The Health Insurance Open Enrollment period will run from May 7th through June 3rd of 2018. The schedule of on-site open enrollment fairs has been released. Remember, if you need to drop someone from your insurance, you must do it now. The most common mistake is failure to remove a recent ex-spouse; they should be removed from coverage unless otherwise ordered by a court. Children are covered until age 26 on medical and age 19 on dental (unless disabled).
The State Employee Healthcare plan has undergone quite a number of changes over recent years and is becoming a bit difficult to follow. Comptroller Lembo has been very good about posting explanations on his website, but none-the-less, it can be a bit overwhelming. If you are seeking to get a grip on the Health Plan, you can start with this overview of the changes from the Comptroller's website.
Among the various components:
HEP: Meeting the required doctors visits annually and if diagnosed with a chronic disease, there is an educational component to meet as well. Meeting these annual requirements will prevent higher monthly premiums and a deductible of $350/person. HEP Chart
Preferred Providers & Site of Service: Out-patient lab work, pathology, and imaging services are being sought at lower-cost, high quality non-hospital settings (examples of services: blood work, urine tests, stool tests, x-rays, MRIs,CT scans, etc.).
The preferred locations for these services can be found using the links below. Important: There is a 20% co-pay for non-preferred, in-network Site-of-Service locations so there is a real value to scheduling Lab Work/Pathology/Radiology at a preferred site. Out-of-network sites are even more expensive or may not be covered at all.
For other doctors/specialties; in-network, Preferred Providers will result in waiving the $15 office visit charge.
To find the preferred in-network sites/doctors visit:
Anthem Preferred Provider/Site of Service
UnitedHealthcare Preferred Provider/Site of Service
SmartShopper: This is a bit intriguing, some common procedures vary wildly in price based on which facility conducts the procedure. By signing up for and utilizing VitalsSmartShopper.com, you can see which facilities charge the least to insurance and therefore will provide you with a cash incentive.
Premium Shares: All union employees will eventually pay 16% of the Health Insurance Premium. Right now, the various plans charge employees various %'s. New employees are starting at a 15% premium share when hired, for all others, the employee share will increase by 1% annually (with a 15% cap) until every plan moves to a 16% cost-share on 7/1/21. For those currently on plans with lower premium share costs, the first increase of 1% will begin on 7/1/19, followed by another 1% on 7/1/2020 and by 7/1/2021 all plans will have a 16% cost-share for employees...some plans are already there or close to it, others will see the incremental increases starting in 2019...important: this is not % of salary, this is % of the insurance premium.
The Comptroller's Office provided this chart showing the current employee costs. The "new hire" column is a fairly good indicator of where your insurance costs are headed over the next few years as we step towards 16%.
A quick way of navigating our health plan: visit some doctors regularly as prescribed by HEP, if you need to see a specialist or have a procedure or "test" conducted, you will want to ensure that the doctor/facility you intend to visit is a preferred doctor at a preferred site to keep your personal expenses low. Ultimately, if you need a procedure, you can check the VitalsSmartShopper and see if there is a cash incentive to have the procedure at a particular facility.