State of MaineDepartment of Administrative and Financial Services

Bureau of Human Resources

Division of Employee Health and Benefits

Phone: (207) 624-7380 or 1-800-422-4503TTY: Dial Maine Relay 711

FAX: (207) 287-6796

www.maine.gov/dehRSS Feed - Subscribe to latest news!

Office Hours: Monday – Friday 8am to 5pm

Effective 01/01/2015 1

Your State of Maine Benefits

• Health Insurance• Wellness Programs • Dental Insurance • Vision Insurance• Voluntary Retirement Savings Plan• Flexible Spending Accounts(*Life Insurance is administered by the Maine

Public Employees Retirement System)

www.maine.gov/deh is your resource for all governing statutes, benefit overviews, premium rates, provider listings and much more!

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Who can participate in the health, dental & vision insurance programs?

• Active State of Maine & ancillary employees who are eligible to participate (contribute) with the Maine Public Employees Retirement Systemo Retired teachers please note this

requirement

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When does my insurance start?

• New employees are eligible the 1st of the month following one month of employmento Example:

• November 3rd - First day of work• December 3rd - One month of

employment• January 1st - Insurance becomes effective

Note: The above example applies if enrollment paperwork is received by Employee Health & Benefits within 60 days of date of hire.

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Health Insurance• Self-Insured plan

o Governed by the State Employee Health Commissiono Administered by:

• Point of Service Policy• In-network coverage AND• Out-of-network coverage

• In-Network Coverage Provideso Preventive Careo Medical and Sick Care (e.g. hospital services)o Prescriptionso Mental Health Services

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Health Insurance:Provider Network

Aetna Network

Doctors

Primary Care

Physicians

Preferred PCP’s

Participating PCP’s

Specialists

Hospitals

Preferred Hospitals

Participating Hospitals

Pharmacies

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Provider Lists and Ratingswww.AetnaStateOfMaine.com

(“DocFind”)www.GetBetterMaine.org

Frequently Asked Question

• What happens if I am traveling outside the State of Maine? Am I covered?

• Yes. Aetna’s network of doctors and hospitals is a national network. Like in Maine, care is covered at either the in-network or out-of-network benefit level. Same copays, deductible and coinsurance would apply. o (Please note: there are no preferred doctors or

hospitals outside the State of Maine.)

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Health Insurance: Tools & Resources

• Customized website for the State of Maine “Express Lane” www.AetnaStateOfMaine.com o Find a Providero Benefit Overview

• Secure member website – Aetna Navigatoro Look up a claimo Order/print an ID cardo Keep track of health care costs

• Aetna Mobileo Mobile webo App for Android & iPhone

• Aetna 24/7 Nurse Lineo 1-800-270-2386

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Health Insurance: Out-of-Pocket Expenses

• Doctor office visits• Prescriptions1. Copays

• Tests (e.g. diagnostic labwork, x-ray)

• Procedures (e.g. surgery)

2. Deductible

• Tests (e.g. diagnostic labwork, x-ray)

• Procedures (e.g. surgery)

3. Coinsurance

• How much the insurance will cost4. Premiums

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Health Insurance: In-Network Copays

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Planned Office Visit Copays

• Preferred PCP $0• Participating PCP

$20*• Specialist $25*

*Waived for preventive visits

Urgent or Emergency

Care• Walk-In Clinic or

Urgent Care $25• Emergency Room

$300 (waived if admitted)

www.AetnaStateOfMaine.com

Frequently Asked Question

• What is considered a preventive visit or test?

• Examples include physical exam, wellness check, preventive lab work, eye exam and immunizations. Any visit that is diagnostic in nature would not be considered preventive.

• Preventive is not necessarily routine.• If you are currently being seen to monitor an

existing medical condition or diagnosis, then the visit and related tests are not preventive.

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Deductibles & Coinsurance

• Any portion of your annual deductible met during October, November or December will roll over to the new year as a credit

Effective 07/01/13 12

Benefit In-Network Out-of-Network

Annual DeductibleCalendar Year

$500 individual$1,000 family

$2,500 individual$5,000 family

Coinsurance 20% or10% preferred

40%

Coinsurance LimitCalendar Year

$1,500 individual$3,000 family

$2,500 individual$5,000 family

Out-of-Pocket Limit (deductible + coinsurance + medical co-pays)Calendar Year

$2,000 individual$4,000 family

$5,000 individual$10,000 family

Out-of-Pocket Limit

Out-of-Pocket Limit

Medical Copays

Deductible

Coinsurance

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Frequently Asked Question

• What is the cost for lab work?

• Preventive lab work: $0 cost to member (covered by the plan at 100%)

• Diagnostic lab work: Deductible and coinsurance applies

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Pharmacy CopaysMedication Category

Copay for a 30-Day Supply

Copay for a 90-Day Supply

Generic $10 $15

Preferred Name Brand $30 $45

Non-preferred Name Brand $45 $70

Lifestyle (e.g. infertility, impotency)

$50 $75

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• Prescriptions can be filled at your local retail pharmacy or through Aetna mail order

• You can view the Aetna Preferred Drug Guide at www.AetnaStateOfMaine.com (“Pharmacy” tab)

Pharmacy Benefit (continued)

• Maine is a generic substitution state• Name brand prescriptions are filled with a

generic medication if there is one available

• Exception: If your provider has determined that there is a medical reason that you cannot take the generic medication, your doctor can request the exception through Aetna Pharmacy

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Health Insurance Premiums

How much will your health insurance cost? There are four factors to consider when calculating your health insurance premium:1. Your base annual rate of pay2. Employment status (full-time, part-time,

intermittent, etc.)3. Family members covered on policy4. Participation in annual Health Credit

Premium Program

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Health Insurance Premiums(continued)

Base Annual Rate of Pay

Employee’s % of Own (individual) Policy

Bi-weekly Premium Deduction

Bi-weekly STATE Portion of Premium Amount

Less than or equal to $30,000 5% $18.76 $356.35

Greater than $30,000 but less than $80,000 10% $37.51 $337.59

Equal to or greater than $80,000 15% $56.27 $318.84

MRS Title 5, 285 (7-C) 18

• Example above is for a full-time employee on a single policy• Deductions are withheld pre-tax (domestic partner premiums are post-tax)

• Part-time employees pay an additional pro-rated share of the individual premium (Contact Employee Health & Benefits for premium amount.)

