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NEW FY09 Medical Insurance Information
Return to Benefits Home Return
to FY08 Medical
Enroll/Change
Governing
Plan Document
Rules
(Benefits-Chapter 11)
Statutes
Important Information about Selecting Your
FY09 Medical Plan
- The information below applies to the
upcoming, FY09 Plan Year.
This is the information you will need to make your
decisions during Open Enrollment (April 21 - May 16,
2008). Changes
for FY09 are highlighted in red.
- Find more information on each option by clicking
on the plan names.
- For FY09, the
OA-30 option of the State's
self-funded plan has been
eliminated.
- PREVENTIVE CARE for the OA Options:
For FY09, primary
preventive services are covered at
90% even before the plan's deductible has
been met.
-
OA (Open Access) options comprise the State's
Self-Funded plan which is administered by
Great-West Healthcare, now a part of CIGNA.
"Open Access" refers to Great-West's Open Access
network of providers.
-
New for FY09, the San
Luis Valley HMO plan has instituted a
deductible.
- For FY09, Kaiser has significantly changed the
payment for specialty drugs,
including injectables and infusions. Click on the
"Kaiser" plan name and refer to the description for
details.
- The Kaiser and San Luis Valley HMO plans are
available only in certain regions of the State.
Your
FY09 Medical Insurance Choices
| Plan Name |
Availability |
Employee's Cost
(monthly) |
Deductible, In-Network
(individual / family) |
Office Visits
(In-Network) |
Prescriptions
(30-day supply) |
|
OA-750 New for FY09 |
Statewide |
Employee
only
$362.24
Employee + Spouse
$980.04
Employee + Child(ren)
$764.68
Employee + Family
$1324.56 |
$750
/ $1500 |
Plan
pays 80% after deductible has been met
|
Generic - $10 co-pay
Preferred Brand Name
- $25 co-pay
Non-preferred Brand Name
- $50 co-pay
Preferred and
non-preferred brand names are subject
to $150 per member prescription deductible
before co-pay applies |
OA-1500 -
for
FY09 |
Statewide |
Employee
only
$38.92
Employee + Spouse
$268.76
Employee + Child(ren)
$182.72
Employee + Family
$354.62 |
$1500
/ $3000 |
Plan
pays 80% after deductible has been met
|
Generic - $10 co-pay
Preferred Brand Name
- $25 co-pay
Non-preferred Brand Name
- $50 co-pay
Preferred and
non-preferred brand names are subject
to $150 per member prescription deductible
before co-pay applies |
OA-3000
-
for
FY09 |
Statewide |
Employee
only
$6.50
Employee + Spouse
$197.44
Employee + Child(ren)
$124.38
Employee + Family
$257.36 |
$3000
/ $6000 |
Plan
pays 75% after deductible has been met
- increased coverage for
FY09 |
Generic - $10 co-pay
Preferred Brand Name
- $25 co-pay
Non-preferred Brand Name
- $50 co-pay
Preferred and
non-preferred brand names are subject
to $150 per member prescription deductible
before co-pay applies |
OA-H
- for
FY09 |
Statewide |
Employee
only
$19.96
Employee + Spouse
$227.04
Employee + Child(ren)
$148.60
Employee + Family
$297.74 |
$1500
/ $3000(1) |
Plan
pays 85% after deductible has been met. |
Plan pays 85% of costs
after deductible is met.
Entire plan deductible must be
met before prescription coverage begins.
|
Kaiser HMO
- for
FY09 |
Denver, Boulder, parts of Colo. Springs - see
Denver/Boulder zip code list or
Colo.
Springs zip code list |
Employee
only
$56.16
Employee + Spouse
$301.48
Employee + Child(ren)
$210.28
Employee + Family
$397.68 |
none,
co-pay for services |
PCP(2) -
$30 co-pay
Specialist - $50
co-pay
Preventive - $15
co-pay |
Generic - $10 co-pay
Brand Name
- $30 co-pay
Specialty
drugs, including self-administered injectables -
20% co-insurance, up to a $75 max per drug
dispensed |
San Luis Valley
HMO
- for
FY09 |
By
county - Alamosa, Conejos, Costilla, Mineral,
Rio Grande and Saguache |
Employee
only
$58.08
Employee + Spouse
$305.72
Employee + Child(ren)
$223.76
Employee+ Family
$403.42 |
Deductible is new for
FY09 $250 /
$750 |
Co-pays apply ONLY after deductible has been met
PCP(2) -
$30 co-pay
Specialist - $50
co-pay
Preventive - with
PCP, $30 co-pay
- with Specialist $50 co-pay |
Formulary
Generic - $10 co-pay (3)
Formulary Brand Name
- $25 co-pay (3)
Non-formulary Brand Name or
Generic
- $50 co-pay (3)
All subject
to $100 per member prescription deductible
before co-pay applies |
(1) The
$1500
deductible only applies to the Employee Only level of
the OA-H option. The $3000 deductible applies to
all other levels of this option and there are no
individual deductibles for these levels.
For the OA-H, the family deductible must be satisfied
before
benefits are paid for any individual family member.
(2) Primary Care Physician
(3) For the lesser of a 30-day supply or a 100-unit
dose.
Note: This is only a
summary, not a contract. Review each options
descriptions for further details. Contact each
plan administrator (GW - 1-888-788-6326; Kaiser -
303-338- 3800 / 1-800-632-9700; SLV - 719-589-3696 /
1-800-475-8466) with specific questions about
treatments, prescriptions, doctors and hospitals. .
Related Links
Insurance Premiums
(now includes new FY09
Premiums)
Who is my
human resources contact?
Insurance
Companies’ Phone Numbers
What do
“Pre-tax” and “After tax” mean?
Instructions for Online Enrollment
HealthLine
Glossary of
Insurance Terms
Forms
For
more information about Benefits contact the
DPA
Benefits Unit.
Email
comments to: DPA
Benefits
These
documents may be presented in PDF format, which requires the Adobe®
Reader.
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Division of Human Resources