharmacy. These "name brand" drugs are sometimes fully reimbursed only if you use those listed on a restricted "formulary" that only allows you to use a particular brand of drug for a condition. See the plan brochure for details.
Prescription Drugs at Local Pharmacy -- Name Brand off Formulary ($ or %)	Most plans allow you to use off-formulary drugs at a higher price. See the plan brochure for details.
Mail Order Prescription Drugs 90 Day Supply -- Generic on Formulary ($ or %)	A "yes" means that the plan gives you a substantial supply, often with a discount (usually a three month supply for the normal cost of one or two months) if you fill a prescription by mail order. Generic drugs are usually less expensive than name brand drugs still under patent. Some plans charge a percentage, most a dollar co-payment, for each prescription. In most plans you can use mail order for maintenance drugs and get a 90 day supply for the same amount, or at worst double the amount, as a 30 day supply at the local pharmacy. See the plan brochure.
Mail Order Prescription Drugs 90 Day Supply -- Name Brand on Formulary ($ or %)	In most plans, you can use mail order for maintenance "name brand" drugs and get a 90 day supply for the same amount, or at worst double the amount as a 30 day prescription at the local pharmacy. Some plans charge a percentage, most a dollar co-payment, for each prescription. These "name brand" drugs are sometimes fully reimbursed only if you use those listed on a restricted "formulary" that only allows you to use a particular brand of drug for a condition. See the plan brochure.
Mail Order Prescription Drugs 90 Day Supply -- Name Brand off Formulary ($ or %)	Some plans allow you to use off-formulary drugs at a higher price. See the plan brochure for details.
Coverage Features
Day Limit in Skilled Nursing Facility	The number of days of post-hospital skilled care that the plan covers.
Maximum Out-of-Network Mental Outpatient Benefit ($)	All plans cover low-cost mental outpatient care PROVIDED that the plan approves both the provider and the number of visits. Rarely are many visits approved. This entry indicates the amount potentially covered if you use a non-preferred provider without prior approval.
Vision Care	All plans cover the cost of medically necessary vision care. A "yes" means that the plan, in addition, will pay for refractions and roughly half or more of the cost of glasses or contact lenses; "exam" that the plan pays the cost of refractions.
Chiropractic	"Yes," "some" and "no" indicate the relative generosity of coverage.
Acupuncture	"Yes," "some" and "no" indicate the relative generosity of coverage.
Hearing Aids	A "yes" means that the plan pays part of the cost of a hearing aid for both children and adults. "Child" means that this benefit is available only for children. Most plans will pay for a hearing aid in the very rare situation that an accident causes loss of hearing; we do not code for this feature.
Diabetic Supplies	"Yes," "some" and "no" indicate the relative generosity of coverage.
Infertility Treatment	"Yes," "some" and "no" indicate the relative generosity of coverage.
Vision
Annual Premium ($)	This is the amount you will pay even if you don't use the plan. Since employees will be enrolling on a tax-preferred basis we show the net amount after the approximately one-third that you will save. Annuitants pay the entire premium without this reduction.
Copays ($)	These are the extra amounts, if any, that you will have to pay for a refractive exam, lenses, or frames.
Frame Allowance/Additional Discount	This is the retail value of the most expensive frame you get within the regular plan coverage and the additional discount, if any, that you get on higher priced frames.
Laser Vision Discount	"Yes" indicates that there is a plan-arranged discount with affiliated providers of Laser treatment for correcting your vision.
Out of Network	This indicates that the plan offers a benefit at non-affiliated providers, but that the benefit is reduced.
Dental
Published Premium ($)	The standalone dental plans charge an extra premium. However, dental benefits in the health insurance plans require no extra premium. The amount shown is the actual charge, with no tax benefits.
Approximate Yearly Cost to You ($) If your Dental Usage is None	This shows the yearly cost to you of the premium, after tax savings through "premium conversion."
Approximate Yearly Cost to You ($) If your Dental Usage is Low	This shows the total cost, both premium (after tax savings through "premium conversion") and out of pocket expense, if your dental costs are entirely for preventive services, such as annual examination, cleaning, and x-rays.
Approximate Yearly Cost to You ($) If your Dental Usage is Average	This shows the total cost, including both premium (after tax savings through "premium conversion") and out of pocket expense, if your dental costs, for both preventive and restorative services, are at the level that is roughly average for all persons or families.
Approximate Yearly Cost to You ($) If your Dental Usage is High	This shows the total cost, including both premium (after tax savings through "premium conversion") and out of pocket expense, if your dental costs, for both preventive and restorative services, are at a level that is roughly triple the average for all persons or families.
Orthodontic	All of the standalone dental plans have a substantial orthodontic benefit. Plans try to discourage you from joining at the last minute to take advantage of these benefits, by imposing waiting periods on eligibility. Orthodontics is the perfect dental expense for combining a dental plan with an FSA account for expenses the plan doesn’t cover.
