Frequently Asked Questions

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State of Maine Health Plan

How can I receive an additional or replacement ID card?
You can request additional ID cards by logging on to Anthem.com or by calling Anthem's dedicated Member Services line for the State of Maine Health Plan at 1-844-273-4614. In addition, the free Anthem Anywhere mobile app contains an image (front & back) of your ID card to be viewed on a smart device.

What are the hours of Anthem Member Services?
Hours of operation are 8:00am-5:00pm EST Monday-Friday. Anthem's Interactive Voice Response (IVR) System is available 24/7.

How can find a provider in the Anthem network?
To find a provider you can log on to your account at Anthem.com or call Anthem Member Services at 1-844-273-4614. If you choose to search online as a guest, Maine providers can be found in the "BlueChoice PPO" network; providers outside of Maine can be found in the "National PPO (Bluecard PPO)" network.

Should my doctor's name appear on my Anthem ID card?
Yes, if you have named a primary care physician (PCP) with Anthem Blue Cross and Blue Shield. If you would like to change your PCP selection, just call Anthem Member Services at 1-844-273-4614.

Am I required to have a Primary Care Physician?
You are not required to name a Primary Care Physician however it is strongly encouraged.

Does the State of Maine Health Plan provide coverage nationwide?
Yes. Check the Find a Doctor online tool to find a provider in your state.

What happens if I need care outside the United States?
Contact the Blue Cross Blue Shield Global Core Service Center at 1-800-810-2583 for assistance.

Which walk-in clinics are part of the Anthem network?
The list of participating walk-in clinics can be found here (pdf); the copay is $25 and you do not need a referral. Please note, services at MMC's Brighton FirstCare will charge an emergency room copay amount of $300.

Do I need a referral to see a specialist?
No, referrals are not required.

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Health Credit Premium Program

Program

What is the Health Credit Premium Program?
This voluntary program provides incentives to State of Maine employees enrolled in the health insurance plan as rewards for healthy behaviors as outlined by the Office of Employee Health & Benefits and the State Employee Health Commission.  The health premium credit of up to 5% is applied to the individual (employee only portion) health insurance premium.

How do I earn the credit for 7/1/2019 - 6/30/2020?
Health Credit Premium Program requirements

Once I earn the premium credit how long do I have it?
The premium credit resets at the start of every fiscal year on July 1st. You will continue to receive the 5% premium discount for the entire fiscal year (July 1 - June 30).

Does the credit carry over from year to year?
No. The requirements must be met each and every (fiscal) year by the identified deadline.

Where can I find the stress video and quiz?
The stress video and quiz is located under the "Mindfulness" tab located in your WellStarME scorecard.

How do I know if I have the credit now?
Take a look at your pay stub to see how much you have deducted for your health insurance. For full-time employees, you can then look at the Health Insurance Premium Rates and locate your salary category and coverage level.  The premium amount will be listed for employees with and without the credit.  Part-time employees can call Employee Health & Benefits to inquire (207)624-7380.

If I have the credit today but do not complete the new requirements for July 1, 2019, will I lose the credit?
Yes; the 5% credit will be removed effective July 1st. Your individual premium will be the base premium rate.

How much is the credit worth?
You will save 5% off of the individual health insurance premium.  This could be a savings of over $500 per year for full-time employees who work year round!

Is the amount of the credit reduced if my lab results are not within the normal limits?
No. Your lab results are considered your protected health information. These results have no impact on the amount of the premium credit received.

Is the amount of the credit reduced if I am a tobacco user?
No. We encourage members to utilize the various resources available to them at either low or no cost to help quit using tobacco. These resources can be found under the tobacco tab within WellStarME.

Am I eligible for the health premium credit if I am covered under the State of Maine Health Plan as a retiree or as a retired teacher?
No. This program applies to active State of Maine active employees only. If you are unsure which plan you are in, please call Employee Health & Benefits at 1-800-422-4503.

