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Important Considerations: Choosing a Medical Plan

Link to: Compare the four main types of options

Compare the four main types of options - the Standard PPO, Standard HMOs and Health Investor PPO or HMO.

Link to: Which plans are available in your area

Check to see which doctors, hospitals and specialists are available in each plan.

Link to: Think about your likely medical care needs for the coming year

Think about your likely medical care needs for the coming year, then compare your cost for that care and your cost for coverage under each of the different options.

Link to: Compare the coverage costs

Factor the Health Savings Account and the Medical Reimbursement Accounts into your decision.

Link to: Health Savings Account and the Reimbursement Accounts

Decide which option is best for you.


Compare the four main types of options - the Standard PPO, Standard HMOs and Health Investor PPO or HMO.

All four types cover the same kinds of services, but the way they pay benefits is different.

Key Decision Points:

 

Access to Care How you pay for care Insurance premiums (payroll deductions)**

Standard HMO

Use network providers to receive benefits

Set dollar copays for more predictable costs

Higher

Health Investor HMO

Use network providers to receive benefits

Annual deductible* and percentage of cost

Lower

Standard PPO

See network or non-network providers … your share of cost is lower when you use the network

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

Higher

Health Investor PPO

See network or non-network providers … your share of cost is lower when you use the network

Annual deductible* and percentage of cost

Lower

*With single coverage, you must meet the individual deductible before anything but preventive care is covered. With family coverage, you must meet the family deductible before plan pays for anything but specified preventive care services.
**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 both the Standard and Health Investor PPO Medical Plan benefit 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.

Many doctors, specialists and other healthcare providers participate in several different networks.

  • Look at the Benefits Statement you'll receive in your enrollment package in late September 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, and that you cannot change plans because a provider leaves the network.
Health Plan Instructions

BlueCross BlueShield (Standard and Health Investor PPO)

1. Click Find a Doctor
2. Select BlueChoice (Preferred Patient Care PPO) as the plan type

AvMed

Click Online Provider Directory

Capital Health Plan

Click Doctors

Florida Health Care Plans

1. Click Providers
2. Click Find a Provider

UnitedHealthcare

1. Click Find Physicians and Facilities
2. Select UnitedHealthcare HMO or United Healthcare Health Investor Health Plan

VISTA Healthplans

1. Use the "Find a …" search near the top left, select physician and click "Go"
2. Select VHP-Vista Healthplan as your plan

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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.

Be sure to use the online Medical Plan Cost Estimator to compare your overall cost for medical care. It adds up:

  • your estimated out-of-pocket costs for care – based on the types of care you anticipate using
  • your cost for coverage … giving you an apples-to-apples comparison of your total cost that can help you see which plan offers you the most favorable financial picture...

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.

The Health Savings Account, Medical Reimbursement Account and Limited Purpose Medical Reimbursement Account all offer a tax advantage by allowing you to set aside pre-tax 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!

  If you enroll in a Health Investor HMO or PPO and have no other medical coverage
If you enroll in the Standard PPO or a Standard HMO

You may enroll in

  • No Health Savings Account available
  • Medical Reimbursement Account is available to set aside pre-tax money to pay medical, dental and vision deductibles, copayments, coinsurance and such

Points to note

  • 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 the end of the year – but the state has added a grace period to make things easier!
  • Unused Medical Reimbursement Account balances are forfeited if you do not use them by the end of the year – but the state has added a grace period to make things easier!
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Decide which option is best for you

  • Take into account everything you've considered in Steps 1 - 4. When you have completed this process, you may be ready to enroll. You can do so between September 22, 2008 at 8:30 a.m. Eastern and October 17, 2008 at 5:30 p.m. Eastern.
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