Out of Network Benefit	Most dental plans do provide out of network coverage. But that coverage is either lower, or loses you the network discount, or both. These plans are good buys only when you plan to make regular use of network providers.
Plan Flexibility
Get Regular Benefits When Outside Plan's Local Area from Partner Plans	Some HMO plans will let you use partner HMOs elsewhere without paying any extra charges for routine care. All plans pay for emergency care anywhere in the world without substantial penalty.
Some Coverage When Using Doctors Not on Plan's Provider List (non-emergency)	All fee for service plans (except Blue Cross Basic), and some HMOs, let you use physicians and other providers who are not "preferred" if you are willing to pay extra for benefits. When HMOs provide this option, it is called "point-of-service" (POS) or "opt-out".
Specialist Visits Covered Without Referral -- Gynecologist	All fee-for-service plans and almost all HMOs now let women get their regular ob-gyn checkups with preferred providers without requiring referral by a primary care physician.
Specialist Visits Covered Without Referral -- Other Specialists	All fee-for-service plans and most HMOs now let you go to any specialist on the preferred provider list without referral by a primary care physician.
Open Formulary	Many plans use a "formulary" that limits your choice of drugs. You have to pay much more, and sometimes the entire cost, if you choose a name brand drug for your condition that is not on the formulary. "Yes" means no restrictions, either no formulary or one that is advisory only. "Pay More" means a higher, tiered copayment, and "No" means either impossible or very difficult to be covered for an off formulary drug. When available, CHECKBOOK attempts to provide a link to the plan's formulary on the plan detail page. You should always consult the plan brochure and plan's website to confirm formulary and drug considerations prior to enrolling in a plan.
Company Offers a Local Medicare Advantage Plan	Medicare-eligible enrollees can leave FEHBP for a Medicare Advantage plan and then come back to an FEHBP plan at the next open season. Some companies offer FEHBP and Medicare Advantage plans. With these plans, you can switch from the FEHBP to a Medicare Advantage plan without leaving your health plan company.
Ratings by Members Green (+)=Statistically better than average within plan type (HDHP/CDHP, HMO, PPO); Red (-)= Statistically lower than average within plan type (HDHP/CDHP, HMO, PPO).
Accreditation	There are four organizations that accredit health plans. Two of these, called NCQA and JCAHO, accredit HMOs and review a wide range of quality-related management and medical practices. One, called URAC, accredits disease management practices in national plans. AAAHC also accredits plans. "Yes" means that the plan is accredited by one or more of these organizations.
Overall Plan Rating (%)	This is the percent of member survey respondents who rated the plan 8, 9, or 10 overall, on a scale of 0 to 10.
Overall Care in Plan (%)	This shows the percentage of respondents who rated the health care provided through the plan 8,9, or 10 overall, on a scale of 0 to 10.
Getting Needed Care  (%)	This shows the percentage of respondents who said they had not had a problem getting needed care (for example, getting a referral to a specialist or getting the care the member or the member's doctor believed was necessary).
Getting Care Quickly  (%)	This shows the percentage of respondents who gave the plan one of the two highest scores for this dimension of quality.
How Well Doctors Communicate  (%)	This shows the percentage of respondents who gave the plan one of the two highest scores for this dimension of quality.
Plan's Customer Service (%)	This shows the percentage of respondents who gave the plan one of the two highest scores for this dimension of quality.
Plan's Claims Processing (%)	This shows the percentage of respondents who gave the plan one of the two highest scores for this dimension of quality.
Overall Rating of Personal Doctor (%)	This is the percent of member survey respondents who rated their personal doctor 8, 9, or 10 overall, on a scale of 0 to 10.
Overall Rating of Most Frequently Used Specialist (%)	This is the percent of member survey respondents who rated the specialist they saw most frequently 8, 9, or 10 overall, on a scale of 0 to 10.
Getting Referrals to Specialists (%)	This is the percentage of member survey respondents who said they or their doctor thought they had needed a “specialist” in the past 12 months who said they had not had a problem getting a referral.
Getting Care You or Believed Necessary (%)	This is the percentage of member survey respondents who said they had gone to a doctor’s office in the past 12 months who said they had not had a problem getting the care they believed necessary.
Getting Explanations You Could Understand from Doctors (%)	This shows the percentage of respondents who gave the plan one of the two highest scores for this dimension of quality.
How Often Personal Doctors Listened Carefully to You (%)	This shows the percentage of respondents who gave the plan one of the two highest scores for this dimension of quality.
Getting Appointment When Sick (%)	This is the percentage of member survey respondents who said they had needed care right away for an illness or injury in the past 12 months who said they usually or always got care as soon as they wanted.
Getting Enough Time With Doctor (%)	This is the percentage of member survey respondents who said they had gone to a doctor’s office or clinic in the past 12 months who said their doctor spent enough time with them.