I plan to drop my spouse/domestic partner from my health insurance during open enrollment; does he/she still need to complete the requirements in order to earn the credit?
Yes.

I previously took a different Health Risk Assessment (HRA) (e.g. with Aetna or Anthem); is it required that I take the other HRA again for the credit for July 1, 2019?
No. Taking any other HRA will not qualify you for the health credit. Only the stated requirements, which includes a Wellness Questionaire at WellStarME, must be met for the fiscal year beginning July 1, 2019.

 

WellStarME

For a full list of WellStarME FAQ's visit the WellStarME website and select "What is WellStarME?" at the top of the screen. For WellStarME technical problems, call (207)620-9202 or wellstar@mcdph.org.

Does my spouse/domestic partner need to create their own WellStarME account?
Yes. Each account must have a unique e-mail address.

Where can I find my Anthem ID number?
The Anthem identification number is located on the front of your Anthem card under your name. It begins with "XVG."

My spouse/domestic partner has the same Anthem ID number as I do; can we both use the same number?
Yes.

I plan to drop my spouse/domestic partner from my health insurance during open enrollment; does he/she still need to complete the requirements in WellStarME in order to earn the credit?
Yes.

If I register for WellStarME and my spouse/domestic partner does not, will I receive any part of the credit?
No.

 

On-Site Health Screenings

Who is eligible for an on-site health screening? 
Active employees, non-Medicare retirees and spouses/domestic partners covered on the State of Maine Health Plan are eligible for one on-site screening each.

Is there a cost to attend an on-site health screening?
No; this service is provided at no cost to the eligible health plan members.

When and where will the on-site health screenings be held?
Current on-site health screening schedule 

Will the tests I receive at an on-site health screening meet that portion of the requirements for the FY19 Health Credit Premium Program? 
Yes. This applies to both the primary subscriber and covered spouse/domestic partner. My Numbers information

What tests will be performed at an on-site health screening?
My Numbers information

What happens with my test results?
The test results are securely uploaded to your individual WellStarME account. Don't forget to register and activate your WellStarME account if you haven't done so; ideally, this should be done before your screening appointment.

Is the amount of the credit reduced if my lab results are not within the normal limits?
No. Your lab results are considered your protected health information. These results have no impact on the amount of the premium credit received.

Will blood be drawn at the on-site health screening (for the hemoglobin A1C & cholesterol tests)?
These tests will involve a quick fingerstick (not a venous blood drawn from the vein in the arm). 

Do I need to fast (not eat or drink) prior to my on-site health screening appointment?
No. The tests provided at the on-site screenings are considered "non-fasting."  Although you should avoid caffeine and exercise at least 30 minutes prior to your screening appointment.

Do I need to bring anything to my screening appointment?
Yes. Please bring your Anthem Blue Cross and Blue Shield ID card to your screening appointment.

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Medicare Advantage Plan

Who do I contact to request a new identification (“ID”) card?
You can order additional ID cards by either logging on to Aetna Navigator or by calling Aetna Member Services at 1-888-267-2637.

Do I need to choose a primary care doctor?
No.  Although managing your health care with a primary care doctor is encouraged, it is not required with this plan.

Do I need a referral to go see a specialist?
No. Referrals are not required with this plan.

When will I receive a bill for my monthly health insurance premium?
Most retirees will have their health insurance premium directly withheld from their MainePERS pension.  If your pension is not large enough to withhold the premium a bill will be mailed to you from Aetna on the 15th of each month.  You will then have 30 days to make your regular monthly premium payment.

I have received a medical bill from my hospital for services and I don’t understand why; who do I call?
Aetna Member Services at 1-888-267-2637.

I received an Explanation of Benefits from Aetna regarding a recent medical claim and I believe it is incorrect; who do I call?
Aetna Member Services at 1-888-267-2637.

I was charged a different copay for my prescription than I usually pay; how do I find out if I paid the correct amount?
Call Aetna Member Services at 1-888-267-2637.

