I Want To...
Find a Provider
Find a Pharmacy
Change My PCP
See FAQ
Contact GlobalHealth
Sign Up for Emails
Have an Agent Contact Me

A salesperson will call.

PLANS & SERVICES FOR FEDERAL EMPLOYEES

Benefits at a Glance (2018)

 

 

This is a summary of the features of the GlobalHealth Plan. Before making a final decision, please read the Plan’s Federal Brochure, RI 73-834. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.

 

BENEFIT FEHB High Option Plan FEHB Standard Option Plan
Annual Deductible* This plan doesn’t have an annual deductible. Self Only - $300 
Self Plus One - $600
Self and Family - $600
Annual out-of-pocket maximum Self Only - $5,000 
Self Plus One - $7,000
Self Plus Family - $7,000
Self Only - $6,500
Self Plus One - $7,500
Self and Family - $7,500
Primary Care Physician Visits $0 copay per visit $0 copay per visit
Specialist Physician Visits $35 copay per visit $45 copay per visit
Preventive Care $0 copay $0 copay
X-Rays & Labs $0 copay $0 copay
Specialized Scans, Imaging & Diagnostic Exams $250 copay per scan in a preferred facility; $500 copay per scan in a non-preferred facility $350 copay per scan in a preferred facility; $700 copay per scan in a non-preferred facility
Inpatient Hospital Stay $250 copay per day with $750 maximum per admission $500 copay per day with $1,500 maximum per admission
Outpatient Surgery $250 copay in a preferred facility; $750 copay in a non-preferred facility $500 copay in a preferred facility; $1,000 copay in a non-preferred facility
Emergency Room Service $250 copay, waived if admitted to hospital inpatient $300 copay, waived if admitted to hospital inpatient
Urgent Care $25 copay in urgent care facility $45 copay in urgent care facility

Prescription Drugs (Chickasaw Nation Refill Center is a home delivery option for Native American members. Click here for more information.)

Preferred Network Retail Pharmacy $4/$12/$50/$80/10% up to $150/10% up to $250

Non-Preferred Network Retail Pharmacy $9/$17/$55/$85/10% up to $150/10% up to $250

Preferred Home Delivery or Extended Supply Retail $8/$24/$125/$240

Non-Preferred Home Delivery or Extended Supply Retail $13/$29/$130/$245

Preferred Network Retail Pharmacy $6/$15/$70/$105/10% up to $200/10% up to $300

Non-Preferred Network Retail Pharmacy $11/$20/$75/$110/10% up to $200/10% up to $300

Preferred Home Delivery or Extended Supply Retail $12/$30/$150/$270

Non-Preferred Home Delivery or Extended Supply Retail $17/$35/$155/$275

Maternity Care $0 copay for prenatal care; $25 one-time copay for delivery and all post-natal care; $250 copay per admission for delivery $0 copay for prenatal care; $45 one-time copay for delivery and all post-natal care; $300 copay per day with $900 maximum per admission for delivery
Family Planning No copay on FDA-approved services; No copay on FDA-approved services;
Allergy Care $0 copay per PCP visit; $35 copay per specialist visit; $0 copay for antigen and administration $0 copay per PCP visit; $45 copay per specialist visit; $0 copay for antigen and administration
Physical, Occupational, Speech Therapy (Limited to 60** combined visits per calendar year) Inpatient: $0 copay Outpatient: $30 copay per visit Inpatient: $0 copay Outpatient: $45 copay per visit
Chiropractic Care (20 visits per year) $20 copay per visit $25 copay per visit
Mental Health Services, Chemical Dependency & Substance Abuse $0 copay per outpatient office visit; $250 copay/day with $750/admission maximum $0 copay per outpatient office visit; $500 copay/day with $1,500/admission maximum

 

*No deductible on high option plan. Standard option plan deductible does not apply to PCP, specialist and behavioral health office visits, lab/x-ray, urgent care, preventive care and prescription drugs.
**60 visits for rehabilitation and 60 visits for habilitation.

