Federal Employees Standard Option HMO Plan

Members in the Standard Option Health Maintenance Organization (HMO) Plan have the freedom to visit any in-network provider for covered services without a referral.

The QualChoice Standard Option HMO Plan provides a full range of medical benefits, access to Arkansas’ largest network of highly qualified doctors, hospitals and pharmacies and the freedom to see QualChoice network specialists without a referral.

You may visit any PCP or specialist in the QualChoice network. You can find QualChoice network providers by using our online Provider Directory.

Out-of-network services and supplies are not covered under this Standard Option HMO Plan. However, eligible expenses for emergency care and urgent care services are covered. See Section 5(d) Emergency Services/Accidents in the Federal Employees brochure.

We ask that you go to the nearest in-network emergency room when you are in need of emergency care.

We define emergency as those health care services provided on a 24-hour/365-days-a-year basis to evaluate and treat medical conditions of a recent onset and severity, leading a prudent lay person, possessing an average knowledge of medicine and health, to believe his or her condition, sickness, or injury is of such a nature where failure to seek immediate medical care could result in: placing the patient's health in serious jeopardy; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part.

If you have to go to an out-of-network facility and need inpatient care you must notify QualChoice as soon as possible or within 48 hours of your stay so that we may attempt to transfer you to an in-network facility.

QualChoice does require notification of your admission if you are admitted to an in- network facility. The network facility will notify us on your behalf. If you are admitted to an out-of- network facility, you are responsible for notifying QualChoice.

You do not need to select a PCP. We encourage you however, to establish a relationship with one as it can help you better manage your health. Your PCP can provide routine care, treat you for illnesses and injuries, or recommend that you see participating providers or specialists, if required. NOTE: The higher specialist copayment will apply if you do not seek care with your PCP for services.

A copayment is the fixed dollar amount or percentage you must pay to a health care professional, facility or pharmacy when you receive covered services.

You pay a copayment at the time of service. The copayment will vary, depending on where the services are delivered and by whom (e.g. PCP, specialist, inpatient hospital stay, emergency room, outpatient hospital and pharmacy).

Please refer to the current plan brochure for copayment amounts.

My Account Member Portal
Your secure, mobile friendly self-service website for health and benefits information. Order an ID card or print a temporary one, check eligibility or claim status, and much more.

Enrollment procedures vary by agency.

The federal enrollment codes for the QualChoice Standard Option HMO Plan are:

• Self Only – DH4
• Self and Family Enrollment – DH5
• Self Plus One – DH6

If you do not receive your ID card by your effective date, you may use a copy of your Health Benefits Election (SF2809) Form or electronic enrollment (e.g. Employee Express, PostalEase, etc.) confirmation.

You and your covered family members have the right to the form of contraception or birth control that your provider recommends is best for your care. FEHB plans must cover, regardless of your gender identity, at least one form of contraception from each category listed in the Women’s Preventive Services Guidelines. There is no out-of-pocket cost for covered contraception. The FDA provides examples of contraceptives categorized in the Women’s Preventive Services Guidelines.

Use the contraception exception process if the contraception recommended by your provider is not covered or has an out-of-pocket cost. You or your provider may submit a Formulary Override Exception (PDF) request.

If you have difficulty accessing contraceptive coverage, you can contact OPM at contraception@opm.gov.