The health insurance plans available to LGHP members differ in the benefit levels they provide, the doctors and hospitals you can access and the out-of-pocket costs. In general, managed care plans, such as Health Maintenance Organizations (HMOs) and Open Access Plans (OAP), deliver healthcare through a system of network providers and have a lower monthly premium than the Local Care Health Plan (LCHP). Members will find a listing of providers who participate in the health plan's network when they go to the provider directory page on the plan's website.
There are several managed care plans located throughout the state available to LGHP members. In addition to managed care, LGHP offers the FY20 Local Care Health Plan (LCHP) (FY21 LCHP - Effective July 1, 2020), administered by Aetna, and allows plan participants to access any provider nationwide. Enhanced benefits are available for LCHP members who receive services from a LCHP network provider. The FY20 Local Consumer-Driven Health Plan (LCDHP) (FY21 LCDHP - Effective July 1, 2020), administered by Aetna.
You will now have telemedicine available to you under your HMO and OAP health plans for a reduced copayment. LCHP and LCDHP enrollees will receive the benefit at the same coinsurance level; however, due to the reduction in the cost of the visit, you as the member, will experience significant savings.
Telemedicine provides quick access to a doctor over the phone, email or video call and can often eliminate visits to your primary care physician (PCP), urgent care center, or ER and the high costs associated with those visits. And, no waiting for an appointment in a room full of other sick people. When appropriate, the consulting doctor can prescribe a medication and send the prescription to the member's preferred pharmacy. Telemedicine coverage includes both General Practitioners and Behavioral Health providers. Your plan can provide you with additional information regarding this benefit.
• Maintenance Choice: The Maintenance Choice tier is available to those members covered under an OAP. LCHP or LCDHP. This tier allows members to obtain specific medications in a 90-day supply from a CVS Caremark® pharmacy or through the CVS Caremark® Mail Service Pharmacy for half of the copayment. Please contact CVS Caremark® to determine if your
medication is available under this benefit.
• Reduced Tier 1: The Reduced Tier 1 pharmacy benefit is available through an HMO carrier. This tier allows members to obtain specific medications in either a 30- or 90-day supply for a reduction of the normal tier 1 applicable copayment. Please contact your HMO to determine if your medication is available under this benefit.
Hearing Instruments and related services
Beginning July 1, 2020, a $2,500 benefit for hearing instruments and related services every 24 months is available through all plans when a hearing care professional prescribes a hearing instrument. Contact plan for additional details.
Benefit recipients may view a map of the various plans’ coverage areas below:
The Affordable Care Act rules require health plans to provide a summary of benefits and coverage and a glossary of health coverage and medical terms, designed to make it easier for you to compare your options and understand exactly what you are buying. The new requirements will also make it easier for employers to compare health insurance options to provide for their employees. Members can view the summary of benefits and coverage for each plan.
Last Updated 04/28/2020