Choosing Your Health Plan for Plan
Active State Employees, Non State Employer Groups and NON-Medicare
Eligible Retiree/Direct Bill Members
Plan A, Plan B or Plan C
You have access to all health plans regardless of where you live.
You have choices when it comes to your health care coverage. Choosing the appropriate health plan for you and your family may be easier than you think!
The State Employee Health Plan offers three health plan options:
- Plan A
- Plan B
- Plan C with Health Savings Account (HSA)
Each option is designed differently (for example, deductibles, coinsurance and annual maximums) and each health plan vendor offers unique features. Be sure to consider these features before making your selection.
There are three health plan vendors:
- Blue Cross and Blue Shield of Kansas
Each of the three health plan vendors has a unique network of contracting providers. Since network providers agree to accept the plan allowance as payment in full, using network providers saves you money! Non network providers have not agreed to accept the plan allowance, so any amount above the plan allowance will be your responsibility. Review the provider directories at www.kdheks.gov/hcf/sehp/VendorProviderDirectories.htm
All options offer the following:
- Access to a broad network of providers nationwide which allows you flexibility in obtaining care with coverage for both network and non network providers.
- 100 percent coverage for certain preventive care services, such as an annual preventive exam, colonoscopy, mammograms and age-appropriate immunizations (including flu shots and allergy shots).
- Policies have no lifetime maximum.
- Prescription drug coverage through Caremark. See page 14 for details.
Plan A and Plan B
Both plans A and B have the Preferred Lab Benefit program available through Quest Diagnostics or Stormont-Vail HealthCare.
Please review the Health Plan Comparison Chart provided with this book to see the differences in the deductible, coinsurance and annual coinsurance maximums for Plans A and B.
Plan C with Health Savings Account (HSA)
Plan C has a few differences including:
- Premiums for coverage are lower than those for Plan A and Plan B.
- The deductible under Plan C is higher but your employer provides you with a contribution to your Health Savings Account (HSA) that can be used to help you pay for your deductible. See “Health Savings Account” on the next page for details.
- The Plan C Caremark Preferred Drug List is the same as Plans A and B. With Plan C, prescription drug purchases are subject to the deductible. In Plan Year 2014, network claims for prescription drugs purchased after the deductible has been satisfied will be covered at 100% if eligible under the pharmacy benefit.
- Most covered services are subject to the deductible. See the Health Plan Comparison Chart included with this booklet to see the deductibles and out-of-pocket costs.
Health Savings Account (HSA) Through the HSA, you can set aside pre-tax money to pay for eligible health care expenses. Examples of the types of medical expenses that you can spend your HSA funds for include:
- Deductibles and coinsurance
- Dental, Drug and Vision expenses
- Over-the-counter medications, such as aspirin, cold medicines, antacids and cough supplements if you have a prescription from your doctor
- Contact lens solution or cleaners
Both you and your employer contribute money to the Health Savings Account (HSA). The maximum annual contribution to an HSA for 2014 is $3,300 for single coverage and $6,550 for dependent coverage. These maximums apply to the sum of you and your employer’s contributions, so the maximum annual contribution for full time employees in 2014 is $1,800 for single coverage and $4,300 for dependent coverage. Members ages 55 + can make additional “catch up” contributions to their HSA each year until they enroll in Medicare. The additional catch-up contribution for 2014 remains at $1,000.