Eligibility
Health insurance is available to Executive Service (AEX), University Support Personnel System (USPS), Faculty (CTP), Administrative and Professional (A&P), and eligible OPS employees.
Monthly Premiums
Standard Health Plans
| Individual | Family | Spouse Program | |
|---|---|---|---|
| Who is Covered | Employee Only | Employee + Dependent(s) | Both Spouses Work for the State Full-time |
| Monthly Payment | $50 | $180 | $15 |
High Deductible Health Plans (HDHP)
| Individual | Family | Spouse Program | |
|---|---|---|---|
| Who is Covered | Employee Only | Employee + Dependent(s) | Both Spouses Work for the State Full-time |
| Monthly Payment | $15 | $64.30 | $15 |
Health Plan Summary Comparisons
Standard Health Plans
| HMO Network Only |
PPO Network |
PPO Out of Network |
|
|---|---|---|---|
| Annual Deductible | None | $250 Single $500 Family |
$750 Single $1,500 Family |
| Global In‐Network Annual Out‐of‐Pocket Maximum | $8,150 per Individual $16,300 per Family (pharmacy and medical) |
$8,150 per Individual $16,300 per Family (pharmacy and medical) |
N/A |
| Preventive Care Based on age and gender | No charge | No charge; no deductible | Amount between charge and out‐of‐network allowance; no deductible |
| Primary Care | $20 copayment | $15 copayment | 40% of out‐of‐network allowance plus the amount between the charge and the out‐of‐network allowance |
| Specialist | $40 copayment | $25 copayment | 40% of out‐of‐network allowance plus the amount between the charge and the out‐of‐network allowance |
| Urgent Care | $25 copayment | $25 copayment | $25 copayment |
| Emergency Room | $100 copayment | $100 copayment | $100 copayment |
| Hospital Stay | $250 copayment | 20% after $250 copayment | 40% after $500 copayment plus the amount between charge and out‐of‐network allowance |
| Prescriptions Generic Drugs Preferred Brand Non‐Preferred Brand |
$7 | $30 | $50 Network Retail (up to 30‐day supply); $14 | $60 | $100 Mail Order to Participating 90‐Day Retail (up to 90‐Day Supply) |
$7 | $30 | $50 Network Retail (up to 30‐day supply) |
Pay in full; file claim for reimbursement |
High Deductible Health Plans (HDHP) - Pair with Health Savings Account
| HMO and PPO Network |
PPO Only Out of Network |
|
|---|---|---|
| Annual Deductible | $1,400 Single $2,800 Family |
$2,500 Single $5,000 Family |
| Global In‐Network Annual Out‐of‐Pocket Maximum | $4,400 (PPO), $3,000 (HMO) per Individual $8,800 (PPO), $6,000 (HMO) per Family (pharmacy and medical) |
N/A |
| Preventive Care Based on age and gender | No charge; no deductible | Amount between charge and out‐of‐network allowance; no deductible |
| Primary Care | Deductible then 20% of network allowed amount | Deductible then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance |
| Specialist | Deductible then 20% of network allowed amount | Deductible then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance |
| Urgent Care | Deductible then 20% of out‐of‐network allowance | Deductible then 20% of out‐of‐network allowance |
| Emergency Room | Deductible then 20% of out‐of‐network allowance | Deductible then 20% of out‐of‐network allowance |
| Hospital Stay | Deductible then 20% of network allowed amount | Deductible, $1,000 copay, then 40% of out‐of‐network allowance plus amount between charge and out‐of‐network allowance |
| Prescriptions Generic Drugs Preferred Brand Non‐Preferred Brand |
After paying deductible, 30% | 30% | 30% Network Retail and Mail Order | Pay in full; file claim for reimbursement |
Preferred Provider Organization (PPO) Option
The PPO health insurance option provides the option to receive care from any doctor or healthcare provider. The cost for care is lower when in-network providers are used. Except for most preventative care, services are not covered until annual deductible is met.
There is a Standard and a High Deductible Health Plan (HDHP) option available. A HDHP provides employees the option to receive care from any doctor or healthcare provider. The HDHP option lowers the monthly premium and increases the annual deductible amount. The higher annual deductible can be offset with a Health Savings Account (HSA), which provides an employer contribution and the option for employee pre-tax contributions.
| Network | Non-Network | |
|---|---|---|
| Office Visits | $15 primary care $25 specialty care |
40% of the allowance, plus the difference between the charge and the allowance |
| Calendar Year Deductible | $250 individual $500 family |
$750 individual $1,500 family |
| Other | Annual global out-of-pocket maximum: $8,150 individual; $16,300 family |
Employee must file claims |
Health Maintenance Organization (HMO) Option
The HMO health insurance option provides coverage for in-network providers and facilities, and coverage for health emergencies. The entire cost of the non-network health care received is the member’s responsibility. HMO companies vary by region.
There is a Standard and a High Deductible Health Plan (HDHP) HMO option available. A HDHP provides employees the option to receive care from any doctor or healthcare provider. The cost of services for the HMO HDHP will be reduced when they are received within network. The HDHP option lowers the monthly premium and increases the annual deductible amount. The higher annual deductible can be offset with a Health Savings Account (HSA), which provides an employer contribution and the option for employee pre-tax contributions.
| Type of Medical Visit | Co-Payment |
|---|---|
| Primary Doctor | $20 |
| Specialist | $40 |
| Emergency Services | $100 |
| Hospital Admission | $250 |
Prescription Drug Plan
Offered by CVS Caremark and provides benefits for all health insurance options. PPO members must use the 90-day supply fill option for maintenance drugs. This can be filled by mail order or at a participating pharmacy. HMO members have the option to us the 90-day supply fill option to receive the discount.
| Prescription drug class | 30-day supply | 90-day supply |
|---|---|---|
| Generic | $7 | $14 |
| Preferred Drugs (contact provider for the list) |
$30 | $60 |
| Non-preferred | $50 | $100 |
