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Benefits Administration

Health Insurance

Eligible state, local education and local government employees may enroll in health coverage through the state group insurance program. Available options include the Partnership PPO, Standard PPO and Limited PPO (available for local education and local government only).

There are specific guidelines regarding the time-frame in which you and your eligible dependents must enroll. Please see the Eligibility and Enrollment Guide for specific information regarding eligibility and enrollment. To review a comparison of some common benefit categories for the healthcare options, please see the Insurance Comparison Charts. For specific information about benefits, refer to the appropriate Member Handbook and Provider Directory. All referenced materials are available on the Publications and Forms sections or can also be obtained through your agency benefits coordinator.

In many ways, the Partnership PPO, Standard PPO and Limited PPO are very similar. They cover the same types of services, treatments and products. However, there's an important difference between the options: If you choose the Partnership PPO, you must commit to a Partnership Promise, but you pay much lower premiums and will have lower cost-sharing for services and procedures.

The following features apply to all options. Refer to the PPO comparison chart or member handbooks for the plans' deductibles, copays, coinsurance and out-of-pocket maximum amounts.

   Annual Deductible All options include an annual deductible. This is the amount you pay out of your pocket before the plan pays for hospital charges and other services that require coinsurance.
   Coinsurance Some services require that you pay coinsurance after you meet a deductible. Coinsurance is a percentage of the total cost.
   Copays Some services require that you pay a copay (instead of a deductible and coinsurance). A copay is a flat dollar amount, like $20 a visit.
   Out-of-Pocket Maximum The out-of-pocket maximum is the most you will pay for your copays and coinsurance each year. Once you reach your out-of-pocket maximum, the play pays 100 percent of covered medical expenses.
   In-Network vs Out-of-
   Network Providers
You can see any doctor or go to any healthcare facility you want. However, if you use an "in-network" provider, you will always pay less. That's because an in-network provider agrees to provide services to our members at discounted rates. Broad networks of doctors and hospitals will continue to be available.

Additional Enrollment Information
Please see the Publications section of this website to view a comparison of covered services and detailed member handbooks. Enrollment applications are available on the Forms Page.