Choosing Your Health Plan
Plan A or Plan C High Deductible Health Plan
You have access to both 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 two health plan options:
- Plan A
- Plan C with Health Savings Account (HSA) or Health Reimbursement Account (HRA).
Please review the Health Plan Comparison Chart at the back of this book to see the differences in the deductible, coinsurance and out-of-pocket maximums for Plans A and C.
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 two health plan vendors:
- Blue Cross and Blue Shield of Kansas
Each health plan vendor 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 in addition to your required out-of-pocket, any amount above the plan allowance will be your responsibility.
Provider directories are listed on each vendor page. You can find them here www.kdheks.gov/hcf/sehp/default.htm
Both Vendors 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).
- Policies have no lifetime maximum.
- Prescription drug coverage through Caremark. See page 12 for details.
- A Preferred Lab Benefit program available through either Quest Diagnostics or Stormont-Vail HealthCare.
Plan C with Health Savings Account (HSA) or Health Reimbursement Account (HRA)
When enrolling in Plan C, new participants will need to:
- Terms and Conditions must be accepted during the enrollment process to open the Health Savings Account.
- Register their Health Reimbursement Account with US Bank at www.mycdh.optum.com in order to have the employer contributions deposited and view account details.
Plan C has a few differences including:
- Premiums for coverage are lower than those for Plan A.
- Your employer provides you with a contribution to your Health Savings Account (HSA) or Health Reimbursement Account (HRA) that can be used towards your deductible.
- 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.
- The Plan C Caremark Preferred Drug List is the same as Plan A’s Preferred Drug List. With Plan C, prescription drug purchases are subject to the deductible. Network claims for prescription drugs purchased after the deductible has been satisfied will be covered at 100% if eligible under the pharmacy benefit.