Medical Plans

General Description of Medical Plans

Please click here for 2012-2013 Medical Rates

Types of Plans

Medical
coverage is available to all individuals and their dependents who are eligible
for health benefits. These benefits are offered through the State
of Maryland Employee Benefits Division
.
There are three types of medical
plans offered: Preferred Provider Organization (PPO), Point-of-Service (POS),
and Exclusive Provider Organization (EPO). While all three types of plans offer
comprehensive coverage, the type of medical plan you choose determines your premium,
out-of-pocket expense, and choice of physician. Please remember that any medical
treatment must be considered a “medical necessity” by your plan in order for
payment to be authorized. The following chart gives a general overview of the
differences in types of plans from Aetna, Carefirst and United Healthcare. Please consult the official Benefits Guide for complete plan details.

AETNA POS

In-Network

POS

Out-of-Network

EPO

In-Network-Only

National Network YES YES YES
Primary Care Physician Required NO NO YES
Plan Year Deductible
Individual None $250 None
Family None $500 None
Out-of-Pocket Coinsurance Maximum*
Individual $1000 $3000 None
Family $2000 $6000 None
Lifetime Maximum None None None
Primary Care Physician’s Office Visit $15 copay 70% of allowed benefit amount after deductible $15 copay
Specialist Office Visit $30 copay $30 copay
CAREFIRST PPO

In-Network

PPO

Out-of-Network

POS

In-Network

POS

Out-of-Network

EPO

In-Network-Only

National Network YES YES NO, Regional YES YES
Primary Care Physician Required NO NO YES NO NO
Plan Year Deductible
Individual None $250 None $250 None
Family None $500 None $500 None
Out-of-Pocket Coinsurance Maximum*
Individual $1000 $3000 $1000 $3000 None
Family $2000 $6000 $2000 $6000 None
Lifetime Maximum None None None None None
Primary Care Physician’s Office Visit $15 copay 70% of allowed benefit amount after deductible $15 copay 70% of allowed benefit amount after deductible $15 copay
Specialist Office Visit $30 copay $30 copay $30 copay
UNITED HEALTHCARE PPO

In-Network

PPO

Out-of-Network

POS

In-Network

POS

Out-of-Network

EPO

In-Network-Only

National Network YES YES YES YES YES
Primary Care Physician Required NO NO NO NO YES
Plan Year Deductible
Individual None $250 None $250 None
Family None $500 None $500 None
Out-of-Pocket Coinsurance Maximum*
Individual $1000 $3000 $1000 $3000 None
Family $2000 $6000 $2000 $6000 None
Lifetime Maximum None None None None None
Primary Care Physician’s Office Visit $15 copay 70% of allowed benefit amount after deductible $15 copay 70% of allowed benefit amount after deductible $15 copay
Specialist Office Visit $30 copay $30 copay $30 copay

For PPO and POS plans:
In-Network Co-Insurance is 90%
Out-of-Network Co-Insurance is 70%

Last updated: June 25, 2013