State Health Plan Coverage
The health insurance plans available to State members differ in the benefit levels they provide, the doctors and hospitals you can access and the out-of-pocket cost to you. In general, managed care plans, such as Health Maintenance Organizations (HMOs) and the Open Access Plan (OAP), deliver healthcare through a system of network providers and have a lower monthly premium than the Quality Care Health Plan (QCHP). Members will find a listing of providers who participate in the health plan's network when they go to the provider directory page on the plan's website. There are several managed care plans located throughout the state available to State members. In addition to managed care, the State plan offers a Quality Care Health Plan (QCHP), administered by Aetna, which allows plan participants to access any provider nationwide. Enhanced benefits are available for QCHP members who receive services from a QCHP network providers.
New this year to active State employees is the Consumer-Driven Health Plan (CDHP). This is a high deductible health plan as defined by the IRS. Consumer Driven Health Plan (CDHP) members may choose any physician or hospital for medical services; however, members receive enhanced benefits, resulting in lower out-of-pocket costs, when receiving services from a CDHP in network provider. And, when paired with the Health Savings Account (HSA), CDHP/HSA members will receive a $500 State contribution for an individual member or $1,000 for family. CDHP has a nationwide network of providers through Aetna PPO. Benefits are outlined in the plan's Summary Plan Document (SPD). It is the member's responsibility to know and follow the specific requirements of the CDHP.
Health Plan Availability
Open Access Plans (OAP) is offered by:
Additionally, members may choose from an HMO Plan, the Consumer-Driven Health Plan (CDHP), or Quality Care Health Plan (QCHP):
- Aetna HMO
- BlueAdvantage HMO
- Health Alliance HMO
- HMO Illinois
- Consumer-Driven Health Plan (CDHP) – administered by Aetna
- Quality Care Health Plan (QCHP) – administered by Aetna
Essential Health Benefit Listings by Health Plans:
Be sure to check the Benefit Choice Booklet and carrier websites for coverage details and provider availability to pick the plan that's right for you.
Benefit recipients may view a map of the various plans' coverage areas below:
Plan Sponsor Notice: Machine-readable Files
A Transparency in Coverage rule (eff: Oct.29, 2020) requires health plans and issuers to publicly disclose pricing info via a machine-readable file. The following are self-funded plan sponsors, responsible for complying with the Transparency in Coverage regulations.
You must enroll or re-enroll in a Flexible Spending Account each plan year. The MCAP benefit is not available if enrolling in an HSA.
Members will find a listing of providers who participate in the health plan's network when they go to the provider directory page on the plan's website.
The Affordable Care Act rules require health plans to provide a summary of benefits and coverage (SBC) and a glossary of health coverage and medical terms. Both are designed to make it easier for you to compare your options and understand exactly what you are buying. The new requirements will also make it easier for employers to compare health insurance options to provide for their employees. Members can view the summary of benefits and coverage for each plan. The benefit levels listed in the SBCs go into effect July 1st of each year.
Health Savings Accounts (HSA) for Active State Employees
Companion to CDHP Enrollment ONLY
An HSA is like a 401(k) for healthcare, yet the HSA tax benefits are far greater. It is a tax-favored, interest-bearing account that active State employees can use to pay for qualified medical expenses now, or in the future. Active State employees who qualify (see Qualifying for an HSA below), can save or invest the account funds. Paired with the Consumer Driven Health Plan (CDHP), an HSA is a powerful financial tool that gives you more control of your healthcare decisions. An HSA oﬀers triple tax savings.
- Pretax or tax deductible contributions
- Tax-free interest or investment earnings
- Tax-free distributions, when used for qualified medical expenses
The State will contribute a third of the deductible to an active State employees' HSA. You may also contribute an additional $3,350 for individual; or $6,750 for family, to your HSA through pre-tax payroll deductions or post-tax direct payment.