Health Insurance Plans
When comparing the available health plans, look at each of the plan's features. Are there services that are limited or not covered? Which doctors, hospitals and other providers participate in the plan’s networks? Do you need a referral or preauthorization? Finally, consider annual deductibles, copayments, coinsurance, out-of-network coverage, and the limits on how much the plan will pay in a year or over a lifetime.
The State Health Plans (SHP) are PPO plans in which there is a network of hospitals, doctors and service providers that agree to specific discounted fees. While you may use any provider for care, typically your costs are less when you receive services in-network. If you go to a provider who is not a member of the PPO network the plan generally pays a higher percentage of the services.
Both the Savings and Standard plans are administered through Blue Cross Blue Shield and have an annual deductible that must be met prior to the plan paying benefits. Once the annual deductible is met, SHP will pay a percentage of coverage. Members do not need a referral from a primary care physician.
BlueChoice is an HMO plan in which members must use only healthcare providers, including hospitals, within the HMO network. If you receive care outside of this network, the plan will not pay benefits unless the care was preauthorized or deemed an emergency.
Subscribers are required to designate a primary care physician (PCP) who will refer them to specialists for services they do not offer.
The Savings plan requires a subscriber to pay the full allowable charge for prescriptions. There is no copayment, but the costs are applied to your annual deductible. Prescription drug benefits are administered by Medco.
The Standard plan offers a "3-tier" prescription plan with copayments available for generic, higher cost brand names and highest cost brand names. Mail order is also available and prescription drug benefits are administered by Medco.
BlueChoice offers copayments for generic, preferred, non-preferred and specialty pharmaceuticals. Mail order is available for up to a 90 day supply.
Mental Health & Substance Abuse Benefits
Savings and Standard subscribers must contact Companion Benefit Alternatives (CBA) 1-800-868-1032 for pre-authorization and must visit in-network providers.
BlueChoice subscribers must contact Companion Benefit Alternatives (CBA) at 1-800-868-1032 for pre-authorization and must visit in-network providers.
To visit each of the insurance providers online, please see our Plan Contact information.