The Annual Open Enrollment period for the Health, Dental, and Vision insurance benefit plans began Monday, May 4, 2026, and ends Friday, May 15, 2026. This is your opportunity to add or remove dependents as well as make any necessary changes to your insurance benefits. Changes made during open enrollment are effective July 1, 2026, provided that your application and required documentation (required documentation is needed to add new dependents during Open Enrollment) are received by Friday, May 15, 2026.
This year is a “passive” enrollment. This means if you wish to keep your Health, Dental, and Vision benefits as they are, with no changes, you do not need to complete an application. Please still take this time to review your current benefits and dependent(s) coverage.
To enroll, State of Maine Employees will want to log into PRISM and look under “Awaiting Your Action”. (As of May 4, 2026)
PRISM How-to-Guide Open Enrollment
Please note that Ancillary Group employees & the State of Maine Legislature Group employees must submit applications and supporting documentation using our digital enrollment form.
- If you wish to print a copy of your application for your records, when you reach the "Review" page, right-click on the page and select "print" to print your application information.
2026-2027 Benefit Changes:
Health Plan
- Updated premiums
- No changes to deductible, co-insurance, or out-of-pocket maximums)
- Primary Care Physician Office Visit: Decreased to a $25 copay
- Specialty Physician Office Visit: Decreased to a $45 copay
- Inpatient Medical Facility: 15% coinsurance after deductible (No Change)
- Urgent Care Visit: Decreased to a $30 copay
Pharmacy Benefit
- Retail Pharmacy (30-Day Supply):
- Generic: $15 copay
- Preferred Brand: $40 copay
- Non-Preferred Brand: $70 copay
- Virta Responsible Prescribing Implementation
- Effective July 1, 2026: State of Maine Health Plan Members with GLP-1 prescriptions for weight loss are required to enroll in Virta Health and receive their GLP-1 prescription from a Virta provider to maintain coverage. Virta is a nutrition-based program that helps you lose weight and improve your health, available at no additional cost. With personalized nutrition plans and expert support, Virta helps you build healthy habits for long-term success.
- Health plan members and their eligible dependents with existing GLP-1 prescriptions for weight loss can begin the application/enrollment process as soon as possible, but must be actively enrolled with Virta by October 30, 2026, to ensure continuity of coverage.
Dental Plan
- No Changes
Vision Plan
- No Changes
2025-2026 Health/Rx Plan Changes
|
Benefit |
2025-2026 |
2026-2027 |
|
(Current) |
(Effective July 1st) |
|
|
Medical |
||
|
Deductible (Single/Family) |
$800 / $1,600 |
$800 / $1,600 |
|
Coinsurance |
15% |
15% |
|
Out-of-Pocket Maximum (Single/Family) |
$3,750 / $7,500 |
$3,750 / $7,500 |
|
Primary Care Physician |
$30 |
$25 |
|
Specialty Physician |
$50 |
$45 |
|
Inpatient Medical Facility |
15% After Deductible |
15% After Deductible |
|
Emergency Room |
$300 |
$300 |
|
Urgent Care (Walk-In Clinics) |
$40 |
$30 |
|
Prescription Drugs |
||
|
Retail: |
||
|
Generic |
$25 |
$15 |
|
Preferred Brand |
$50 |
$40 |
|
Non-Preferred Brand |
$80 |
$70 |
|
Specialty |
25% Up To $200 |
25% Up To $200 |
|
Mail Order: |
2X Retail Copay |
2X Retail Copay |
|
Out-of-Pocket Maximum |
$4,600 / $9,200 |
$4,600 / $9,200 |
Additional 2026-2027 Health Plan information:
- The plan renewal occurs on July 1, and all deductibles and other accumulators will reset annually on January 1.
.