Federal Employees Health Benefits Program
Plan Highlights for 2025
Our 2025 plans offer:
- MedFlex Medical Network: If you are enrolled on the Basic Option or Standard Option you will continue to have access to the MedFlex Network in 2025. Please be sure to determine if your existing providers are in the MedFlex network.
- Walgreens Advantage Pharmacy Network: You will continue to have access to the Walgreens Advantage Network for retail prescriptions in 2025. The Walgreens Advantage Pharmacy Network provides access to most chain and independent pharmacies in Ohio.
- Preventive Medications at no cost: In addition to medications covered on the formulary when you fill a prescription for a medicine on the Standard Preventive Medications list at a network pharmacy, you will pay $0 out of pocket. The medicines on this list are typically taken to maintain good health and prevent illness.
- Drug Formulary: Please take time to review the 2025 National Preferred Formulary.
How to Enroll
To enroll in Federal Employee Health Benefits Plan, visit OPM.org or contact your employing agency or retirement office for FEHB enrollment procedures and other information. Annuitants may call the Retirement Information Center at 1-888-767-6378 (TTY 1-855-887-4957 for hearing impaired) or email Retire@OPM.gov Be sure you have the enrollment code applicable for the plan you have selected. The enrollment codes for Medical Mutual’s plan options are listed in the chart below.
If you have specific questions regarding the plan options available, please contact our Customer Care team at 1-800-315-3144.
FEHB Enrollment Codes for the Medical Mutual Standard, Basic Plans
| Northern Ohio Standard & Basic Option If you live or work in Allen, Auglaize, Ashland, Ashtabula, Columbiana, Cuyahoga, Defiance, Erie, Fulton, Geauga, Henry, Huron, Lake, Lorain, Lucas, Mahoning, Medina, Mercer, Ottawa, Portage, Putnam, Richland, Sandusky, Seneca, Stark, Summit, Trumbull, Wayne, Williams, or Wood county |
Southern Ohio Basic Option If you live or work in Adams, Brown, Butler, Champaign, Clark, Clermont, Greene, Hamilton, Miami, Montgomery or Warren county |
|---|---|
| 644 Standard Option – Self Only | Standard Option not available. |
| 646 Standard Option – Self Plus One |
Standard Option not available. |
| 645 Standard Option – Self and Family |
Standard Option not available. |
| UX1 Basic Option – Self Only |
YF61 Basic Option – Self Only |
| UX3 Basic Option – Self Plus One |
YF63 Basic Option – Self Plus One |
| UX2 Basic Option – Self Plus Family |
YF62 Basic Option – Self Plus Family |
2025 Plan Documents
- 2025 Plan Brochure (Northern Ohio) — our plan brochure gives you an in-depth description of what is covered by our plans and also provides instructions for enrolling
- 2025 Plan Brochure (Southern Ohio) — our plan brochure gives you an in-depth description of what is covered by our plans and also provides instructions for enrolling
- 2025 Coverage Guide — review this reference guide to help you get the most out of your 2024 benefits
- 2025 Standard Plus Preventive Medication List (Generics Only )
- Select Home Delivery Active Choice Program
- Over-the-Counter (OTC) COVID-19 Test Reimbursement Claim Form
- Over-the-Counter (OTC) COVID-19 Tests Reimbursement Process Flyer
- Updates Regarding the COVID-19 National Emergency and the Public Health Emergency (PHE) on May 11, 2023
Summary of Benefits and Coverage (SBC) and Uniform Glossary
- 2025 Summary of Benefits and Coverage (SBC) for Basic Option Plan (73-017 Northern Ohio and 73-899 Southern Ohio)
- 2025 Summary of Benefits and Coverage (SBC) for Standard Option Plan (73-017 Northern Ohio)
- Uniform Glossary — the Uniform Glossary is a list of commonly used healthcare terms and definitions designed to be used with an SBC
Dental and Vision Coverage
Although our plan doesn’t include dental and vision plans for federal employees, you can get coverage through the Federal Employees Dental/Vision Insurance Program (FEDVIP). You can obtain information regarding FEHB Dental/Vision benefits on BENEFEDS.com or by phone at 877-888-3337 (TTY 877-889-5680).
Need Help?
If you have questions or need help, please call FEHBP Employees/Annuitants Customer Care:
Call 1-800-315-3144 (TTY 711 for hearing impaired)
Monday – Thursday: 7:30 a.m. to 7:30 p.m.
Friday: 7:30 a.m. to 6 p.m.
Saturday: 9 a.m. to 1 p.m.
All times are Eastern Standard Time
Additional Information
Federal Employee Health Benefits Program (FEHBP) Disputed Claims Process
We have provided information in this section regarding the FEHBP disputed claims process for your review. You can obtain additional information and assistance with this process by calling our Customer Care team at 800-315-3144 (TTY: 711)
View the Disputed Claims Fact Sheet to review helpful information regarding the disputed claims process.
The Disputed Claims Process information is described in your FEHB plan brochure:
- Section 8 - The Disputed Claims Process
Find a Provider
See what providers are in your plan's network:
Wellness Programs
We offer a variety of programs and tools that promote a healthy lifestyle. Learn more about our resources and how they can help you reach your wellness goals.
Prescription Drug Information
Review our prescription drug benefits and view a list of covered medications.
Contraceptive Exception Process
Contraceptive coverage is available at no cost to FEHB members. The contraceptive benefit includes at least one option in all methods of contraception (as well as the screening, education, counseling, and follow-up care). Any contraceptive that is not already available without cost sharing on the formulary can be accessed through the contraceptive exceptions process described below.
Medical Mutual offers robust coverage of contraceptive options in all categories. If a contraceptive is not covered but medically necessary, we offer a simple exceptions process. Your provider can contact Express Scripts to request the exception by calling 1-800-753-2851. If your provider agrees that a non-covered contraceptive is medically necessary, the exception will be granted and your request will be approved for $0 coverage.
Reimbursement for over-the-counter contraceptives can be submitted by, Medical Mutual allows online adjudication of OTC contraceptives at the pharmacy, which prevents members from having to pay out of pocket and submit for reimbursement later.
If you have difficulty accessing contraceptive coverage or other reproductive healthcare, you can contact contraception @opm.gov.
Surgical Contraceptive Assistance
If the attending Physician determines a particular service or FDA-approved item is required for medical reasons, Medical Mutual will cover that Contraceptive service or item without cost sharing.
For assistance regarding which contraceptives are covered on your plan including surgical contraceptive services, contact our Customer Care at 1-800-315-3144. Your plan covers tubal ligations without a cost share. Pre-authorization is only required for surgeries that require an inpatient admission. We will respond to any inquires you have regarding contraceptive services within 24 hours.
MedMutual Part B Reimbursement Account
Find out if you're eligible for Medicare Part B premium reimbursement.
Policies and Procedures
Learn more about important policies and procedures that impact your health plan.
Telehealth (Telemedicine)
Connect with your provider via computer, tablet or smart phone from the comfort of home.
Primary Care Provider (PCP) Visit Checklist
It is important to visit your primary care provider at least once a year. To help you make the most of your visit, we created a checklist with important tips and helpful reminders of what you should discuss with your provider.
Infertility Services Information
Learn about the infertility services and infertility drugs that are covered on your plan.