Health Insurance

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
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