Opening SAMBA

There's a new health plan in town -- for many federal employees, at least. The Office of Personnel Management recently sent a notice to agencies letting them know that the SAMBA Health Benefit Plan now will be open to all federal employees and annuitants who are eligible for the Federal Employees Health Benefits Program. SAMBA's not new; it's been around for 60 years. But it was first restricted to law enforcement employees. Later, members of the intelligence community became eligible to join. Now anybody can. SAMBA has changed its name from the Special Agents Mutual Benefit Association to the SAMBA Federal Employee Benefit Association. There are no association dues. Anyone who enrolls in any SAMBA plan will automatically become SAMBA members. SAMBA has some attractive features, so let's get ready for the 2008 open season with an introduction to an old member of FEHBP that is now new to many employees.

SAMBA Benefits

• Preferred provider network. Like traditional health insurance that allows you to choose your own providers, SAMBA gives members access to the extensive CIGNA preferred provider organization.
• Children over 22. If you have children who have turned 22 and are no longer eligible under FEHBP, SAMBA offers a dependent children health benefit. This plan offers health coverage for dependent children ages 22 to 27, and they do not need to be students to enroll. At least one parent must be enrolled in the federal SAMBA Health Benefit Plan to enroll your child in the SAMBA Dependent Children Health Benefit Plan, and your child must be: age 22 through age 26; unmarried; wholly dependent on you for support and maintenance; enrolled during the plan's open season, or within 60 days of their 22nd birthday, or when a qualifying eligibility event occurs (such as the child reaches age 22).
• Dental and vision care. The SAMBA Standard Option plan covers preventive dental services. For an additional premium you can enroll in SAMBA's dental and vision Care plan (similar to the Federal Employee Dental and Vision Insurance Program) at any time throughout the year.
• Medicare. SAMBA will waive many of out-of-pocket expenses for inpatient and outpatient care when Medicare is your primary insurance.
• Life insurance, disability insurance, long-term care insurance and legal assistance plans. These plans are open to all employees, even if they are not enrolled in the SAMBA health plan. Employees and annuitants don't have to wait until an open season to enroll.

Standard Option

If you use doctors who are in the CIGNA network, you will pay nothing for well-child office visits, cancer screening and accidental injuries (within 72 hours). For annual physicals (adult) and doctor's office visits, you will only pay a $20 co-payment. Inpatient care is covered 100 percent after a $200 co-payment. For other office visits and outpatient care, there is a 15 percent co-payment. If you go out of the CIGNA network, your co-payment will increase to 30 percent of the plan allowance.

For prescriptions at a retail pharmacy (up to a 30-day supply), you will pay $10 for generic, $30 for formulary and $45 for non-formulary. The mail-order program covers all but $20 for generic (up to a 90-day supply), 25 percent for formulary name brand (a $45 minimum and $80 maximum) or 25 percent non-formulary name brand (a $60 minimum and $100 maximum).

Catastrophic coverage provides no payments after you have spent $4,000 for PPO and $6,000 for non-PPO for you and your family members.

If you use non-PPO providers, your co-payments will increase to 30 percent of the plan allowance for most medical care, including in-patient care.

High Option

Co-payments are 10 percent instead of 15 percent for most outpatient charges. If you choose to go out of the CIGNA network, your co-payments will increase to 30 percent of the plan allowance. Prescription coverage appears to be the same as Standard Option, but Medicare Part B enrollees will only pay a $5 co-payment on mail-order prescriptions and $20 for formulary name brand or $35 for non-formulary name brand prescriptions. Catastrophic coverage provides no payments after you have spent $3,500 for you and your family members for PPO participants and $5,000 for non-PPO participants.

For those who are generally in good health, SAMBA Standard Option provides looks like the best value. The 2008 premiums are $4,237 per year more expensive for self- and family enrollment and $1,627.68 per year more for self-only enrollment for High Option coverage than the Standard Option premiums.

Premium Information

Here are this year's premiums for SAMBA health plans (2009 premiums will be announced closer to the open season):

Interested employees can learn more about SAMBA plans at www.sambaplans.com or by calling 1-800-638-6589.

Remember, the 2008 federal benefits open season for the 2009 plan year will run from Nov. 10 to Dec. 8. It is still about three months away, but when there are significant changes, I will bring those to you as they are announced. During the open season, I will do an index of all of my past columns related to insurance that will highlight the significance of the various insurance benefits. With so much to think about such as dental, vision, flexible spending accounts, health savings accounts, etc., getting that information early should make it all less overwhelming.

Tammy Flanagan is the senior benefits director for the National Institute of Transition Planning Inc., which conducts federal retirement planning workshops and seminars. She has spent 25 years helping federal employees take charge of their retirement by understanding their benefits.