Changing Health Plans
During the annual Benefit Choice period, the Benefit Choice Options booklet is available online for employees outlining any changes that will occur for the new plan year, July 1 through June 30. This may include changes to premiums, provisions, providers, participating plans, and level of benefits. Changes take effect the following July 1.
During this period, employees may change from one type of health insurance plan (QCHP, HMO, or OAP) to another. Changing plans may be done online through NESSIE, by selecting the link at the top of the Benefits Choice page.
Dependents must be enrolled in the same health and dental
plans as the employee. Employees electing to opt out or
waive health plan coverage may enroll their dependents
with life insurance coverage only.
When both parents are State employees, either employee may
elect to cover the dependents; however, the same
dependent cannot be enrolled under both employees for the
same type of coverage. For example, eligible dependents
may be enrolled under one parent for health and dental
coverage and enrolled under the other for life coverage.
You may change from the current plan you are on to any other available health care plan; Quality Care Health Plan (QCHP) or one of the Managed Care Plans (MCP) - Health Maintenance Organization (HMO) or one of the Open Access Plans (OAP).
Enrolling in one of the health insurance plans automatically enrolls you in the Vision Plan, at no additional cost.
If you select a Managed Care HMO Plan, you must select a Primary Care Physician (PCP). When entering your information, you will be required to enter your PCP's National Provider Identification (NPI) number. This number can be found in your plan's Provider Directory. The plan websites have the NPI numbers listed. Some HMOs also require a medical group code. See the HMO provider links for information on obtaining NPI numbers and medical group codes.
Keep in mind that in an HMO plan your PCP will direct all healthcare services and will make referrals for specialists and hospitalizations.
If you wish to change your PCP, this change can only be made by calling your insurance plan's Customer Service department directly. This phone number can be found in your HMO Provider Directory.
In most cases, Managed Care Plan benefits are not available for you or your dependents if you reside outside the service area. This may include children attending college away from home. Check with your health plan administrator for passport or reciprocity programs. See the Managed Care Plan map for plan availability. If you have concerns about specific benefit limitations or exclusions, contact your health plan administrator directly.
When enrolling in a Managed Care Plan, keep in mind that you may be required to pay co-pays at the time of visit.