State of Michigan Employees: Open Enrollment Brings Choices
July 31, 2008
It’s that time of year again—open enrollment is Aug. 11 – 29 —which gives all benefits-eligible employees the opportunity to review health benefits and make new or different choices for the coming year. It’s also a chance to think about your stage of life and how the offerings might be relevant. Are you relatively healthy, or are you under the care of several specialists? Do you prefer one doctor to take care of all of your health care needs, or do you want to be able to see any doctor, whether they’re in- or out-of-network?
View listing of Open Enrollment Meetings being held around the state from August 11-27, 2008.
Here are a few other considerations when choosing a health care plan:
Provider networks
Is your current provider in the network? Are you willing to travel to the other side of town for care, or do you want a doctor that’s near work or home? Do you want a doctor that’s affiliated with a specific hospital? Is the hospital in the network?
Benefit coverage
Does the plan cover what you need (e.g., infertility, acupuncture, behavioral health)? Are there any benefit limitations on the services you’ll need?
In- and out-of-network coverage
Do you want flexibility to go outside the network? PPO plans offer employees the ability to seek care both in- and out-of-network. Seeking service out-of-network does come with a higher price tag, as you may have to meet a higher deductible and a co-insurance for out-of-network services.
Most HMOs require you to receive services in-network only. Most plans don’t cover services rendered by out-of-network providers.
Monthly premium share
How much will a particular plan cost per month?
Coverage while traveling
When you travel within the United States or internationally, how will the plan cover emergencies, urgent care, or follow-up care? Will students away from home be covered?
Prescription drug
Are your prescription drugs currently listed on the prescription plan formulary? Does the plan cover non-preferred brand name drugs? If not, you may pay more for the drug, or the drug may not be covered. Does the plan require prior authorizations for the drug(s) you’re currently taking?
Decision-making tool
Here’s a guide to help you determine the right type of health care coverage for you and your family:
State Health Plan HMOs
Premium Contribution Increased employee preimum (10%) Increased employee premium (5% min.)
Deductible In-network: increased to No deductible - no change
$300 individual/$600 family
Out-of-network: increased to
$600 individual/$1,200 family
In-network office visit
co-payments: Increased to $15 $10 - no change
- Physician Office
- Office consultations
- Chiropractic spinal
manipulations
- Urgent care
- Medical hearing exam
- Medical eye exam
Emergency room co-pay Increased to $50 (waived if admitted) $50 (waived if admitted) - no change
Prescription drug co-pay * Retail increase: Retail/Mail order - no change:
$10 generic, $20 preferred brand, $5 generic, $10 brand name
$40 non-preferred brand
* Mail order increase: $20 generic, $40 brand name,
$80 non-preferred brand
In/out network coverage Both In-network only
Referrals to specialists
required No Yes