Member Focus

Health Plan Changes will Expand Member Options, Encourage Health and Boost Financial Stability

woman smilingThe State Health Plan's Board of Trustees recently approved new health plan options for teachers and state employees that reward a range of healthy activities, including smoking cessation, taking an online Health Assessment and naming a primary care physician.

During a recent listening tour, in surveys and through focus groups, members consistently expressed the desire for more options and incentives for healthy choices.

Beginning Jan. 1, 2014, Active and non-Medicare Primary members will have new choices for their health care benefits. In addition to providing more options, this new plan focuses on helping members understand and improve their health. A healthy and engaged member population leads to cost savings and improves the long-term financial stability of the State Health Plan.

Under the new plan, Active and non-Medicare Primary employees will have the option to remain on the current premium-free 70/30 plan or select a "buy-up" 80/20 plan that comes with a premium, but allows members to reduce their premium and out-of-pocket costs by completing healthy activities. Members may also select a Consumer Driven Health Plan, also called a high-deductible plan.

Due to these changes, the Plan will have two enrollment periods this year. The first enrollment will take place May 20-31, 2013. This enrollment will be for a shortened benefit year effective July 1, 2013-Dec. 31, 2013. The second enrollment period – which will include the new options described above – will take place in October for benefits effective Jan. 1, 2014-Dec. 31, 2014.

Deductibles and coinsurance amounts will be cut in half as a result of the short benefit year effective July 1, 2013–Dec. 31, 2013. Otherwise, copayments will remain the same for the PPO plan options through the end of 2013. Premiums for January 2014 have not been finalized. However, based on the decision made by the Plan's Board of Trustees on Feb. 4, 2013, regarding plan options, the premium increase for members and dependents is projected to be 4.7 percent.

Here is a brief summary of member options in the buy-up 80/20 plan and the Consumer Driven Health Plan. There will be three surcharges applicable to active and non-Medicare retirees who enroll in the buy-up 80/20 plan or the Consumer Driven Health Plan. However, members can eliminate each surcharge by taking a healthy action step. The surcharges include the following:

Active and Non-Medicare Primary Retiree Options
Traditional 70/30 Plan Buy-Up Plan 80/20 Consumer Driven Health Plan 85/15
Employee Premium Credits
NA Smoker Surcharge $20
Employee and Spouse must attest to not smoking
Smoker Surcharge $20
Employee and Spouse must attest to not smoking
NA Primary Care Physician Election $15
Each family member must elect a Primary Care Physician
Primary Care Physician Election $10
Each family member must elect a Primary Care Physician
NA Health Assessment (HA) $15
Subscriber must complete HA
Health Assessment (HA) $10
Subscriber must complete HA
Incentive Rewards
NA 100% Preventive Coverage $15 PCP Copay Reductions Copay waivers/reductions for Blue Select Network 100% Preventive Coverage
Additional HRA Funds for PCP Visits and Blue Select Network Access

As a healthy incentive, both plans cover preventive services at 100 percent. In addition, if you select a primary care physician during enrollment you will receive a $15 copay reduction for any office visit to that designated physician. There are also copay reductions available for providers in the Blue Select Network. More detailed information about these incentives will be available prior to the October enrollment period.

Medicare Primary retirees will have the option to remain on the current premium-free 70/30 plan or select a Medicare Advantage plan. Details and any premiums associated with the Medicare Advantage plans have yet to be determined, and retirees should watch for more information.

The new changes were first announced in a Feb. 4 press release from the Department of State Treasurer, which oversees the State Health Plan.

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