2019 Benefit Information: Active Members

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As a reminder, during Open Enrollment, all active members and any dependents were automatically enrolled in the 70/30 Plan, which will have an $85 employee-only premium. Subscribers could reduce their premium by $60, down to $25, by completing the tobacco attestation. Subscribers also had the option to enroll in the 80/20 Plan and reduce that premium by $60 by completing the tobacoo attestation if they took action during Open Enrollment.

2019 Changes to Highlight

  • Premiums frozen at 2018 rates!
  • The 80/20 Plan’s out-of-pocket maximum has changed from a separate medical and pharmacy out-of-pocket amount to a combined medical and pharmacy out-of-pocket maximum, which totals $4,890.
  • There has also been a change in the 80/20 Plan’s specialist and inpatient hospital copay.
  • The tobacco attestation premium credit activity has changed for tobacco users who want to reduce their monthly premium. Now, tobacco users must commit to visit a CVS Minute Clinic for at least one tobacco cessation counseling session within 90 days after the last day of Open Enrollment or risk losing the monthly premium credit. If you agree to visit a CVS MinuteClinic to satisfy your credit, you will receive a voucher in the mail, after Open Enrollment. That voucher can be used for two free counseling sessions. The voucher will be required at the time of both visits.
  • The formulary, or drug list of covered medications, changes quarterly, so changes in drug coverage are possible.

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Pharmacy Resources

Drug Lists and Lookup Tools

*For drug lookup tools: If a drug is not covered, the following advisory will appear under Plan Notes: “Not covered: Ask your doctor about alternatives.”

Pharmacy Information

CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager.

The State Health Plan utilizes a custom, closed formulary (drug list). The formulary indicates which drugs are excluded from the formulary and not covered by the Plan. All other drugs that are on the formulary are grouped into tiers. Your medication’s tier determines your portion of the drug cost.

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Please Note: These tools include information based on the 2018 formulary and are subject to change prior to January 1, 2019.
 

How to Lower Your Monthly Premium

During Open Enrollment, if you completed the tobacco attestation, you earned a wellness premium credit that will reduce your monthly premium by $60 a month. (The wellness premium credit only applies to the employee-only premium.)

At Time of Enrollment 80/20 Plan 70/30 Plan
Subscriber Only Monthly Premium $110 $85
Attest to being a non-tobacco user or agree to visit the CVS MinuteClinic for at least one tobacco cessation counseling session to earn a monthly premium credit of $60 -$60 -$60
Total Monthly Employee-Only Premium: (With Credit) $50 $25

If you agreed to visit a CVS MinuteClinic to satisfy your credit, you will receive a voucher in the mail, after Open Enrollment. That voucher can be used for two free counseling sessions. The voucher will be required at the time of both visits.

Additional Wellness Incentives on the 80/20 Plan

Additional wellness incentives are available in the 80/20 Plan that lower your out-of-pocket costs for various health care services you receive throughout the year.

Additional Wellness Activities 80/20 Plan 70/30 Plan
Visit the Primary Care Provider (PCP) listed on your ID card or another provider in the same practice $10 copay N/A