Postal Service Health Benefits Program

Medical Mutual offers great healthcare coverage for postal service employees and annuitants who live or work in the following northern Ohio counties: Allen, Ashland, Ashtabula, Auglaize, 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 and Wood.

If you are a PSHB annuitant, please click here to access more benefit information.

Plan Highlights for 2026

For Employees

  • Standard and Basic Plan Options: Both featuring our MedFlex™ provider network.
  • Walgreens Advantage Pharmacy Network: You will continue to have access to the Walgreens Advantage Pharmacy Network for retail prescriptions in 2026. The Walgreens Advantage Pharmacy Network provides access to most chain and independent pharmacies in Ohio.
  • No-Cost Preventive Medications: 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 2026 Prescription Drug Formulary.
  • Emergency Services Copay: The copay for emergency care will increase from $325/visit to $500/visit. The copay will be waived if the member is admitted directly to the hospital as an inpatient.  

To review prescription drug information, click here.

How to Enroll in a PSHB Plan

Employees and annuitants can enroll online. Visit https://health-benefits.opm.gov/PSHB. Employees and annuitants can call 1-844-451-1261 for any technical assistance only. No information will be provided at this number for the enrollment process. 

If you have specific questions regarding the available plan options, please contact Medical Mutual Customer Care at 1-800-315-3144.

PSHB Plans and Enrollment Codes

 
Plan   Category Type of Enrollment Enrollment Code
 Standard Option  Employee Self D3D
 Standard Option  Employee Self Plus One D3F
 Standard Option  Employee Self and Family D3E
 Basic Option  Employee Self D3A
 Basic Option  Employee Self Plus One D3C
 Basic Option  Employee Self and Family D3B

2026 Plan Documents

Summary of Benefits and Coverage (SBC) and Uniform Glossary

Additional Information

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. 

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 PCP at least once a year. To help you make the most of your visit, we've created a checklist with important tips and helpful reminders of what to discuss with your provider.

Infertility Services Information
Learn about the infertility services and infertility drugs that are covered on your plan.  

Contraceptive Exception Process

Contraceptive coverage is available at no cost to PSHB 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.

Sex-Trait Modification Information

If you are mid-treatment under this Plan, within a surgical or chemical regimen for Sex-Trait Modification for diagnosed gender dysphoria, for services for which you received coverage under the 2025 Plan brochure, you may seek an exception to continue care.

Our exception process is as follows:

The exception process will be applied on a case-by-case basis. You can click here to obtain a copy of our Transition of Care Waiver form. You will need to complete the top portion of the form (General Information and Patient Information) and take the form to your provider so they can complete the remaining information on the form. Your provider will need to submit the completed form and provide all the applicable supporting medical documentation that supports your request via the Cohere portal. The Medical Mutual care management team will review each request for necessity and provide response on approval or denial of your transition of care waiver request. We will respond to your request within 15 days of receipt of the waiver.

If you need additional assistance or have questions regarding this exception process,  please contact our Customer Care Team at 1-800-315-3144 to speak to a representative

Individuals under age 19 are not eligible for exceptions related to services for ongoing surgical or hormonal treatment for diagnosed gender dysphoria.

Disputed Claims Process
We have provided information in this section regarding the PSHB disputed claims process for your review. You can obtain additional information and assistance with this process by calling Medical Mutual 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 PSHB plan brochure:

  • Section 8 – The Disputed Claims Process  – (for Employees)
  • Section 8(a)  – Medicare PDP EGWP Disputed Claims Process (for Annuitants) 

Date: PSHB 11/10/2024

Need Help?

Please call Medical Mutual Customer Care for PSHB employees/annuitants at 1-800-315-3144 (TTY 711 for hearing impaired).

Monday – Thursday: 7:30 a.m. to 7:30 p.m. EST
Friday: 7:30 a.m. to 6 p.m. EST
Saturday: 9 a.m. to 1 p.m. EST