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Medical/Prescription Drugs
Your State Medical/Prescription Drugs Plan
The chart below shows a general comparison of the Plan options offered by the State. For more comprehensive information, refer to your open enrollment booklet and other materials available online at www.ben.omb.delaware.gov/oe.
| |
| Carrier |
Highmark Blue Cross Blue Shield Delaware |
Highmark Blue Cross Blue Shield Delaware and Aetna |
Highmark Blue Cross Blue Shield Delaware (BlueCare HMO) and Aetna |
Highmark Blue Cross Blue Shield Delaware |
| Type of Plan |
Preferred Provider Organization (PPO) |
Consumer Directed Health (CDH) Plan |
Health Maintenance Organization (HMO) |
Preferred Provider Organization (PPO) |
| Percentage of Premiums State Pays |
96% |
95% |
93.5% |
86.75% |
| Percentage of Premiums You Pay |
4% |
5% |
6.5% |
13.25% |
| Plan Features |
Lowest premiums offered. Freedom to visit providers in or out-of-network, but benefits are greater in-network. After you meet an annual deductible, plan begins to pay benefits. Most in-network covered services are paid at 90%. You pay the other 10%. |
Low premiums. Freedom to visit providers in or out-of-network, but benefits are greater in-network. Plan includes a State-Funded health reimbursement account (HRA) that can be used to pay for eligible expenses, including your deductible. Deductible is higher than other plans, but is mostly covered by the HRA. If you reach your out-of-pocket maximum, plan pays 100% of all costs for the rest of the plan year. If you have money left in your HRA, it rolls over year-to-year. |
Slightly higher premiums. Must visit providers within the network to receive coverage, must designate a Primary Care Physician (PCP) and obtain referrals to see most specialists. No deductibles or coinsurance; most services require a flat co-payment for services. |
Highest premiums. Freedom to visit providers in or out-of-network, but benefits are greater in-network. No deductible in-network. Most in-network covered services are paid at 100% in-network after applicable copayment. |
| Premium Contributions |
| Employee |
| Employee + Spouse |
| Employee + Child(ren) |
| Family |
|
| |
| $21.90 |
| $45.30 |
| $33.28 |
| $56.62 |
|
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| $28.32 |
| $58.72 |
| $43.28 |
| $74.62 |
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| Aetna/BlueCare |
| $37.14/$37.16 |
| $78.32/$78.56 |
| $56.82/$56.88 |
| $97.72/$98.02 |
|
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| $82.80 |
| $171.82 |
| $127.60 |
| $214.80 |
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| In-Network Deductible |
$500 individual
$1,000 family |
$250 individual ($1,500 minus State's contribution to HRA of $1,250)
$500 family ($3,000 minus State's contribution to HRA of $2,500) |
None |
None |
| Preventive Care |
Paid at 100%, no deductible |
Paid at 100%, no deductible |
$10 copay (office visit) |
$15 copay (office visit) |
| Office Visits |
| Primary Care Physician |
| Specialist |
|
Paid at 90% after deductible |
Paid at 90% after deductible |
|
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| Copayments* |
No |
No |
Yes |
Yes |
| In-Network Coinsurance for Most Services* |
Plan pays 90% after deductible |
Plan pays 90% after deductible |
N/A |
N/A |
| Out-of-Network Coverage* |
Plan pays 70% after deductible of $1,000 per individual or $2,000 per family |
Plan pays 70% after deductible |
None available |
Plan pays 80% after deductible of $300 per individual or $600 per family |
Out-of-Pocket Maximum
(in-network, excluding deductibles) |
$2,000 individual
$4,000 family |
$3,000 individual
$6,000 family |
None |
None |
* For more details about how eligible expenses are covered, refer to your Summary Plan Description, available online at www.ben.omb.delaware.gov/medical.
Separate Prescription Drug Coverage
Prescription drug copays will remain the same for the 2013 - 2014
plan year. Your prescription copays do not apply to your deductible
or coinsurance maximums.
Coverage for Adult Children Under Age 26 Effective July 1, 2011
Effective July 1, 2011, the State Group Health Insurance Plan (GHIP) will include coverage
for adult children up to age 26. Your adult dependent children may be enrolled in the plan,
up to age 26, with no requirement or restriction on marital, employment, student, resident
or tax status. In other words, you may enroll an otherwise eligible adult child, up to age 26,
whether or not the child is married, employed, a student, a tax eligible dependent or living
with you.* Coverage of eligible adult children may continue until the end of the month in
which the adult child turns age 26.
* The new federal health insurance law relating to dependent coverage of children requires the State
of Delaware to offer group health coverage to an employee's children who have not reached age 26.
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