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.
Review the new plan year Summaries of Benefits and Coverage (SBC) – Starting July 1, 2023
Benefit Highlights:
Retiree Medical Plan Comparison & Plan Contract
Feature Name | PPO In-Network | PPO Out-of-Network | Traditional | High Deductible |
---|---|---|---|---|
FY23 Plan Contracts | Retiree PPO | Retiree PPO | Retiree Traditional | Retiree HDHP |
FY23 Plan Summary | Retiree PPO SBC | Retiree PPO SBC | Retiree Traditional SBC | Retiree HDHP Single SBC Retiree Family HDHP SBC |
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) |
Prescription Drug Coverage
Prescription Drug Formulary
Tier | Copay |
---|---|
Tier 1 - Generic | $10 |
Tier 2 - Preferred Brand | $30 |
Tier 3 - Non-preferred Brand | $60 |
Tier 4 - Specialty | $100 |
Mail Order Prescriptions | 90 days for 2 copays |
ATTENTION HDHP MEMBERS: The costs for all prescriptions not listed on the HDHP Preventive List are subject to the HDHP deductible. Benefits will not begin until the deductible is met on the HDHP plan.