2020 Open Enrollment: COBRA Participants & Direct Bill Members

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During Open Enrollment, all non-Medicare Primacy members and any dependents will be automatically enrolled in the 70/30 Plan, which will have an $85 employee-only premium. You may reduce your premium by $60, down to $25, by completing the tobacco attestation. You may also enroll in the 80/20 Plan and reduce that premium by $60 by completing the tobacco attestation if you take action during Open Enrollment. To reduce your premium or enroll in the 80/20 Plan, you must take action during Open Enrollment!

Click here to get started to complete Open Enrollment

2020 Summary of Changes

  • The SAME network will be available in 2020 as in 2019.
  • Premiums have been FROZEN for 2020 at the same rate as 2019!
  • The 70/30 Plan has several changes:
    • Preventive services will be covered at 100% ($0 copay)
    • Primary Care Provider (PCP) copay reduced from $45 down to $30 when you visit the PCP listed on your ID card
    • Medical coinsurance and pharmacy maximums will be combined into one maximum out-of-pocket amount
    • Deductible and some copays will increase
  • The 80/20 Plan remains the same, with no changes to any out-of-pocket amounts.
  • The tobacco attestation premium credit activity has been simplified for tobacco users who want to reduce their monthly premium. Tobacco users must still commit to visit a CVS MinuteClinic for at least one tobacco cessation counseling session by December 31, 2019, or risk losing the monthly premium credit. However, a voucher is no longer required!
  • The formulary, or drug list of covered medications, changes quarterly, so changes in drug coverage are possible.

More information and details regarding your 2020 benefits coming soon!

Tobacco Attestation Premium Credit

The tobacco attestation premium credit activity has been simplified for tobacco users who want to reduce their monthly premium. Tobacco users must commit to visit a CVS MinuteClinic for at least one tobacco cessation counseling session by December 31, 2019, or risk losing the monthly premium credit. However, a voucher is no longer required!

Pharmacy Resources

*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.”

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.

Please Note: These tools include information based on the 2019 formulary and are subject to change prior to January 1, 2020.

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State Health Plan 101 Webinars: Open Enrollment 2020

Stay up-to-date on Open Enrollment, plan benefits and changes to get the most out of your State Health Plan in 2020.

Click here to listen to a recorded version of the Open Enrollment webinar or click here to download the presentation.

Click here to view 2020 Open Enrollment Frequently Asked Questions.

How to Lower Your Monthly Premium

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

Please note these are COBRA rates.

At Time of Enrollment 70/30 Plan 80/20 Plan
Subscriber Only Premium $617.36 $642.36
Attest to being a non-tobacco user or agree to visit the CVS MinuteClinic by Dec. 31, 2019, for at least one tobacco cessation counseling session. -$60 -$60
Total Monthly Subscriber-Only Premium: (With Credit) $557.36 $582.36

If you are a tobacco user and agreed to visit a CVS MinuteClinic for a free counseling session to satisfy your credit, you must fulfill that visit by December 31, 2019. No voucher is required for the visit! For your convenience, you can find a MinuteClinic location on this handy MinuteClinic locator tool.

Wellness Incentives on the 70/30 & 80/20 Plan (**New incentive on 70/30 Plan for 2020**)

Lower your out-of-pocket costs for various health care services you receive throughout the year on both plans!

Primary Care Provider Office Visit Reduction 70/30 Plan 80/20 Plan
Visit the Primary Care Provider (PCP) listed on your ID card or another provider in the same practice. $30 (reduced from $45) $10 (reduced from $25)