This Plan is a health maintenance organization (HMO). OPM requires that FEHB plans be accredited to validate that plan operations and care management meet nationally recognized standards. SelectHealth, Inc. holds the following accreditation: National Committee for Quality Assurance (www.ncqa.org). To learn more about the plan's accreditation please visit the following website: www.ncqa.org. We require you to see specific physicians, hospitals, and other providers (including lab and pathology providers) that contract with us. These Plan providers coordinate your healthcare services. We are solely responsible for the selection of these providers in your area. Contact us for a copy of our most recent provider directory. We give you a choice of enrollment in a Standard Option or a High Deductible Health Plan (HDHP).
HMOs emphasize preventive care such as routine office visits, physical exams, well-baby care, and immunizations, in addition to treatment for illness and injury. Our providers follow generally accepted medical practice when prescribing any course of treatment.
When you receive services from Plan providers, you will not have to submit claim forms or pay bills. You pay only the copayments, coinsurance, and deductibles described in this brochure. When you receive urgent and/or emergency services from non-Plan providers, you may have to submit claim forms.
You should join an HMO because you prefer the plan's benefits, not because a particular provider is available. You cannot change plans because a provider leaves our Plan. We cannot guarantee that any one physician, hospital, or other provider will be available and/or remain under contract with us.
General features of our Standard Option
You do not have to select a Primary Care Provider (PCP); you may self-refer to Plan specialists. However, we recommend that you select a PCP to coordinate all of your medical care. A PCP should practice one of the following disciplines: General Practice, Family Medicine, Internal Medicine, Obstetrics/Gynecology (OB/GYN), or Pediatrics. You are responsible for making sure that a provider is a participating provider. To contact Member Services, call 844-345-FEHB weekdays, from 7 a.m. to 8 p.m., and Saturdays, from 9 a.m. to 2 p.m., or visit our website at www.selecthealth.org/fehb. Representatives are available during extended hours to answer questions and help resolve concerns. Member Services can provide you with information about participating providers such as name, address, phone number, professional qualifications, specialty, medical school attended, residency completed and board certification status. SelectHealth, Inc. offers foreign language assistance. Member Services can also provide you with information about receiving care after business hours.
We have Open Access benefits
Our HMO offers open access benefits. This means you can receive covered services from a participating provider without a required referral from your primary care provider or by another participating provider in the network.
How we pay providers
We contract with individual physicians, medical groups, and hospitals to provide the benefits in this brochure. These Plan providers accept a negotiated payment from us, and you will only be responsible for your cost-sharing (deductible, if applicable, copayments, coinsurance, and non-covered services and supplies).
General features of our High Deductible Health Plan (HDHP)
HDHPs have higher annual deductibles and annual out-of-pocket maximum limits than other types of FEHB plans. FEHB Program HDHPs also offer health savings accounts or health reimbursement arrangements. Please see below for more information about these savings features.
Preventive care services
Preventive care services are generally covered with no cost sharing and are not subject to copayments, deductibles or annual limits when received from a network provider.
Annual deductible
The annual deductible must be met before Plan benefits are paid for care other than preventive care services.
Health Savings Account (HSA)
You are eligible for an HSA if you are enrolled in an HDHP, not covered by any other health plan that is not an HDHP (including a spouse's health plan, excluding specific injury insurance and accident, disability, dental care, vision care, or long-term coverage), not enrolled in Medicare, not received VA (except for veterans with a service-connected disability) or Indian Health Service (IHS) benefits within the last three months, not covered by your own or your spouse's flexible spending account (FSA), and are not claimed as a dependent on someone else's tax return.
- You may use the money in your HSA to pay all or a portion of the annual deductible, copayments, coinsurance, or other out-of-pocket costs that meet the IRS definition of a qualified medical expense.
- Distributions from your HSA are tax-free for qualified medical expenses for you, your spouse, and your dependents, even if they are not covered by a HDHP.
- You may withdraw money from your HSA for items other than qualified medical expenses, but it will be subject to income tax and, if you are under 65 years old, an additional 20% penalty tax on the amount withdrawn.