• The State pays 60% of the dependent premium; the employee pays 40%• Health Credit Premium Program – Up to 5% savings on your premium• The entire premium rate sheet can be found at www.maine.gov/deh

Health Insurance Family

Contract

Available to:• Two married State of Maine employees with

children.• Domestic Partners who are both State of

Maine employees with children. Partners must qualify by filing a domestic partner affidavit.*

Portion of the family premium for child(ren) is waived!

Contact Employee Health & Benefits (207)624-7380

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Healthcare Reform• Health Insurance Marketplace notice

is given to all employeesoCopy of the notice is available at

www.maine.gov/deh

• More information about healthcare options in the Marketplace can be found at www.healthcare.gov

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COBRA• As a new employee of the State of Maine you will

receive a required notice: “Continuation Coverage Rights Under COBRA”

• The purpose of the notice is to explain what COBRA coverage is, when it may be available to you and your family and how to protect the right to receive it

• The State of Maine contracts with Combined Services to administer the COBRA notification and billing process

• For more information about COBRA:www.dol.gov/ebsa

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Expert Medical Opinion Program

• Program Highlights• Access to the world’s medical experts*• Free• 100% Confidential• Open to any and all conditions and

treatments• Advance Medical 1-888-218-0992• www.advance-medical.com/maine

(*EMO physicians are not a substitute for your current provider)

Wellness Programs• Aetna Extras – www.AetnaStateOfMaine.com

o Discount programs• Aetna Fitness (health club memberships, home exercise equipment

and videos through GlobalFit™)• Aetna Weight Management (CalorieKing®, Jenny Craig®,

Nutrisystem®)

• Wellness Works – www.wellnessworksme.org o Healthy Directions (education and training programs)o On-site gyms (Augusta East Side and Bangor)o ME FIRST

• Statewide Fitness Program – www.maine.gov/deh o Network of many YMCA and University of Maine facilities

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Dental Insurance

Member Services1-800-832-5700

www.NEDelta.com

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Dental Insurance: Coverage

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Coverage Category

State Of Maine PPO Network

Delta Dental Premier Network

Out-of-Network

Preventive & Diagnostic

100% 100% 90%

Basic Restorative 90% 80% 70%

Major Restorative 60% 50% 40%

Orthodontics 60% 50% 40%• Level of coverage based on reasonable & customary charges• Please refer to your Summary of Benefits for calendar year and

lifetime maximums• Provider lists can be found at www.nedelta.com • Secure member login available

• View balance of your calendar year maximums, claims, recent treatment summary, etc.

Dental Bi-weekly Premiums

• Full time employees are automatically enrolled• Part time employees pay a pro-rated premium• There is no State contribution for dependent

premium on the dental insurance

Premiums Effective 7/1/13 - 06/30/15 26

CoverageBi-Weekly Premium

Full Time Employee$0 (no cost to you)

Employee + 1 Family Member $10.34

Employee + 2 or more $31.78

Vision Insurance• “Blue View Vision” –

• Supplemental vision insurance coverage• Find a provider at www.anthem.com

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Aetna Health Plan Blue View Vision Plan

Routine eye exam Routine eye exam

Eye infection Glasses

Eye injury Contact lenses

Non-routine services

• Refer to your benefit overview for more information• Check with your Human Resources department regarding

the Video Display Terminal benefit (“VDT”)

Blue View VisionBiweekly Pretax Premiums

• Employee Only: $2.46• Employee + 1 family member: $3.94• Employee + 2 or more family

members: $6.40

Premiums Effective 7/1/13 - 6/30/15 28

When can I add or delete

dependents from my insurance

policies?• Within 60 days of hire• During Annual / Open Enrollment- Begins in

May through early June for a July 1 effective date.

• Within 60 days of a “life event” such as marriage, divorce or birth/adoption. (Note: change must be consistent with the event.) The complete list of events can be found at www.maine.gov/deh.

*Note: Dependent children can remain on the health, dental & vision insurance up to age 26. COBRA will be offered.

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MaineSaves 457b Plan

• Voluntary retirement savings account

• Convenience of payroll deduction

• Contributions are pre-tax• For more information:

www.MaineSaves457.com

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Flexible Spending Accounts

Set aside funds pretax for out of pocket medical and/or daycare expenses.

Flex-Plan Services, Inc.www.flex-plan.com or 1-800-669-

3539

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Employee Assistance Program

• “EAP” provides short-term, confidential counseling to employees and members of the household

• Up to 5 visits per calendar year with a licensed counselor at no cost to you

• Administrative leave is granted for counseling appointments

1-800-451-1834www.allonehealth.com

• AllOne Health Discount Programs:o Legal – Consultations and mediation serviceso Financial – Consultations, coaching & income tax

planning

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Retirement• Upon retirement there may be health

benefits available to you

• It is especially important to keep this in mind if you cancel your insurance coverage during your employment; this could effect your retiree health insurance

www.maine.gov/deh 33

Any Questions??

Call (207)624-7380 and ask to speak with a Benefits

Specialist

www.maine.gov/deh

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