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Health

State PPO

HMO

Life Insurance

Dental

Vision

Supplemental

   

Standard HMOs

Depending on where you live or work, in many parts of the state, you may also select a Standard HMO.

With a Standard HMO you must use network providers to receive benefits - no benefits are paid when you use out-of-network providers, except in medical emergencies. In addition, set dollar copays keep your costs more predictable.

View a list of the Standard 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

Standard HMOs
Covers care received in network only

No annual deductible

 
  • Individual
$0
  • Family
$0

What you pay for care received

 
  • Doctor office visits

$20/visit for PCP; $40/visit for specialists

  • Hospital stay

$250

Prescription drugs

 
  • Generic

$7/retail; $14/mail order

  • Preferred Brand-name

$30/retail; $60/mail order

  • Nonpreferred Brand-name

$50/retail; $100/mail order

Annual out-of-pocket maximum

 
  • Individual

$1,500

  • Family

$3,000

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

See the HMO's Certificate of Coverage (COC) or Summary Plan Document (SPD).