- For each month that you are enrolled in an HDHP and eligible for an HSA, the HDHP will pass through (contribute) a portion of the health plan premium to your HSA. In addition, you (the account holder) may contribute your own money to your HSA up to an allowable amount determined by IRS rules. Your HSA dollars earn tax-free interest.
- You may allow the contributions in your HSA to grow over time, like a savings account. The HSA is portable - you may take the HSA with you if you leave the Federal government or switch to another plan.
Health Reimbursement Arrangement (HRA)
If you are not eligible for an HSA, or become ineligible to continue an HSA, you are eligible for a Health Reimbursement Arrangement (HRA). Although an HRA is similar to an HSA, there are major differences.
- An HRA does not earn interest.
- An HRA is not portable if you leave the Federal government or switch to another plan.
Catastrophic protection
We protect you against catastrophic out-of-pocket expenses for covered services. The IRS limits annual out-of-pocket expenses for covered services, including deductibles, coinsurance, and copayments, to no more than $7,050 for Self Only enrollment, and $14,100 for a Self Plus One or Self and Family. The out-of-pocket limit for this Plan may differ from the IRS limit, but cannot exceed that amount.
Health education resources and accounts management tools
HealthEquity will send you a welcome packet once your account has been established. Access account support materials and other educational resources by visiting the HealthEquity website at www.healthequity.com or call them directly for assistance at 866-346-5800.
Your rights and responsibilities
OPM requires that all FEHB plans provide certain information to their FEHB members. You may get information about us, our networks, and our providers. OPM's FEHB website (www.opm.gov/healthcare-insurance) lists the specific types of information that we must make available to you. Some of the required information is listed below.
- Intermountain Health, our parent company, is a not-for-profit health system based in Salt Lake City with nearly 40,000 employees. Since 1984, SelectHealth, Inc. has been providing coverage for high-quality healthcare for the communities of Utah;
- Not-for-profit
You are also entitled to a wide range of consumer protections and have specific responsibilities as a member of this Plan. You can view the complete list of these rights and responsibilities by visiting our SelectHealth, Inc. website at
www.selecthealth.org/fehb. You can also contact us to request that we mail a copy to you.
If you want more information about us, call 844-345-FEHB, or write to P.O. Box 30192 Salt Lake City, UT 84130-0192. You may also visit our website at www.selecthealth.org/fehb.
By law, you have the right to access your protected health information (PHI). For more information regarding access to PHI, visit our SelectHealth, Inc. website at www.selecthealth.org/fehb to obtain our Notice of Privacy Practices. You can also contact us to request that we mail you a copy of that Notice.
Your medical and claims records are confidential
We will keep your medical and claims records confidential. Please note that we may disclose your medical and claims information (including your prescription drug utilization) to any of your treating physicians or dispensing pharmacies.
Service Area
To enroll in this Plan, you must live in or work in our service area. This is where our providers practice. Our service area is:
Utah - Statewide
Under the HMO benefits, you must get your care from providers who contract with us. If you or a covered family member moves outside our service area, you can enroll in another plan. You do not have to wait until Open Season to change plans. Contact your employing or retirement office. If you receive care outside our service area, we will pay only for emergency or urgent care benefits, as described in Section 5(d). We will not pay for any other healthcare services out of our service area unless it is an emergency, urgent care service or services which have prior plan approval.
Under the POS benefits, you may receive care from a non-Plan provider, and we will provide benefits for covered services as described in Section 5(i).
Under the HDHP benefit, you may receive care from Plan providers as described in Section 5 HDHP. If you or a covered family member moves outside our service area, you can enroll in another plan. If your dependents live out of the area (for example, if your child goes to college in another state), you should consider enrolling in a fee-for-service plan or complete the SelectHealth, Inc. Dependent Address Change Form to access out of area extended coverage. See HDHP Section 5(h) to learn more about the Out of Area Child(ren) Dependent Coverage benefit.