Reimagine Your Healthcare

We are reimagining how we provide health insurance and wellness programs to our State employees. This update for FY22, while substantial, is designed to make a positive change in the lives of our benefits members and their families.

In order to provide you with as much information as possible about the changes to the health plan for FY22, a number of informational sessions, both virtual and in-person, will be scheduled for the next few months. A list of dates and times for January are now available.

Because your previous selections will not carry over to the next year, you must participate in FY22 Annual Enrollment. This is true even for individuals who have previously opted out of the health plan.

The Health Plans

Click here for the Washington Plan Design Matrix - a complete breakdown of medical, pharmacy, and premium costs.

The Washington Plan is one of two High Deductible Health Plans being offered for Fiscal Year 2022. This plan offers zero premium for employee coverage. The Washington Plan has a $5,500 deductible for single coverage and $11,000 deductible for two or more members.

Your out-of-pocket maximums are the same as your deductibles. This means that if you have single coverage, and you meet your deductible of $5,500, the plan will then pay 100% of your healthcare and prescription costs for the remainder of the plan year.

An important new feature in this plan is the way the deductible is met when more than two individuals are covered. For example, if you have family coverage, and one of your family members reaches the $5,500 deductible, the plan will then begin to pay 100% of covered healthcare and prescription costs for the remainder of the plan year for that family member. Then, if you and a different family member reaches the additional $5,500 remaining deductible of $11,000, the plan will pay 100% of covered healthcare and prescription costs for all of your covered family members for the remainder of the plan year.

Because there is no coinsurance with the Washington plan, you can expect to pay the reduced network costs of prescriptions, office visits, or other medical services until you have met your deductible. The exception to this is certain generic preventive prescriptions, which are not subject to the deductible, and may be covered at 100% depending on the type of the prescription.

Preventive services will still be covered at 100%, and not subject to co-insurance.

Since the Washington Plan is a High Deductible Health Plan, it is compatible with a Health Savings Account, assuming you are eligible to participate in a Health Savings Account. If you (and your covered spouse, if applicable) complete the Wellness Qualification before April 1, 2021, you will receive a $500 contribution to your Health Savings Account at the beginning of the new plan year in July 2021.

It is important to the state to offer this premium-free option. But we are also excited to provide the opportunity for you to buy up coverage levels that are more appropriate for you and your family.

Click here for the Lincoln Plan Design Matrix - a complete breakdown of medical, pharmacy, and premium costs.

The Lincoln Plan is one of two High Deductible Health Plans being offered for the Fiscal Year 22 and offers a $3,000 deductible for single coverage or a $6,000 deductible for coverage for two or more family members.

The Lincoln Plan is similar to other High Deductible Health Plans, in that you have to satisfy your deductible before the plan begins to pay benefits. Once you have reached your deductible, the Plan pays 75% of billed services, and you then pay the remaining 25% of the costs.

For example, if you go in for an urgent care visit before you meet your deductible, you will pay the reduced network cost of the visit as you would any other medical cost. If you go after meeting after meeting your deductible, you will pay just 25% of the cost. Once you meet your out-of-pocket maximum, the visit will be covered at 100%.

All co-payments and co-insurance count towards your annual out-of-pocket maximum, which is $6,000 for single coverage, or $12,000 for family coverage. Once you meet that out-of-pocket maximum, services will be covered at 100% for the remainder of the plan year. Preventive services will still be covered at 100%, and not subject to co-insurance.

One of the new features of the Lincoln Plan is that you will no longer have to meet the family coverage deductible before the plan begins to pay. In our previous High Deductible Health Plan, if you covered yourself and any family members, the full deductible had to be met before the plan began paying any benefits. Now, if one member of your family meets the single deductible, the plan will begin to pay allowable charges for that family member.

As an enhanced High Deductible Health Plan, you buy up through a small premium to enroll in this plan.

Because the Lincoln Plan is a High Deductible Health Plan, it is compatible with a Health Savings Account, assuming you are eligible to participate in a Health Savings Account. If you (and your covered spouse, if applicable) complete the Wellness Qualification before April 1, 2021, you will receive a $500 contribution to your Health Savings Account at the beginning of the new plan year in July 2021.

Click here for the Jefferson Plan Design Matrix - a complete breakdown of medical, pharmacy, and premium costs.

The Jefferson Plan is one of two Low Deductible Health Plans being offered in Fiscal Year 2022 and has a $1,750 deductible for single coverage or a $3,500 deductible for coverage for two or more members.

This plan introduces a mix of co-payments and co-insurance. What this means is that some services are paid at a flat dollar amount without having to satisfy your deductible, while other services may be covered with a co-payment and co-insurance, and others with a simple co-insurance amount.

