Unsure of how to choose your health insurance plan? Here’s a quick guide to help you make your determination.

Step 1 – Choose a Plan Design

First, decide which plan design you would like. The following is a summary of the four plan designs that the State Group Health Insurance program offers. Take a moment to read about these options and see which one is best for you– you can click on the plan design to learn more. Not everyone is eligible for the HDHP and Access HDHP plan designs.

The plan designs generally differ in monthly premiums and cost-sharing. To compare the four plan designs, see the Comparison of Medical Benefits chart.

Health Plan

Approximately 98% of state members are enrolled in the Health Plan design. You can choose from a variety of health plans (insurance carriers) that offer the same Uniform Benefits package.

Note: While these plans all offer the same Uniform Benefits package, this does not mean that they will treat all illnesses or injuries in an identical manner. Treatment will vary depending on patient needs, the provider’s preferred practices, and the health plan provider’s managed care policies and procedures.

High Deductible Health Plan (HDHP)

The High Deductible Health Plan (HDHP) provides the same Uniform Benefits package and health plans (insurance carriers) as the Health Plan design. The difference is that this plan design has a higher deductible and higher out-of-pocket limits. In exchange for increased cost sharing, this plan design offers a lower monthly premium cost and is paired with a required Health Savings Account (HSA) to help pay your out-of-pocket costs. If you enroll in an HDHP health plan, you must also enroll in the HSA.

Not everyone is eligible to enroll in this plan design. Click on the plan design to learn more.

Access Plan

The Access plan design provides freedom of choice for doctors and hospitals across the country. While you may see any doctor of your choice, you will pay less out-of-pocket if you use in-network providers. In exchange for the increased flexibility in medical providers, the monthly premium cost is more than the Health Plan and HDHP plan designs.

Access HDHP

The Access HDHP plan design provides the same benefits package as the Access Plan design. It provides the same freedom of choice for doctors and hospitals across the country that the Access Plan design provides. While you may see any doctor of your choice, you will pay less out-of-pocket if you use in-network providers. The difference is that the Access HDHP plan design has a higher deductible and higher out-of-pocket limits. In exchange for the increased cost sharing, this plan design offers a lower monthly premium cost and is paired with a required Health Savings Account (HSA) to help pay your out-of-pocket costs. If you enroll in the Access HDHP health plan, you must also enroll in the HSA.

Not everyone is eligible to enroll in this plan design. Click on the plan design to learn more.

Note: The Access and Access HDHP plan designs are administered by WPS only. If you choose either of these plan designs, you may go directly to Step 4 to enroll. If you have chosen the Health Plan or the HDHP plan designs, continue to Step 2 to choose a geographic coverage area.

Step 2 – Choose a Geographic Coverage Area

Now that you know which plan design you would like, review the Health Plan Provider Map. This interactive map shows you which health plans (insurance carriers) are available in your area. You do not have to choose a health plan in your county, but keep in mind how far you are willing to travel for services.

The map also shows whether the available health plan providers are considered “qualified.” A qualified health plan provider meets certain medical provider access requirements. A non-qualified plan is one that has limited provider availability in that area.

In the event that there are no qualified insurance carriers in your county with a Tier 1 monthly premium cost (all plans other than IYC Medicare Plus or Access Plan), you will have the option to choose the State Maintenance Plan (SMP).

Step 3 – Choose a Health Plan (Insurance Carrier)

Now you know which health plans (insurance carriers) you have to choose from. Next, you will want to check out the specific health plan features and plan descriptions to learn about their quality ratings and medical provider networks (including specialists and hospitals), as well as other features, which may include:

  • Referral and prior authorization requirements,
  • Whether they require you to select a primary care provider (PCP) and other administrative requirements, and
  • Plan features, such as whether they offer a member web portal, a 24-hour nurse line, and wellness and health management programs.
  • Quality and member satisfaction (see Health Plan Report Cards)
  • Access to specific physicians or other health care providers

Keep in mind that most health plans require you to receive services within its network in order to be covered.

Step 4 – Determine if you want Uniform Dental benefits

All offered health plans provide medical and prescription drug coverage. Uniform Dental benefits may be included for a minimal cost. To learn more about Uniform Dental benefits, click here.

Step 5 – Enroll or Make a Change

Now that you have chosen a plan design and health plan (insurance carrier), you will need to either enroll or make a change to your current enrollment. Make changes or enroll online using Self Service (eBenefits).

If you are declining health insurance and electing the Opt-Out Incentive, you must complete the Health Insurance Application/Change Form and submit it to your human resources office.

You will receive an email confirmation of the elections you make using Self Service (eBenefits).


last updated: 12/9/2016

Every effort has been made to ensure this information is current and correct. This page does not guarantee enrollment or the ability to make changes to your benefits.