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Health

State PPO

HMO

Life Insurance

Dental

Vision

Supplemental

   

Health Investor HMOs

Health Investor HMOs require you to use network providers to receive benefits - no benefits are paid when you use out-of-network providers, except in medical emergencies. Health Investor HMOs cover all the same services and supplies as their Standard HMO counterparts – and use the same provider networks (for example, the UnitedHealthcare Standard HMO and UnitedHealthcare Health Investor HMO have the same network).

There are some key differences under the Health Investor HMO:

  • If you contribute toward the cost of your coverage, your monthly insurance premiums are lower.
  • For specific preventive care services, there's no deductible. For other health services or prescription drugs, you meet the deductible before benefits begin.
  • The deductible applies before anything but preventive care is covered.
  • You may open a Health Savings Account with a contribution from the state and can add your own contributions, as long as you do not have health coverage outside the state.* You can use the HSA to pay out-of-pocket expenses like your deductible and coinsurance - now or in the future.

View a list of Health Investor HMOs that will be offered and the areas where each is available. The Benefit Statement you receive will show the specific HMO options available to you. Use the Health Plan Cost Estimator to compare your options.

Plan Highlights

Health Investor HMO
Covers care received in network only

Annual deductible

 
  • Individual coverage (before anything but preventive care is covered)

$1,250

  • Family coverage (before anything but preventive care is covered for the family)

$2,500

What you pay for care received after deductible

 
  • Health care

20%

Prescription drugs

 
  • Generic and Preferred brand-name

30%

  • Nonpreferred brand-name

50%

Annual out-of-pocket maximum (after deductible)

 
  • Individual coverage

$3,000

  • Family coverage

$6,000

 

After you reach your out-of-pocket maximum, the plan pays 100% up to allowable cost for most covered care for the rest of the calendar year

Preventive care (coverage based on age and gender): Certain routine physical exams, health screenings, and immunizations.

Same as standard HMOs; no deductible required

  • routine annual physicals
  • screenings at published intervals

*For purposes of determining whether you may open a Health Savings Account, "other coverage" includes coverage through your spouse's employer's plan, Medicare, Medicaid, a Healthcare Flexible Spending Account that covers medical expenses (like the state's Medical Reimbursement Account), or any other medical plan. You may participate in an HSA if you have a Limited Purpose Medical Reimbursement Account or enroll in the supplemental cancer, hospital or intensive care policies available to you as a state employee.