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Living Resources Program

Who is eligible for the services under this program?
Employees, retirees and their household members of the following employers: the State of Maine, Maine Community College System, Maine Public Employees Retirement System ("MainePERS"), Finance Authority of Maine ("FAME"), Maine Maritime Academy and Maine Educational Center for the Deaf and Hard of Hearing.  (Note: Enrollment in the State of Maine health plan is not required to be eligible for these services.)

How many counseling visits am I eligible for?
Those listed above are eligible for a total of up to 5 counseling visits per calendar year.

I am an active State of Maine employee.  Can I use administrative leave ("admin leave") for my counseling visits?
Administrative leave is granted for up to 5 counseling visits per calendar year. Please note, admin leave is not available for services provided through the legal and financial programs.

Are services provided by the Living Resources Program confidential? 
Yes.

How do I access programs and services?
You may contact the Living Resources Program at 1-844-207-LINK (5465).

I am interested in seeing a counselor through the Living Resources Program; how do I get started?  What is the process?
Just call 1-844-207-LINK (5465).  (The Program is available 24 hours a day, 7 days a week.)  A counselor will listen to your issue over the phone and then provide you with a referral to a licensed counselor in your community. 

Does this program have information online?
Yes; just go to GuidanceResources Online. First-time users will need to register.  The web ID is LivingME.  There you will find articles, tutorials, streaming videos, etc. on a wide variety of topics and issues.

I wish to see a counselor that isn't part of ComPsych's network of providers; how do I request that he or she be added?
You can direct the counselor to the Provider Resource Center at ComPsych's website. There they will find a Prospective Provider Interest Form to complete.

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Retired Fire Fighter & Law Enforcement Officer Program

(For County & Municipal Law Enforcement and Firefighter employees only)

What is the benefit offered by the law?
The law – Public Law Chapter 636 – provides retired county and municipal law enforcement officers and retired municipal firefighters with a premium subsidy for their individual health insurance coverage. The subsidy amount is equal to 45% of an index plan, which happens to be the best plan available through the Maine Municipal Employees Health Trust, in which many counties and municipalities already participate.

 

When must an active employee enroll?

An active employee must elect to enroll within 60 days of his/her date of hire.  There is a form that must be completed indicating whether you are enrolling or not.  This form is supplied to you by your employer upon being hired.

 

What are the requirements to be eligible for the subsidy program at retirement?

  • An individual (employee or retiree) must be at least 50 years of age: and

  • Must be a county or municipal law enforcement officer or municipal firefighter or a retired count or municipal law enforcement officer or retired municipal firefighter (as defined by State Statue): and

  • Must be actively employed by the county or municipality, a plan participant in the employer's health insurance plan at the time of retirement: and

  • Is a participant in the employer-sponsored retirement plan, (e.g. Maine Public Employees Retirement System, another defined contribution retirement plan), Social Security does not qualify as an employer-sponsored retirement plan.

 

Once the individual retires, he/she must be eligible to receive or be receiving a retirement benefit from either MainePERS or another defined contribution retirement plan (not Social Security).  If the individual retires after less than 25 years of creditable service as a law enforcement officer or firefighter, the benefit received must be at least 50% of their average final compensation, with no reduction for early retirement.  There are forms which must be completed at the time of retirement. 

 

When will the premium subsidy be effective?

The subsidy will be effective the first of the month following retirement.

 

What is considered a Defined Contribution Plan?

An employer-sponsored 401(k), 401(a), 403(b) and 457(b) are defined contribution plans.

 

As an employee enrolled in the program, do you have to continue contributing until you retire?

Yes, an active employee must continue to contribute while actively working until retirement in order to be eligible for the subsidy program.

 

Can plan participants withdraw from the subsidy program at any time?

Yes, withdrawal at any time is allowed.  However, as a result of withdrawing all money contributed will be forfeited and the opportunity to rejoin is lost unless you are hired by another participating municipality.