 

GlobalHealth, Inc., a NCQA Accredited Health Plan, was rated 3 out of 5 in NCQA's Private Health Insurance Plan Ratings 2017-2018, the only HMO plan in Oklahoma to receive this rating.

 

GENERAL EXCLUSIONS-SERVICES, DRUGS, AND SUPPLIES WE DO NOT COVER.

The exclusions in this section apply to all benefits. There may be other exclusions and limitations listed in Section 5 of the FEHB brochure. Although we may list a specific service as a benefit, we will not cover it unless it is medically necessary to prevent, diagnose, or treat your illness, disease, injury, or condition. For information on obtaining prior approval for specific services, such as transplants, see Section 3 of your FEHB Brochure when you need prior Plan
approval for certain services.

We do not cover the following:

  • Care by non-Plan providers except for authorized referrals or emergencies (see Emergency services/accidents).
  • Services, drugs, or supplies you receive while you are not enrolled in this Plan.
  • Services, drugs, or supplies not medically necessary.
  • Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice.
  • Experimental or investigational procedures, treatments, drugs, or devices (see specifics regarding transplants).
  • Services, drugs, or supplies related to abortions, except when the life of the mother would be endangered if the fetus were carried to term, or when the pregnancy is the result of an act of rape or incest.
  • Services, drugs, or supplies you receive from a provider or facility barred from the FEHB Program.
  • Services, drugs, or supplies you receive without charge while in active military service.

 

Benefits at a Glance (2017)

 

 

This is a summary of the features of the GlobalHealth Plan. Before making a final decision, please read the Plan’s Federal Brochure, RI 73-834. All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.

 

BENEFIT FEHB High Option Plan FEHB Standard Option Plan
Annual Deductible* This plan doesn’t have an annual deductible. Self Only - $300
Self Plus One - $600
Self and Family - $600
Annual out-of-pocket maximum Self Only - $5,000
Self Plus One - $7,000
Self Plus Family - $7,000
Self Only - $6,500
Self Plus One - $7,500
Self and Family - $7,500
Primary Care Physician Visits $0 copay per visit $0 copay per visit
Specialist Physician Visits $35 copay per visit $45 copay per visit
Preventive Care/Well Child Visits $0 copay $0 copay
X-Rays & Labs $0 copay $0 copay
Specialized Scans, Imaging & Diagnostic Exams $250 copay per scan in a preferred facility; $500 copay per scan in a non-preferred facility $350 copay per scan in a preferred facility; $700 copay per scan in a non-preferred facility
Inpatient Hospital Stay $250 copay per day with $750 maximum per admission $500 copay per day with $1,500 maximum per admission
Outpatient Surgery $250 copay in a preferred facility; $750 copay in a non-preferred facility $500 copay in a preferred facility; $1,000 copay in a non-preferred facility
Emergency Room Service $250 copay, waived if admitted to hospital inpatient $300 copay, waived if admitted to hospital inpatient
Urgent Care $25 copay in urgent care facility $45 copay in urgent care facility

Prescription Drugs (Chickasaw Nation Refill Center is a home delivery option for Native American members. Click here for more information.)

Preferred Network Retail Pharmacy $4/$12/$50/$80/10% up to $150/10% up to $250

Non-Preferred Network Retail Pharmacy $9/$17/$55/$85/10% up to $150/10% up to $250

Preferred Home Delivery or Extended Supply Retail $8/$24/$125/$240

Non-Preferred Home Delivery or Extended Supply Retail $13/$29/$130/$245

Preferred Network Retail Pharmacy $6/$15/$70/$105/10% up to $200/10% up to $300

Non-Preferred Network Retail Pharmacy $11/$20/$75/$110/10% up to $200/10% up to $300

