State Health Plan Coverage

The health insurance plans available to State members differ in the benefit levels they provide, the doctors and hospitals you can access and the out-of-pocket cost to you. In general, managed care plans, such as Health Maintenance Organizations (HMOs) and the Open Access Plan (OAP), deliver healthcare through a system of network providers and have a lower monthly premium than the Quality Care Health Plan (QCHP).  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 State members. In addition to managed care, the State plan offers the Quality Care Health Plan (QCHP), administered by Aetna, which allows plan participants to access any provider nationwide.  Enhanced benefits are available for QCHP members who receive services from a QCHP network provider.

New this year to active State employees is the Consumer Driven Health Plan (CDHP). This is a high deductible health plan as defined by the IRS.  Consumer Driven Health Plan (CDHP) members may choose any physician or hospital for medical services; however, members receive enhanced benefits, resulting in lower out-of-pocket costs, when receiving services from a CDHP in network provider. And, when paired with the Health Savings Account (HSA), CDHP/HSA members will receive a $500 State contribution for an individual member or $1,000 for family. CDHP has a nationwide network of providers through Aetna PPO. Benefits are outlined in the plan's Summary Plan Document (SPD). It is the member's responsibility to know and follow the specific requirements of the CDHP. 

For a more comprehensive comparison of all the plans being offered for FY21, click on the following links to:

  1. Understand How the Plans Differ
  2. Understand How You Pay for Healthcare in Each Plan
  3. Get Plan Suggestions

 

Telemedicine

You will now have telemedicine available to you under your HMO and OAP health plans for a reduced copayment. QCHP and CDHP 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.

Pharmacy

Maintenance Choice: The Maintenance Choice tier is available to those members covered under an OAP, QCHP or CDHP. 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.

Medical Care Assistance Plan (MCAP)

The MCAP maximum contribution amount will be $2,750 for the FY21 plan year with a $500 maximum rollover. Employees must reenroll in MCAP for the new plan year in order to qualify for the rollover. You must enroll or reenroll in a Flexible Spending Account each plan year. The MCAP benefit is not available if enrolling in an HSA.

New IRS Guidance for FY20/FY21 Flexible Spending Accounts

The following is New IRS Guidance for State Employees which can affect your Flexible Spending (Pre-Tax) Contributions for FY20 & FY21, click here: MCAP-DCAP UpdatesNONBC.pdf

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:

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.

The Affordable Care Act rules require health plans to provide a summary of benefits and coverage (SBC) and a glossary of health coverage and medical terms.  Both are 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.  The benefit levels listed in the SBCs go into effect July 1st of each year.



Updated 05/06/2020