 

What are the definitions of “law enforcement officer” and “firefighter”?

"County or municipal law enforcement officer" means a person who by virtue of employment by a county or municipal government in the State is vested by law with the power to make arrests for crimes or serve criminal process, whether that power extends to all crimes or is limited to specific crimes. "County or municipal law enforcement officer" does not include a state or federal law enforcement officer, an attorney prosecuting for a county or municipal government or a reserve officer.

 

"Municipal firefighter" means a person employed by a municipal fire department with the primary responsibility of aiding in the extinguishment of fires and includes a member of emergency medical services line personnel but does not include a member of a volunteer firefighter association. For the purposes of this paragraph, "emergency medical services line personnel" means persons who are career employees employed full-time by a public sector agency or employer and whose primary responsibility is to provide emergency medical services.

 

Who is not eligible for the subsidy program?

Volunteer or on-call firefighters and reserve law enforcement officers are not eligible for this program.

Under the law, the subsidy is not available for dependents or for retirees with “supplemental health insurance coverage”.  This means that retirees who have reached the age of 65 and/or on Medicare, including those who are provided with Companion Plan and Major Medical coverage through the Maine Municipal Employee Health Trust, are no longer eligible to receive the premium subsidy.

 

Can you use the subsidy for any health insurance plan you choose?

No, the subsidy is only available for the participating Municipality's plan from which you retired.  However, for law enforcement officers and firefighters retired from the City of Portland, special arrangements have been made to allow you to participate in the State Employees Health Insurance Program. These arrangements were set up because the City of Portland does not administer any retirement benefits for its employees. The State Employee Health Insurance Program is a self-insured plan, run by the State of Maine’s Office of Employee Health and Benefits.

 

Many towns and counties have group health insurance through the Maine Municipal Employee Health Trust.  Two important points – first, the subsidy is only available for your coverage; it doesn’t extend to the cost of insuring your dependents. Second, you have to remain in the same insurance plan option that your former employer is in – if that coverage changes, you must change, too. If you decide not to buy into the group plan when you retire, the rules of the Municipal Municipal Employees Health Trust prohibits you from enrolling at a later date.  Some local municipalities provide coverage through an insured commercial insurance plan.  The City of Bangor, for example, chooses to purchase coverage for its employees directly from Cigna.  Law enforcement officers and firefighters retiring from towns purchasing coverage in this manner are also free to continue to buy into their former employer's group plans upon retirement if their towns allows them to do so and they are participating with the Subsidy Program.  If you choose to do this, you will be eligible to receive a subsidy toward the cost of the monthly premium for your own coverage, up to the value of the subsidy for the best plan offered through the Maine Municipal Employees Health Trust Program.  Again, the subsidy is 45% and is only allowed for the cost of your single coverage, not toward your dependents. 

 

I am a retired law enforcement officer, but I decided to purchase health insurance coverage on my own, rather than opting to buy into my former employer’s group plan. Can I still get the subsidy? 

No. The subsidy is only available for coverage through the county or municipal employer’s group plan in which you participated as an active employee. Special Provisions are in place for retirees from the City of Portland.

 

I’m a retiree from the City of Portland.  What benefits are covered by the State Employee Health Plan?

The State Employee Health Plan is comprehensive and includes coverage of prescription drugs. You can see a list of benefits by visiting our website.  Only retirees from the City of Portland are eligible for enrollment in the State of Maine’s Employee Health Plan.  Please contact the Office of Employee Health & Benefits for more information.

 

What if my Municipality is not part of the Maine Municipal Employees Health Trust?

If your Municipality is not part of the Maine Municipality Employees Health Trust, the State of Maine’s Office of Employee Health &  Benefits will work directly with your employer’s insurance carrier as long as you are enrolled with a participating municipality.

