Medical + Prescription Drug - OFFICE OF GROUP INSURANCE

The State offers three medical plan options so that retirees can select the plan that best meets their needs as well as access providers in their geographic area. Each medical plan provides comprehensive coverage, with different levels of out-of-pocket expenses and premium contribution rates. Prescription Drug Coverage is included with medical plan enrollment. Retiree plans do not include Vision or EAP benefits or dental coverage. Deductibles and benefits for all plans are provided on a fiscal year, from July 1 through June 30.

Starting July 1, 2024, Regence BlueShield of Idaho will service the retiree medical and prescription drug plans.

Benefit Highlights

FY26 Summary of Plan Benefits and Coverages (SBC’s)

FY26 Retiree PPO SBC
FY26 Retiree Trad SBC
FY26 Retiree Family HDHP SBC

FY26 Plan Contracts

FY26 Contracts will be posted soon

FY25 Summary of Plan Benefits and Coverages (SBC’s)

FY25 Retiree PPO SBC
FY25 Retiree Trad SBC
FY25 Retiree HDHP SBC

FY25 Plan Contracts

FY25 Retiree PPO Contract
FY25 Retiree Trad Contract
FY25 Retiree HDHP Contract

Retiree Medical Plan Comparison & Plan Contract

Feature Name	PPO In-Network	PPO Out-of-Network	Traditional	High Deductible
Deductible – Individual	$350	$600	$450	$2,000
Deductible – Family	$950	$1,700	$1,250	$4,000
Out-of-Pocket Limit – Individual	$3,250	$6,500	$4,300	$5,000
Out-of-Pocket Limit – Family	$6,750	$13,500	$8,600	$10,000
Plan Payment (% of allowable charges after deductible)	$20 copay / 85%	70%	80%	70%
Wellness/Preventive Care	No-copay for listed services	70%	100%	100%
Telehealth/MDLive	No copay (Covered 100% during the Federal State of Emergency)	N/A	No copay (Covered 100% during the Federal State of Emergency)	100% after deductible (Covered 100% during the Federal State of Emergency)

For details about premiums, please see Retiree Premium Rates.

Please keep in mind that deductibles and benefit payments are based on allowable charges. Details about the medical plans, exclusions and waiting periods, can be found in each medical plan document and Summary of Benefits & Coverage (SBC).

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Prescription Drug Coverage

The Regence formulary is a 6-tier formulary with the same copay structure that you are used to seeing. Please review the Drug List below to see where you medications may be on this State Health Plan-specific list.

Regence 6-Tier Drug List

Regence 6-Tier Rx Benefit Information

ATTENTION HDHP MEMBERS:

The costs for all prescriptions not listed on the Optimum Value Medication List are subject to the HDHP deductible. Benefits will not begin until the deductible is met on the HDHP plan.

Optimum Value Medication List

For a covered Prescription Drug dispensed by a Physician or a Licensed Pharmacist who is not a Participating Pharmacist, the Insured is responsible for paying for the Prescription Drug at the time of purchase and must submit a claim to BCI or one (1) of its designated claims processing vendors. The amount of payment for a covered Prescription Drug is the balance remaining after subtracting the Prescription Drug Copayment and/or Coinsurance from the lower of the Allowed Charge or the Usual Charge for the Prescription Drug.