State Employee Health Plan (SEHP)

Medical Insurance

Major medical insurance through SEHP includes:

• Comprehensive medical coverage
• Prescription drug coverage
• Preferred lab benefit
• 100% coverage of defined preventive care services

It is the employee's responsibility to make any changes to their health plans during a period of time referred to as Open Enrollment, or if they experience a qualifying event such as birth of a child, adoption, loss/gain of coverage, etc. You have 31 days to provide documentation if you experience an event that changes the status of your health benefits.

To review your health insurance benefits, or to update your information with your health insurance providers, log into SEHP Member Administration Portal (MAP)

Carrier Options

Members can choose from two insurance carriers to administer their medical benefits. Plan options, premiums, and prescription drug coverage are identical with each carrier. However, each carrier has their own unique national provider network. SEHP medical insurance offers out-of-network coverage for certain services, but it is at a much higher cost to the member. When electing a carrier, all members are encouraged to first confirm that all medical providers seen by the member or their spouse/dependents are in-network with the selected carrier.

• Aetna
• Blue Cross Blue Shield (BCBS) of Kansas

Plan Options

SEHP has several Plans to choose from, each with its own advantages and disadvantages. See 2024 Enrollment Booklet for more details. In general, the plans can be categorized as:

• Plan A: Traditional plan with office visit copays
• Plan J: Low-deductible plan
• Plans C & N: High-deductible plan with employer-contributing Health Savings Account (HSA) or Health Reimbursement Account (HRA)

What do all plans have in common?

All five plans cover preventive care services, as defined by the Affordable Care Act (ACA), at 100%. This includes annual Well-Man, -Woman, and -Child exams, age-appropriate standard vaccinations, including flu shots, and age-appropriate standard health screenings, such as pap smears, colonoscopies, and mammograms.

All four plans also include the same prescription drug coverage through Caremark, and preferred lab benefits with Quest Diagnostics/Stormont-Vail Health.

What is covered and the providers who are covered are identical across all five plans – the plan selections differ only in cost-sharing. Providers may differ across different carriers.

What is different about the plans?

All plans are a combination of fixed costs (semi-monthly premiums) and variable costs (copays, deductible, etc.). 

• Fixed Costs: semi-monthly premiums - See rates chart below.
• Copay: flat amount paid for certain services (available only on Plan A)
• Deductible: Flat amount paid by member before insurance begins paying on claims
• Coinsurance: Percentage amount of cost-sharing by the member after the deductible is met
• Out-of-pocket (OOP) Maximum: The maximum out-of-pocket expenses a member will pay in a plan year (January 1-December 31) on eligible in-network services.

How do I pay for my coverage?

Members have the option to pay for their premiums on a before-tax or after-tax basis. Members who pay before-tax will see a lower change to their net or "take home" pay, while members who pay after-tax will have the option to waive coverage for themselves and/or their spouse/dependents mid-year without a qualifying event. This election is made during the initial enrollment, as well as during Open Enrollment each year.

Rates

Plan Year 2024 Semi-Monthly Rates for State of Kansas Active Employees

**If you have qualified for the HealthQuest Rewards Program Premium Incentive Discount, subtract $20 per pay period from the rates above to determine the amount of your discounted semi-monthly premium. Non State Group Employees should check with their HR office for premium rates.

For additional information please see below resources.

• State Employee Health Plan Information
• Plan Year 2024 Enrollment Plan Booklet

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Prescription Insurance

Prescription drug coverage is provided through Caremark for all medical plans, and its cost is included in the semi-monthly medical premiums. While the Preferred Drug List (PDL) is the same for both plans, the amount you pay will vary depending on the plan you select as explained below.