 

For more information regarding the Law Enforcement and Firefighters Insurance Subsidy Program, please contact the State of Maine, Office of Employee Health & Benefits at 1-800-422-4503.

 

 

The Retired County and Municipal Law Enforcement and Municipal Firefighters Health Insurance Program is administered by the State of Maine Office of Employee Health & Benefits.

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New Employees

What benefits programs am I eligible for as a State of Maine employee?
This presentation (pdf format) reviews the menu of benefits.  (Note, retired teachers and return-to-work State of Maine retirees are only eligible for MaineSaves & Flexible Spending under the active employee benefits.)

How long do I have to decide which benefits I'd like to enroll in?
You have 60 days from your original date of hire to enroll in the health, dental, vision insurance plans as well as the flexible spending accounts.  Enrollment in the voluntary retirement savings plan (MaineSaves) is done monthly.

When does my insurance become effective?
Your insurance becomes effective the first of the month following one month of employment.  The effective date of coverage may be different for employees of the ancillary employers (e.g. Maine Community College System, MainePERS, etc.).

Are there any waiting periods for certain services on the insurance plans?
No. Once your coverage becomes effective you have access to all services provided.

Where can I find my Anthem PCP ID?
Log on to Anthem's website and select 'Find/rate a doctor.' Enter your doctor's information. The PCP ID is located under the doctor's name.

Who do I call if I have a question?
Your Benefit Specialist at Employee Health & Benefits can assist you with topics such as insurance premium deductions and enrollment questions. For questions regarding a particular plan's coverage and claims, please call the Member Services number located on the back of your plan's identification card.

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Gym Membership Reimbursement Program

Who qualifies for the Gym Membership Reimbursement Program?
State of Maine employees eligible for State-paid benefits.  That includes full-time, part-time, intermittent, seasonal, acting capacity and paid intern employees.  (Contract employees are not eligible.)  Seasonal employees should contact their own agency’s Human Resources/Payroll office for more information.  Note:  Employment is required for reimbursement. 

Can I submit for reimbursement when I terminate my employment with the State during a quarter?
You must be employed during the submission period at the end of a quarter in order to submit for reimbursement for that quarter. For example, in order to receive reimbursement for July, August, and/or September, you must be employed at the time you submit for reimbursement between October 1 and October 15.  Note: termination of employment is not the same as going on seasonal leave. Seasonal employees should contact their agency HR/Payroll office for further instruction on submitting for reimbursement. 

Why do I have to go 8 times per month to qualify for gym reimbursement?
The Centers for Disease Control and Prevention (CDC) suggest regular exercise will help improve overall health while reducing the risk for many chronic diseases. Visit the CDC's website for specific physical activity guidelines.

How do I track visits to ensure I qualify for reimbursement?
You can use the Gym Attendance Verification sheet (MS-Word), an official tracking sheet signed by a gym employee that tracks each visit, or a gym-generated printout of attendance.  All employees must identify the gym, the employee name and the date of every gym visit.  If the gym document does not include the name of the gym and/or employee name, you may write that on the document.

I also use the Eastside or Bangor Wellness Center; will those gym visits count towards my 8 visits per month requirement for the Gym Membership Reimbursement Program?
No. Membership at the Eastside and Bangor Wellness Centers is an entirely separate program from the Gym Membership Reimbursement Program.  (Note, use of the Wellness Center facilities is not a taxable benefit as it is a state-owned facility.)

I'm having surgery and will not be able to work out; can I get an exception to the 8 visits per month requirement?
In this new program, you only qualify for reimbursement for those months in which you meet the 8 visit minimum.  Failure to meet the 8 visit minimum does not disqualify you from receiving reimbursement for the other months in that quarter in which you did meet the 8 visit requirement.  Nor does it restrict you from applying for reimbursement in other quarters.

What happens if I do not meet the 8 visits per month requirement?
You do not qualify for reimbursement for that month.

