Health Insurance Plans
There are three (3) types of medical plan structures offered by the State:
Preferred Provider Organizations (PPO): This type of plan provides employees with the maximum amount of flexibility in the selection of physician services. Employees in this type of plan do not select a primary care physician and may visit any medical provider desired, whether generalist or specialist. When visiting a provider within the PPO network, the employee pays only a co-pay. The PPO plans also offer employees the option to receive services outside of the network at a ratio of 80% plan, 20% patient after the appropriate deductible has been met ($250/Individual, $500/Family). Vision benefits (purchase of eyeglasses/contact lenses) with limited reimbursement for specified services, are offered as part of medical plan coverage. PPO plans are available to all employees regardless of county/state of residence.
Point of Service (POS) Plans: These plans are set up similarly to the PPO plans wherein the employee has the option to go outside the network for services and the plan will still pay the 80%-20% ratio after the deductible. However, employees must select a Primary Care Physician and that physician must make any subsequent referrals in or outside the network in order for the plan to pay 100% for services rendered. If an employee elects not to go through their Primary Care Physician, the out-of-network rates will apply. An employee who visits a provider within the network after a referral will pay only co-pay.
The POS plans also provide for vision coverage toward the purchase of eyeglasses/contact lenses. Check plan brochure for fee schedules and participating physician information.
Exclusive Provider Organizations (EPO): These are strictly managed care programs which require employees to utilize the physicians within the EPO plan network. The plan will not
cover services rendered outside the network. Employees must select a Primary Care Physician and may elect to utilize other participating physicians within the network, without a referral. The employee pays a co-pay for all visits.
EPO plans also provide vision benefits associated with the purchase of eyeglasses/contact lenses. Check plan brochure for fee schedules and participating physician information.