The State offers managed care plans located throughout the State each administered by the respective plan administrators.
In addition to managed care, the State offers the Quality Care Health Plan administered by Aetna, and offers an enhanced benefit when services are provided by a QCHP network provider.
Plan participants who have other health insurance coverage provide their agency Group Insurance Representative (GIR) (PDF 137 KB) with a copy of the health insurance card from the other plan.
Each health plan participant (members and dependents) will be required to pay a prescription deductible each plan year. Once the deductible has been satisfied, individuals will not be required to meet the deductible again until the beginning of the next plan year.
Plan participants enrolled in any of the State health plans have prescription drug coverage included in their health plan benefits. Prescription benefits are administered by the health plan's Prescription Benefit Manager (PBM). Members who use the PBMs pharmacy network to obtain their medication will be charged the applicable prescription copayment after the prescription deductible has been met. A pharmacy that is not in the network may charge more than the copayment amount; therefore, members should verify that a pharmacy is in network in order to avoid high prescription costs.
Most health plans also offer mail order and/or maintenance medication programs. Plan participants who use a maintenance medication (such as medication for high blood pressure or high cholesterol) may receive an enhanced benefit by using these programs. Check with your health plan to see if they offer these types of programs.
EyeMed administers the vision benefits. When plan participants utilize a network provider, the benefit levels are greater. Services provided by an out-of-network provider are paid at a lower benefit level. Plan participants must submit an EyeMed Claim form for reimbursement when an out-of-network provider is used. Specific questions regarding the vision benefit can be found in the Certificate of Coverage.
Members can utilize any dental provider and will have charges for dental procedures paid according to the Schedule of Benefits. The QCDP is administered by Delta Dental. Delta Dental offers two separate networks of dentists that a plan participant may utilize for dental services in addition to out-of-network providers: the Delta Dental PPOSM network and the Delta Dental PremierSM network. When a plan participant receives services through a network provider, they may pay less out-of-pocket.
Most providers will file the dental claim with the plan administrator electronically, but for those who do not, the member must complete a claim form. Claims must be filed within one year of the date of service.
Securian/Minnesota Life administers life insurance benefits. Members should maintain an up-to-date beneficiary form especially when life-changing events, such as marriage or divorce, occur. All life coverage benefits may be found in the Life Certificate.
When adding optional life coverage, such as Spouse Life and/or Child Life coverage, or when adding or increasing member Optional Life coverage, an Evidence of Insurability application must be submitted to the plan administrator for approval. Approvals are effective the first day of the following pay period. Accidental Death and Dismemberment (AD&D) coverage may be added at any time without Statement of Health approval.
Members and dependents whose life coverage terminates have the option to continue coverage through porting (PDF 74 KB) or converting their life coverage within 31 days of the coverage termination date. Individuals interested in this option should contact Minnesota Life for assistance at (toll free) 888-202-5525.
The behavioral health service benefit can be used for the diagnosis and treatment of mental health and/or substance abuse disorders. Behavioral health services are a component of the health plan in which the member is enrolled. Magellan is the behavioral health plan administrator for members enrolled in the QCHP plan.