Preferred Home Delivery or Extended Supply Retail $12/$30/$150/$270

Non-Preferred Home Delivery or Extended Supply Retail $17/$35/$155/$275

Maternity Care $0 copay for prenatal care; $25 one-time copay for delivery and all post-natal care; $250 copay per admission for delivery $0 copay for prenatal care; $45 one-time copay for delivery and all post-natal care; $300 copay per day with $900 maximum per admission for delivery
Family Planning No copay on FDA-approved services; No copay on FDA-approved services;
Allergy Care $0 copay per PCP visit; $35 copay per specialist visit; $0 copay for antigen and administration $0 copay per PCP visit; $45 copay per specialist visit; $0 copay for antigen and administration
Physical, Occupational, Speech Therapy (Limited to 60 combined visits per course of therapy.) Inpatient: $0 copay Outpatient: $30 copay per visit Inpatient: $0 copay Outpatient: $45 copay per visit
Chiropractic Care (20 visits per year) $20 copay per visit $25 copay per visit
Mental Health Services, Chemical Dependency & Substance Abuse $0 copay per outpatient office visit; $250 copay/day with $750/admission maximum $0 copay per outpatient office visit; $500 copay/day with $1,500/admission maximum

 

* No deductible on high option plan. Standard option plan deductible does not apply to PCP, specialist and behavioral health office visits, lab/x-ray, urgent care, preventive care and prescription drugs.

 

GlobalHealth, Inc., a NCQA Accredited Health Plan, was rated 3 out of 5 in NCQA's Private Health Insurance Plan Ratings 2017-2018, the only HMO plan in Oklahoma to receive this rating.

 

Exclusions and Limitations

The exclusions in this section apply to all benefits. There may be other exclusions and limitations listed in your Plan brochure. Although we may list a specific service as a benefit, we will not cover it unless it is medically necessary to prevent, diagnose or treat your illness, disease, injury or condition.

We do not cover the following:

  • Care by non-Plan providers except for authorized referrals or emergencies (see Emergency services/accidents in the FEHB brochure).
  • Services, drugs, or supplies you receive while you are not enrolled in this Plan.
  • Services, drugs, or supplies not medically necessary.
  • Services, drugs, or supplies not required according to accepted standards of medical, dental, or psychiatric practice.
  • Experimental or investigational procedures, treatments, drugs, or devices (see specifics regarding transplants in the FEHB brochure).
  • Services, drugs, or supplies related to abortions, except when the life of the mother would be endangered if the fetus were carried to term, or when the pregnancy is the result of an act of rape or incest.
  • Services, drugs, or supplies you receive from a provider or facility barred from the FEHB Program.
  • Services, drugs, or supplies you receive without charge while in active military service.
  • Services, drugs, or supplies you would not be charged for if you had no health insurance.
  • Services that you get without a referral from your primary care physician, when a referral from your primary care physician is required for getting that service.
  • Services that you get without prior authorization, when prior authorization is required for getting that service.
  • Emergency facility services for non-authorized, routine conditions that do not appear to a reasonable person to be based on a medical emergency.
  • Personal convenience items, such as a telephone or television in your room at a hospital or skilled nursing facility.
  • Nursing care on a full-time basis in your home.
  • Custodial care is not covered by GlobalHealth unless it is provided in conjunction with skilled nursing care and/or skilled rehabilitation services. “Custodial care” includes care that helps people with activities of daily living, like walking, getting in and out of bed, bathing, dressing, eating, and using the bathroom, preparation of special diets, and supervision of medication that is usually self-administered.
  • Homemaker services.
  • Meals delivered to your home.
  • Charges imposed by immediate relatives or members of your household.
  • Elective or voluntary enhancement procedures, services, supplies, and medications including but not limited to: Hair growth, athletic performance, cosmetic purposes, anti-aging, and mental performance.
  • Cosmetic surgery or procedures, unless it is needed because of accidental injury or to improve the function of a malformed part of the body. Breast surgery and all stages of reconstruction for the breast on which a mastectomy was performed and, to produce a symmetrical appearance, surgery and reconstruction of the unaffected breast, is covered.