2022 annual open enrollment period for the health, dental and vision insurance plans begins on May 9th, 2022 and ends May 23rd, 2022 at 4:30 PM. Changes made during open enrollment are effective July 1, 2022 provided that your application and required documentation (if applicable) was received by 4:30 pm, Monday May 23rd, 2022.
We've created multiple options for the submission of open enrollment applications and required documentation. The available options include:
· Option 1: An online application that can be completed and submitted along with required documentation using a secure application portal.
· Option 2: A PDF version of the application that can be printed, completed, scanned and emailed or mailed back with required documentation. *Important note: Please use this option only if you intend to email the completed application from your SOM email using SOM intranet.
· Option 3: By Request Only: A hard copy of the application mailed to your home, completed and mailed back with required documentation.
o The State Employee Health Commission recently voted to mitigate this increase through another “premium holiday,” which will ultimately decrease the total annual cost to the employee. Details and timing for the premium holiday are still being finalized and will be published here as soon as possible.
· Mental Health and Substance Use Disorder office visits will be covered at 100% both in and out of network (out of network is subject to balance billing)
· LHO (LiveHealth Online) will now cover dermatology and virtual sleep medicine clinics. These telehealth visits are provided at no cost to members.
· The health plan will cover virtual primary care visits via the Anthem Sydney App. You can schedule a virtual primary care appointment for routine care, wellness check-ins and prescription refills.
· Maintenance chiropractic visits will now be covered under the health plan. The copays and visit limits remain the same.
· Addition of Hinge Health programs for back, knee, hip, shoulder, neck and other pain – Hinge programming will be available at no cost to members.
· Important update: The State Employee Health Commission voted to implement a new pilot program: As of July 1, 2022 it will be mandatory for plan members to go through the Plan's Carrum Health benefit when receiving total and partial hip and knee replacement surgery. Surgery expenses for these joint replacements will be fully covered at Spectrum Orthopedics, for plan members and dependents ages 18+ when going through Carrum Health. Information about limited exceptions and prior authorization may be obtained through Carrum Health.
o Please visit carrum.me/stateofmaine or call 1-888-855-7806 for more information about Carrum Health.
· No changes will be made to the out-of-pocket maximums. The copay amounts for in-person office visits, walk-in clinics, emergency room, and prescriptions* will remain the same. *Note the formulary (list of covered medications) will continue to be updated every July 1st and January 1st.
Premiums (No changes for July 1st)
The following plan enhancements will become effective on July 1st:
· Coverage for night guards.
· Adult orthodontic coverage.
· Addition of Delta’s Double-Up Max feature.
o This program allows enrollees to double their calendar year maximum by earning an additional $250 per year for use in future benefit periods. An enrollee must have a claim paid for either an oral exam or a cleaning during a calendar year.
Premiums (No changes for July 1st)
No coverage changes