The State Employee Health Plan (SEHP) offers five medical plans (Plans A, C, J, N and Q) for Active State Employees, Non State Employer Group and NON-MEDICARE Eligible Retiree/Direct Bill Members.
The Deductible, Coinsurance and Out-of-Pocket (OOP) maximums differ among the plans and your medical benefits have no lifetime maximum.
Your medical and pharmacy Out-of-Pocket maximums are combined. Prescription benefits for all five plans are provided by CVS Caremark.
All Plans include 100% coverage for preventive services when using a Network provider, including services like annual preventive exams, age-appropriate immunizations, mammograms, colonoscopies, etc.
Network Providers accept the plan allowance as payment in full and saves you money. Non Network Providers have not agreed to accept the plan allowance. This means that in addition to your required Out-of-Pocket cost, any amount above the plan allowance will be your responsibility. Out-of-Pocket maximums which includes deductible, coinsurance and copays accumulate separately for Network and Non Network providers.