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General Description of Medical Plans

Please click here for 2009-2010 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.

Type of Plan	Basic Format	Premium	Choice of Physician	Copay	Out-of-Network
PPO Blue Cross Blue Sheild United Healthcare PPO	May choose any physician, but choice determines out-of-pocket expense.	Highest Premium	Any PPO or Non-PPO physician at time of service. No need for plan referral to a specialist.	PPO Physician: $15 Primary Care $25 Specialist Care	Out-of-Network services subject to a deductible and 20% coinsurance.
POS Aetna POS BCBSM Maryland POS United healthcare POS	A Managed-Care-In-Network plan with the option to choose an Out-of-Network physician, subject to a deductible and 20% coinsurance.	Lower Premium	Must choose a Primary Care Physician for Carefirst BC/BS only. Aetna and United Healthcare require no primary care physician selection. However, it is strongly encouraged that all participants who enroll in the Aetna and United Healthcare plans choose a Primary Care Physician. Carefirst BC/BS requires a referral from your primary care physician in order to see a specialist. Aetna and United Healthcare do not require referrals.	In-Network $15 Primary Care $25 Specialist Care	Out-of-Network: May choose any physician at time of service, but such service is subject to a deductible and 20% coinsurance.
EPO BCBS Blue Choice EPO Aetna EPO United Healthcare EPO	EPO plans are managed care plans similar to HMO's and only cover services by in-network providers, except in the event of an emergency. All EPO plans have a national network.	Lowest Premium	Aetna and United Healthcare require selection of a primary care physician. Carefirst BC/BS does not require a selection of a primary care physician. No referrals are required by Carefirst BC/BS and United Healthcare to see a specialist.	$15 Primary Care $25 Specialist Care	No coverage for Out-of-Network services, unless services are result of a medical emergency.