Voluntary Retirement OptionsSOPH video/templatefiles/umc_video.aspx?id=2147548944Mannings for Health
  • State Health Plan Changes for 2016

    The State and School Employees' Health Insurance Plan has several benefit changes for 2016.

    Benefit changes (click for PDF)

    $25 office visit copay

    • Applies to participants with Select Coverage
    • $25 copay covers in-network PCP office visit charge only - no deductible or coinsurance.
    • PCP: family physicians, general practice physicians, gynecologists, internists, pediatricians and registered dieticians
    • Participant owes 20% of other services performed (i.e., labs, X-rays).
    • Regular plan benefits apply to out-of-office lab services.
    • Does not apply to specialist providers, out-of-network providers, hospital visits

    Maternity management

    • 100% coverage for covered routine physician prenatal care and delivery services provided by a network physician for participants who complete the maternity management program
    • Regular Plan benefits apply to hospital and anesthesiologist services.
    • Benefit is for the enrollee and dependent spouse.
    • Participants who choose not to complete the program, regular Plan benefits will apply
    • Contact ActiveHealth at (866) 939-4721 for information.

    Imaging services

    • Pre-certification for outpatient imaging services (MRI, CT, CAT scans, etc.) will be eliminated beginning Jan. 1, 2016.

    Contraceptive coverage

    • All FDA-approved generic contraceptive drugs are currently covered at no cost to participants
    • Recent federal guidelines require coverage of at least one form of contraception within each method identified by the FDA, at no charge to the participant.
    • Coverage at 100% for certain brand contraceptives when a generic is not available or not medically appropriate
    • When generic becomes available, brand copay will apply.

    Chiropractic care

    • Current annual limit is $2,000 per participant
    • New annual limit is 30 visits per participant

     

    Pharmacy benefit

    Prime Therapeutics LLC (Prime) will be the new Pharmacy Benefit Manager for the State and School Employees' Health Insurance Plan effective Jan. 1, 2016. Catamaran, the Plan's current pharmacy benefit manager until Dec. 31, 2015, is working with Prime to help ensure a smooth transition. In December, Prime will be mailing participants welcome packets to their home address along with a new ID card as well as other helpful information to assist with any pharmacy benefit questions.    

    If you currently participate in Catamaran's home delivery service, you will need to register for PrimeMail to continue receiving your medications by mail. Information on registering for PrimeMail will be included in your welcome packet.

    Starting Dec. 1, 2015, participants can reach Prime's Customer Service Center at (855) 457-0408, 8 a.m.-5 p.m. Monday-Friday. More information about this transition is available at http://knowyourbenefits.dfa.ms.gov/ .    

     

    For more information regarding the State and School Employees Health Insurance Plan, please visit the Know Your Benefits site.