Medical

Minnesota Advantage Health Plan is the medical benefits program for all state employees, retirees (under age 65 and/or not Medicare eligible), and eligible dependents.

Summary of Benefits - This document provides a description of the medical coverage available to SEGIP members through the Minnesota Advantage Health Plan.

Schedule of Benefits - A chart outlining benefits, coverages, and copay amounts.

Rate Summary - These are the employee rates for the Minnesota Advantage Health Plan organized according to employer contribution percentages.

FAQ – Related SEGIP Participants - These FAQs have information for family members who are each eligible for their own individual SEGIP benefits, but are interested in being covered under one family policy.

• Primary care clinics can change cost levels each year, meaning potentially higher out-of-pocket costs for you or a family member
• Many primary care clinics are offered at different cost levels across SEGIP’s three plan administrators (for example, Cost Level 2 through one plan administrator and Cost Level 4 through another)
• SEGIP members can only change plan administrators once per year, during Open Enrollment
• SEGIP members can change primary care clinics up to once per month by calling your plan administrator

Advantage High Deductible Health Plan (HDHP) is available to employees covered by the Commissioner’s Plan, Managerial Plan, and most unrepresented employees. The Minnesota Advantage Health Plan will still be offered to these employees, but they will now have the option to choose the high deductible health plan with an accompanying Health Savings Account (HSA).

Summary of Benefits HDHP - This document provides a description of the medical coverage available to SEGIP members through the Minnesota Advantage High Deductible Health Plan (HDHP). 

Summary of Material Modifications - This document notes changes to the Summary of Benefits.

HDHP Design - A chart outlining benefits, coverages, and copay amounts.

HDHP Rates - These are the employee rates for HDHP organized according to employer contribution percentages. 

HDHP FAQ - Frequently asked questions about the Minnesota Advantage High Deductible Health Plan and Healthcare Savings Account.

CVS Caremark® is the pharmacy benefit manager (PBM) for the Advantage Health Plans regardless of the plan administrator under which you enroll.

• Your pharmacy benefit offers a high level of access to low cost, clinically effective medications. CVS Caremark has one drug formulary with three copay tiers. When you are prescribed formulary medications by your doctor, it will generally fall into one of these three tiers:
  
  • Tier 1: Includes mainly generic medications, but some brands. It is the best cost value for most drugs.
    
  • Tier 2: Includes preferred brand drugs and some generics; greater access to additional medication choices.
    
  • Tier 3: Includes more costly non-preferred brand drug options.

• When the amount you have paid for prescriptions for yourself or a covered family member has reached the out-of-pocket maximum, the plan will pay all remaining eligible expenses for that year.

• You may have prescriptions filled at any pharmacy in the CVS Caremark network.
  

• We recommend (not required) that you set up an account at the CVS Caremark website once you have received your identification card. The member portal will give you access to:

•    -  visit the Pharmacy Checker to find an in-network pharmacy.

•    -  find formulary costs for prescriptions using the Check Drug Cost feature.

• Certain Prescription Drugs may be purchased through an in-network Retail Pharmacy or the CVS Caremark Mail Order Pharmacy for two Copayments for a three-month supply.

Notice of Creditable Coverage
An important notice from Minnesota Advantage Health Plan about your prescription drug coverage and Medicare.

Clinical Documentation for the State Employee Group Insurance Program.

• Adult participants diagnosed with type I or type II diabetes will receive high-value medical services associated with diabetes for reduced costs or no copays.
  
  
• There is no enrollment process and reduced copays occur when visits or diabetic medications or testing supplies are received.
  
  
• For more information, visit the AVD page.

• Convenience care clinics are available in some areas at a $0 copay level in all cost levels and is not subject to the annual deductible.
  
  
• Employees in the high deductible plan must satisfy their deductible prior to receiving a $0 co-pay.
  
  
• Convenience clinics provide a cost-effective alternative to emergency rooms, urgent care, and family practice clinics when used for simple illnesses, tests, and vaccinations. Each clinic is staffed by a certified family nurse practitioner or physician assistant who delivers the service in 10 to 15 minutes.
  
  
• Appointments are not required. Call your plan administrator for the most up to date information on convenience care clinics and locations.

• Online Care clinics provide access to a health care provider via the internet, regardless of your location or access to a certain care system. 
• The benefit is designed to function like the in-network Convenience Care Benefit without the confines of office walls. 
• The Online Care Benefit is provided without referrals, is not subject to the annual deductible, and is provided at a $0.00 copay, regardless of your cost level. 
• If you are a member of BlueCross or HealthPartners you have access to Doctor on Demand and/or virtuwell.
• If you are a member of PreferredOne you only have access to virtuwell and/or MDLive. 
  • To learn more about them or use this benefit visit: Doctor on Demand, virtuwell, or MDLive.

• Employees and dependents (who reside in the service area) traveling out of the service area can receive out-of-area Emergency and Urgent Care benefit which is equivalent to the in-network Emergency Room and Urgent Care benefit.
  
• Under Advantage, each plan administrator offers a National Preferred Provider Organization (PPO) available outside the Advantage Plan service area.
  
  • Benefits in the National PPO vary depending on specific circumstances and the member’s residence status.
    
  • Employees traveling out of Minnesota and the Advantage Plan service area may receive provider discounts when using the National Preferred Provider Organization (PPO) of the plan administrator in which they are enrolled.
    
• The out-of-network Emergency and Urgent Care benefits for participants who permanently reside in the Advantage Plan service area will be administered consistent with their Point of Service Benefit when they are in a travel status.

• Point of Service (POS) coverage is available for members whose permanent residence is outside the state of Minnesota and outside the service areas of the carriers participating in Advantage.
• The POS benefit is available to
  • employees on temporary assignment
  • employees on paid leave (including sabbatical)
  • retirees
  • former employees with disability
  • COBRA enrollees
  • dependent children away at college
  • dependent children, including young adult dependents
  • spouses and former spouses
• Access to POS benefits must be requested by providing the permanent address outside the service area to SEGIP on the Point of Service Form and by calling your plan administrator to request access to Point of Service (POS) benefits.
  
  • The form and call must be completed again if you change carriers during an Open Enrollment.
• Benefits in the National PPO vary depending on specific circumstances and the member’s status.
• Children who have lived out of area with an ex-spouse since 2003 will receive level 2 coverage with a national PPO provider. If a national PPO provider is not available a dependent may self-refer and receive level 2 benefits. This benefit applies if enrollment is continued with the same carrier.

• Most medical care is coordinated through your Primary Care Clinic (PCC) and you will generally need a referral to see a specialist.
  
• You may self-refer to certain specialists including obstetricians/gynecologists, chiropractors, mental health/chemical dependency practitioners, and routine eye exams.
  
• How you access specialty care depends on your plan administrator and your PCC.