How It Works
Convenience and Ease of Administration
During the initial enrollment period, each employee will select a network health plan from the options chosen by the employer group . Some of the plans will require the selection of a primary care physician by each member; however referrals are generally not required to see a specialist. A gatekeeper option, one that requires referrals, is available for some Point of Enrollment (POE) plans. Enrollees may change their primary care physician during the year, but they must stay within their chosen health plan.
The carrier choice will remain in effect until the next policy anniversary 12 months later. An employee will have the option to change their selection during the next open enrollment period, which typically begins 30-days prior to the next policy anniversary date.
How Network Health Plans Work: Employers may choose either a POE plan that requires members to use only network providers or POS plans (including PPO options with Anthem) that allow employees to use network providers or any licensed provider outside of the network. The out-of-network benefits are subject to a deductible and coinsurance. The POS and PPO options are also known as a "dual option" since they cover both network and out-of-network expenses. Employers may also select a dual option. The PPO and POS plans will not utilize a "gatekeeper physician" or require referrals for specialists. A gatekeeper is optional for the POE plans.
Employer Contribution: Each of the network health plans in the Municipal Employees Health Insurance Program offers a single, comparable set of benefits. To promote price competition, the Program strongly encourages participating employers to pay a percentage equal to at least 50% and no more than 100% of employee premiums charged by the lowest cost plan available. A 50% minimum employer contribution is required. MEHIP Commercial Small Group requires employers to comply with all State of Connecticut "Small Group" contribution law.
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