If you go for an office visit or urgent care, it will cost you $50. A visit to the emergency room will cost you $250 plus 30% of the remaining bill. For example, if the emergency room visit costs $1,000 dollars, you will pay a total of $475 if you have not yet reached your out-of-pocket maximum.

Prescription drug costs will also be co-payments, depending on the type of prescription you have filled. All co-payments and co-insurance count toward your annual out-of-pocket maximum, which is $4,000 for single coverage, or $8,000 for family coverage. Once you have met that out-of-pocket maximum, services will be covered at 100% for the remainder of the plan year.

As a participant in the Jefferson Plan, you will know your out-of-pocket costs for the most common medical and prescription expenses, allowing you to budget for you and your family’s expenses more easily.

Preventive services will still be covered at 100%, and not subject to co-payments. With this plan, you buy a higher value with your monthly premium.

Like all Low Deductible Health Plans, the Jefferson Plan is not compatible with a Health Savings Account. However, you can elect to participate and set aside pre-tax money in a Medical Flexible Savings Account to help budget for costs. Additionally, if you (and your covered spouse, if applicable) complete the Wellness Qualification before April 1, 2021, you will be reimbursed up to $500 in a Health Reimbursement Account to offset medical expenses you incur in the plan year.

Click here for the Roosevelt Plan Design Matrix - a complete breakdown of medical, pharmacy, and premium costs.

The Roosevelt Plan is one of two Low Deductible Health Plans being offered in Fiscal Year 22, and offers a zero-dollar deductible, whether you have single or family coverage; you will not have to meet a deductible before the plan starts paying benefits. This plan also introduces a new feature not previously available with our prior Health Plan, a set of co-payments for all for all covered services.

The Roosevelt Plan is ideal for people who want to know exactly what medical services will cost with no surprises. It also provides an opportunity to budget medical expenses because you are paying these in a more predictable way – a combination of your monthly premium and these established co-pays.

If you or a covered family member have a visit with your primary care physician, need to go to an urgent care facility, or have an x-ray, you will pay a flat $30 to your provider. An emergency room visit will cost you $500, while an inpatient or outpatient service will cost you $3,500 or $2,500 respectively.

Prescription drug costs will also be co-payments, depending on the type of prescription you have filled. All co-payments do count towards your annual out-of-pocket maximum, which is $4,500 for single coverage, or $9,000 for family coverage. Once you meet that out-of-pocket maximum, services will be covered at 100% for the remainder of the plan year.

So, what does this mean for you? As a participant in the Roosevelt Plan, you will know what your out-of-pocket costs will be for medical and prescription coverages, allowing you to budget for you and your family’s expenses for the plan year.

Preventive services will still be covered at 100%, and not subject to co-payments.

With this robust plan, you buy up to the higher value through premium.

Like all Low Deductible Health Plans, the Roosevelt Plan is not compatible with a Health Savings Account. However, you can elect to participate and set aside pre-tax money in a Medical Flexible Savings Account to help budget for costs. Additionally, if you (and your covered spouse, if applicable) complete the Wellness Qualification before April 1, 2021, you will be reimbursed up to $500 in a Health Reimbursement Account to offset medical expenses you incur in the plan year.



Additional Plan Enhancements

  • Dental Premium Enhancements - Dental premiums will include a cost share of 50% of the employee only premium.
  • Covered Eye Exam - Medical insurance coverage will include one eye exam for each covered member per year.
  • Opt-Outs and Flexible Benefits -Flexible benefits such as Dental, Vision, and others will continue to be available to Opt-Out employees
  • Well-being Program - The health screening is the one qualification needed for employees to earn their incentive this year. The health screening qualification can be completed at one of the events offered, or it can be met by scheduling an annual wellness preventive exam with your primary health care provider. Complete the health care provider form with your physician, then submit.

    If an employee and their covered spouse (if applicable) complete the health screening qualification by April 1, 2021, the State will contribute $500 towards one of the following accounts, based upon the type of health plan the employee is enrolled:

    1. Low Deductible Health Plan - receive reimbursement of up to $500 in a Health Reimbursement Account (HRA) to offset costs during the plan year. The completion of the wellness qualification is no longer required in order to select a low deductible health plan.
    2. High Deductible Health Plan - receive the State contribution of $500 into a Health Savings Account (HSA) if eligible based on IRS rules. Employees who do not qualify for the HSA can choose one of the Low Deductible Health Plans and receive the HRA or choose a High Deductible Health Plan and decline the HSA.

    Note: The completion of the wellness qualification is no longer required in order to select a low deductible health plan. Starting in July 2021, there will be a new, customized well-being portal experience as well as an enhanced well-being incentive with additional earning potential.


Resources:

Click below to watch the January 14 Health Plan Presentation