Important Considerations: Choosing a Health Plan
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Compare the four main types of options - the Standard PPO, Standard
HMOs and Health Investor PPO or HMO.
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All four types cover the same kinds of services, but the way they
pay benefits is different.
Key Decision Points:
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Standard HMO
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Use network providers to receive benefits
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Set dollar copays for more predictable costs
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Higher
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Health Investor HMO
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Use network providers to receive benefits
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Annual deductible* and percentage of cost
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Lower
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Standard PPO
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See network or non-network providers
your share of cost
is lower when you use the network
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Set dollar copays for more predictable costs for some network
care. A percentage of cost - or annual deductible and percentage
of cost for other care
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Higher
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Health Investor PPO
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See network or non-network providers
your share of cost
is lower when you use the network
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Annual deductible* and percentage of cost
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Lower
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*Individuals must meet the deductible before
anything but preventive care is covered.
**For those employees' who pay premiums for coverage - including state
Career Service employees' and University Faculty, Staff and Administrative
and Professional Employees'.
Use the highlights for the Standard
PPO, the Standard HMOs, the Health
Investor PPO and the Health Investor
HMO to help you understand key differences in how the four types
of plans work.
For more information, view the State Employees’
PPO Plan Booklet and Benefits Document or the individual HMO's certificates of coverage (available from the HMOs).
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Check to see which doctors, hospitals and specialists are available
in each plan.
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Many doctors, specialists and other healthcare providers participate
in several different networks.
- Go to HMO Oferrings in Your Area to see which health plans are available
in your geographic area. Then go to the Web sites for those plan administrators
to find out what doctors and hospitals are in the network. The chart
below includes web links and easy step-by-step instructions to help
make your search easier.
- Keep in mind that health providers are subject to change at any
time without notice. You cannot change plans because a provider
leaves the network.
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Compare your cost for anticipated care under the different health
plan options, then compare your cost for that care and your cost
for coverage under each of the different options.
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Be sure to use the online Medical
Plan Cost Estimator to compare your overall cost for medical care.
Coverage costs are also listed on the Benefit Statement in the enrollment
package you receive.
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Factor the Health Savings Account and the Medical Reimbursement
Accounts into your health plan decision.
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The Health Savings Account,
Medical Reimbursement Account and
Limited
Purpose Medical Reimbursement Account all offer a tax advantage by allowing
you to set aside pretax dollars for eligible healthcare expenses. And
the Health Savings Account (available when you enroll in one of the
Health Investor Health Plans) offers more including state contributions
to your account and a carryforward of any unused HSA account balance
from year-to-year. If you have deductibles, copayments or coinsurance
to pay, consider funding them through these accounts tax free!
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You may enroll in
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- Medical
Reimbursement Account is available to set aside pretax
money to pay health, dental and vision deductibles, copayments,
coinsurance and such
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Points to note
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- HSA balance earns interest and you may have the opportunity
to decide how it is invested
- Unused HSA balance carries forward year-to-year; portable
if you leave
- Unused Limited Purpose Medical Reimbursement Account balances
are forfeited if you do not use them by March 15 for the previous plan year.
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- Unused Medical Reimbursement Account balances are forfeited
if you do not use them by March 15 for the previous plan year.
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Decide which option is best for you
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