An HMO is a managed care plan that provides medical care through its network of physicians, pharmacies, contracted hospitals, and medical care suppliers. You can choose your own "primary care physician" who will provide direct care or make referrals from within the network. An HMO provides necessary hospital and medical treatment when you are sick or injured, prescription medicine services, substance abuse treatment, short-term mental health care, and routine "preventive health maintenance" services such as immunizations. There are no deductible requirements.
You may enroll in an authorized HMO plan serving your residential area . Refer to Section 5 for a listing of HMOs by zip code. Contact the HMO that interests you to request their benefit booklet. If you select a new HMO, that HMO may ask you to select your primary care physician. Respond promptly to the carrier to complete the final phase of the enrollment process.
Note: This information also relates to the New State Health Plan (NSHP) and the New HMOs (NHMO).
CATASTROPHIC HEALTH PLAN (BCBSM)
The State will cover the full premium cost of this plan,* and you will receive a $50 payment biweekly for being enrolled in the Catastrophic Health Plan. Please refer to the FY 2014-2015 Insurance Rates Page.
This is a hospitalization-only plan intended as an option if you are over-insured because you have coverage elsewhere (for example, through a spouse who works for another employer). This plan covers inpatient hospital expenses, as well as certain other services received at the hospital on an outpatient basis (including emergency room care). This plan does not cover prescription charges, office visit charges, medical equipment, psychiatric services, or other Major Medical services.
Benefits under this plan are payable only after you have covered those expenses equal to one month's basic salary (your deductible requirement). The maximum deductible for two or more covered persons in your family is limited to 1½ months of your basic salary. If you are covered by a spouse who works for a non-State employer, that plan will generally cover those expenses not covered by this plan (for example, the expenses you incur in meeting this plan's deductible requirement, community-based services, prescriptions, etc.)
If your spouse's (non-State) employer will not cover you under their group plan because you are enrolled in any of the State-sponsored health care options, including the Catastrophic Plan, you can "opt out" completely and still receive the $50 biweekly payment (select "Health Waiver with Rebate"). You must be in pay status to receive this payment.
*Except for those employees in certain bargaining units who are hired on or after 1/1/00 who have a regular work schedule of 40 hours or less per bi-weekly pay period (not permanent-intermittent positions).