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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.  In addition, the plan will pay 90% toward in-patient hospital and other diagnostic services and the employee would be responsible for the remaining 10% coinsurance up to a maximum of $1,000 for Individual or $2,000 for Family.  Review the Benefit Plan Summary booklet for more details regarding specific in-patient and diagnostic services.  The PPO plans also offer employees the option to receive services outside of the network at a ratio of 70% (plan), 30% (patient) after the appropriate deductible has been met ($250/Individual, $500/Family) with a co-insurance out-of-pocket maximum of $3,000 for Individual and $6,000 for 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.  There is a regional physician network, and the employee must select a primary care physician and the physician must make referrals inside or outside the network in order for the plan to pay toward services rendered.  In addition, the plan will pay 90% toward in-patient hospital and other diagnostic services and the employee would be responsible for the remaining 10% coinsurance up to a maximum of $1,000 for Individual or $2,000 for Family.  Review the Benefit Plan Summary booklet for more details regarding specific in-patient and diagnostic services.  The POS plans also offer employees the option to receive services outside of the network at a ratio of 70% (plan), 30% (patient) after the appropriate deductible has been met ($250/Individual, $500/Family) with a co-insurance out-of-pocket maximum of $3,000 for Individual and $6,000 for Family.  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 same physician network available under the PPO plans).  In addition, the plan will cover 100% for all in-network services.  The plan will not cover services rendered outside the network.  Employees are not required to select a Primary Care Physician, (it is recommended) and may elect to utilize other participating physicians within the network, without a referral.  The employee pays a co-pay for physician visits.