Can I be reimbursed if I buy a family or 2-person gym membership?
Yes, however, the reimbursement is for the employee only.  The employee will be eligible for reimbursement at the individual reimbursement rate of up to $40 per month (not to exceed the total cost of the purchased membership). This program is only available to the State of Maine employees eligible for state-paid benefits; family members are not covered by the Gym Membership Reimbursement Program.  You will need to provide the cost of an individual membership to that gym on your Gym Membership Reimbursement Request Form (MS-Word)

I have another member of my household who is also a state employee.  If we buy a joint or family membership, can we both be reimbursed?
Yes.  If two State employees are on the same gym membership, the total of their combined reimbursement amounts shall not exceed the cost of the membership, the gym’s rate for 2 individual memberships, and the amount of the receipt submitted, up to $40 per month for each.  Each employee must complete their own Gym Membership Reimbursement Request Form (MS-Word) including information about the other state employee(s) in their household who share their membership. 

How do I show proof of payment?
Acceptable forms of proof include a copy of: a receipt from the gym; a canceled check; credit card statement; online purchase receipt.  All forms must include employee name, gym name, amount paid, and date paid.  You must submit proof to cover the quarter for which you are seeking reimbursement. This may require you to submit multiple receipts or the same receipt more than once.  Keep the originals or copies for your records.

Do I have to pay my gym membership fee monthly?
No. You can buy any type of membership you want and will need to indicate that on your Gym Membership Reimbursement Request Form (MS-Word).  You may need to submit the same receipt more than once.

Is my gym membership reimbursement taxed and how is it reimbursed?
The reimbursement is paid in your paycheck and it is taxed as taxable income.  For more information regarding taxable fringe benefits see IRS Publication 15-B.

Who pays for my gym membership?
You are responsible for paying for your gym membership up front and are responsible for submitting reimbursement quarterly. 

Does the reimbursement cover the gym fees other than the membership?
No, you (the employee) will be responsible for any additional fees charged by the gym such as one-time joiner fees, processing fees, annual fees, class fees, etc.

Does the reimbursement cover the cost for sessions with a personal trainer, physical therapist or classes that have a cost in addition to the gym membership fee?
No.  The reimbursement is only for the cost of your gym membership (up to $40 per month).

I occasionally travel and would like to use another gym (other than my primary gym); will this apply towards my 8 visits per month?
If your primary gym offers reciprocity that can be documented or you can properly document visits at another facility, these visits may qualify towards your 8 visit minimum. Gym membership reimbursement is based on your primary gym membership.  For more information or have questions contact Info.Wellness@maine.gov.

What happens if I change my primary gym during a quarter?
You may count all visits at either gym towards your 8 visit minimum.  You may only be reimbursed for the cost of one membership.  You will be reimbursed for the facility where you had the majority of your visits.  If your visits were split equally between the two gyms, you will be reimbursed for the new membership only.

Can I be reimbursed for two gyms?
No.  You will only be reimbursed for your one primary gym.

What type of gyms qualify for this program?
A facility primarily focused on physical fitness, such as a YMCA, Planet Fitness, Cross Fit, etc. If you are uncertain if your gym qualifies, please seek confirmation prior to purchasing a membership.  E-mail Info.Wellness@maine.gov.

What types of facilities or memberships would not qualify for reimbursement from this program?
Some examples include yoga studios, martial arts classes, swimming pool membership, class-based facilities, by appointment only facilities, etc.

Who do I contact if I have questions about this Gym Membership Reimbursement Program?
Email Info.Wellness@maine.gov.

I would like to provide feedback regarding this program; who do I contact?
Your input is valuable and could lead to changes in the future. It was employee feedback regarding the prior program that led to the creation of this expanded reimbursement program. Representatives from each of the unions and management worked together to develop the requirements for this Gym Membership Reimbursement Program. You are welcome to provide feedback via e-mail to info.wellness@maine.gov. Please note that you may not receive a response to your input/comments, but feedback will be noted for future discussions.

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