• Plan A: Under this plan, generally you pay a Coinsurance for your prescription drug costs throughout the year, up to a combined medical and pharmacy Out Of Pocket maximum of $6,250 for single and $12,500 for member with dependent coverage per year. Click here to check drug cost for Plan A. The amount shown is your estimated cost for the specific medication.
• Plan C, J, and N: Until you reach your deductible, you will pay 100% of the discounted cost for your prescription drugs when you present your Caremark ID card. Once you have reached your annual health plan Deductible, you pay a Coinsurance for your prescription drug costs throughout the year, up to the plan Out Of Pocket maximum. Click here to check drug cost for Plan C, J, and N. Search results will give you the estimated plan allowance for the specific medication, then you will need to apply the applicable prescription benefits.

Note: When using the drug cost links it is recommended the search be performed using a 30 day supply of your medication. If you are already an active SEHP participant, you should log on to Caremark.com and perform your search. The Caremark.com site will provide you with a cost estimate based upon your actual health plan enrollment.

Regardless of which plan you elect, your Out Of Pocket costs will be lower if you use generic and/or preferred brand name drugs. The PDL is available at either the State of Kansas CVS page or www.caremark.com

You can also call Caremark at 800-294-6324 for help finding a preferred drug.

Before talking to your physician about prescriptions, it is suggested that you print out the Preferred Drug List (PDL) from the website and take it to any appointments so you can discuss your options. The Caremark plan is designed to encourage you and your health care provider to choose the most cost-effective and clinically-effective medications available. Home delivery is available through Caremark and reorders are processed in as little as five to seven days. To place an initial order or reorder by phone, call 1-800-294-6324 or e-mail online@caremark.com

Specialty and biotech drugs are designed for difficult conditions that don’t respond to traditional therapy. A complete list of Specialty Drugs is availablethe State of Kansas CVS page. These drugs are available only through the Caremark Connect Specialty Pharmacy. Contact Caremark Connect at 1-800-237-2767. A Caremark representative will coordinate patient care with the provider and arrange for medication delivery.

SEHP offers an additional voluntary benefit which provides an opportunity for members to save on prescription drugs: Rx Savings Solutions

Preferred Lab Benefit Program

The Preferred Lab Benefit is completely voluntary. If you and your health care provider choose to use a lab other than those provided by either Quest Diagnostics or Stormont-Vail HealthCare, you still have laboratory coverage. However, you will be responsible for any charges applied by the health plan, including, but not limited to, deductible and coinsurance.

It is the member's responsibility to verbally request Quest Diagnostics from their medical provider, before specimens are drawn or processed.

• Quest Diagnostics offers collection sites at various locations throughout the State of Kansas (including Wichita) and nationwide. Also, you can arrange to have specimens picked up from your doctor’s office. All it takes is a telephone call to the number on the back of your Quest ID card.
• Stormont-Vail offers 10 locations in northeast Kansas for all SEHP members. Lab orders from your physician are required.

The Preferred Lab Benefit Program does NOT cover:

• Testing ordered during hospitalization
• Lab work needed on an emergency or rush basis
• Testing done at any other laboratory
• Non-laboratory testing such as mammography, x-rays, imaging and dental work
• Time-sensitive, esoteric testing such as fertility testing, bone marrow studies and spinal fluid tests
• Testing not approved and/or not covered by the Plan
• Lab work billed by your doctor or another laboratory

If your doctor doesn't use Quest Diagnostics, bring the lab orders from your doctor to one of the locations provided by Quest Diagnostics or Stormont-Vail to have the lab work done and receive either benefit. For more information on the Preferred Lab Benefit Program, see the  Quest Diagnostic Prefered Lab Benifit Program page from the State of Kansas.

Who to Contact

• SEHP
  For general inquires and questions on the benefits of the State Employee Health Plan and Health Plan vendors, email the State Employee Health Plan at SEHPBenefits@ks.gov. Additional contact information can be found at State of Kansas SEHP page.
• Kansas State Employees Health Care Commission (HCC)
  The Kansas State Employees Health Care Commission (HCC) develops the implementation and administration of the State of Kansas health care benefits program. Email HCC Commissioners at SEHPBenefits@ks.gov. 

• HR Total Rewards Team totalrewards@wichita.edu

  

SME: CT
Revised: 02/09/2024 SDM