2022 Health Benefits Guide - dbm.maryland.gov

1 Department of Budget & ManagementEmployee Benefits Division301 West Preston StreetRoom 510 Baltimore, MD 21201 Guide to yourWhat s new in 2022: Visit our Benefits Microsite - Enroll online via SPS Benefits Healthcare FSA - $2,750 Wellness activities carry thru 2022 Awareness Ownership Accountability ImprovementLarry Hogan, GovernorBoyd K. Rutherford, Lt. GovernorDavid R. Brinkley, SecretaryMarc L. Nicole, Deputy SecretaryBENGUID21 Together healthier community, we are working toward aJanuary 2022 to December 2022 Health BenefitsEMPLOYEE Benefits DIVISION301 West Preston Street Room 510 Baltimore, MD 21201410-767-4775 Fax: 410-333-7104 1-800-30-STATE (1-800-307-8283) Email us at: Twitter: CONTACTSS tate Retirement Pension System410-625-5555 or Security Benefits System*410-767-4112 (Job Aids) for SPS Benefits System410-767-4775 INFORMATIONPLANPHONEWEBSITEMEDICAL PLANSCareFirst BlueCross BlueShield EPO, PPO1-800-225-01311-800-735-2258 (TTY) Permanente IHM1-855-839-57631-855-839-5763 (TTY) MD Relay Choice EPO, ChoicePlus PPO1-800-382-7513(TTY) MD Relay DRUG PLANCVS Caremark(844) 460-8767(800) 863-5488 (TTY) PLANSD elta Dental Concordia DPPO1-888-MD-TEETH (1-888-638-3384) SPENDING ACCOUNTSP&A LIFE INSURANCE PLANMetLife1-866-574-2863 DEATH AND DISMEMBERMENT PLANM etlife1-866-574-2863 *MDOT, Judiciary, General Assembly, University and DHS employees should contact your agency help desk for login assistance .

2 Availability of Summary Health InformationAs an employee, the Health Benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in case of illness or State of maryland offers a series of Health coverage options. Choosing a medical plan is an important decision. To help you make an informed choice, we make available a number of documents including our Guide to Your Health Benefits ( Guide ) and a Summary of Benefits and Coverage (SBC). The SBC summarizes important information about any of the medical plan options available to you in a standard format to help you compare options. The Guide provides a more detailed description of all of the Health Benefits options available to you, not just the medical SBCs are available on our website at A paper copy is also available, free of charge, by calling the Employee Benefits Division at 410-767-4775 or Health Benefits GuideTHIS Guide IS NOT A CONTRACTThis Guide is a summary of general Benefits available to State of maryland eligible employees and retirees through the State Employee and Retiree Health and Welfare Benefits Program (the Program).

3 Wherever conflicts occur between the contents of this Guide and the contracts, rules, regulations, or laws governing the administration of the various programs , the terms set forth in the various program contracts, rules, regulations, or laws shall prevail. Space does not permit listing all limitations and exclusions that apply to each plan. Before using your Benefits , call the plan for information. Benefits provided can be changed at any time without the consent of 08/26/2021 TABLE OF CONTENTSWhat s New for 2022? 3 Wellness Plan 4 medical Benefits 6 Prescription Drug Benefits 20 Dental Benefits 26 Flexible Spending Accounts 29 Term Life Insurance 33 Accidental Death and Dismemberment 36 Eligibility 37 When Coverage Begins.

4 37 Enrolling Eligible Dependents ..39 Qualifying Status Changes ..50 Leave of Absence ..53 COBRA Continuation of Coverage ..55 Medicare and Your State Benefits ..57 Important Notices & Information 63 Benefits Appeal Process ..75 Nondiscrimination and Accessibility Requirements Notice ..76 Definitions ..7822022 Health Benefits GuideThe State of maryland provides a generous benefit package to eligible employees and retirees with a wide range of benefit options from healthcare to income protection. The following chart outlines your benefit options for the plan year January 1, 2022 - December 31, details about each specific plan, review the sections in this Guide or see the inside of the front cover for contact information for each of the OptionsPlanOptionsCoverageWho Is Eligible*MedicalPPO Plans CareFirst BlueCross BlueShield UnitedHealthcareEPO Plans CareFirst BlueCross BlueShield UnitedHealthcareIHM KaiserProvide Benefits for a variety of medical services and supplies.

5 Benefit coverage levels vary by plan; review the information carefully. medical plans include routine vision services and behavioral Health coverage. Active Full-time State/Satellite employees* Part-time State employees State retirees** ORP retirees**Prescription Drug CVS Caremark SilverScript EGWPP rovide Benefits for a variety of prescription drugs. Some limitations (quantity limits, prior authorization, and step therapy) apply for certain wraps around Medicare Part D for Medicare eligible retirees and dependents. Active Full-time State/Satellite employees* Part-time State employees State retirees ORP retireesDentalDPPO United ConcordiaDHMO Delta DentalProvide Benefits for a variety of dental services and supplies. Active Full-time State/Satellite employees* Part-time State employees State retirees ORP retireesFlexible Spending AccountsP&A Group Healthcare Dependent DaycareAllow you to set aside money on a pre-tax basis to reimburse yourself for eligible healthcare or dependent daycare expenses.

6 Active Full-time State employees*Term LifeMetLifeCoverage for you in increments of $10,000 up to $300,000 Coverage for dependents in increments of $5,000 up to 50% of your coveragePays a benefit to your designated beneficiary in the event of your death. You are automatically the beneficiary for your dependent s be subject to medical review. Active Full-time State/Satellite employees* Part-time State employees State retirees** ORP retirees**Accidental Death and Dismemberment MetLifeCoverage amounts for yourself and/or your dependents: $100,000, $200,000, or $300, a benefit to you or your beneficiary in the event of accidental death or dismemberment. Active Full-time State/Satellite employees* Part-time State employees* To be eligible you must meet the eligibility requirements as outlined in the Eligibility section of this Guide . Amount of state subsidy, if any, varies by what category of employee (including contractuals) or retiree you are.

7 ** For retirees and their dependents who are Medicare-eligible, all medical plans are secondary to Medicare Parts A & B regardless of whether the individual has enrolled in each.** Only retirees who are enrolled in life insurance as an active employee at the time of retirement may continue life insurance coverage in Health Benefits GuideWhat s New for 2022? Online Benefits enrollment is mandatory for active and contractual employees who wish to make or change Benefits elections for plan year 2022. Wellness activities carryover in 2022. See pages 4-5 for details on earning incentives to reduce your costs this calendar year. As a result of the injunction granted by the court in Fitch vs. State of maryland , there are no changes to the prescription coverage provided to Medicare eligible retirees in 2022. Healthcare FSA annual amount is unchanged at $2,750. FSA s require an annual election Healthcare funds may be used for employees and their eligible family members Dependent care funds may be used for daycare expenses for dependents under the age of 13 Expanded access to Flu Shots at most pharmacies nationwide - $0 copay42022 Health Benefits GuideNotice Regarding Wellness PlanThe wellness plan administered under the Program is a voluntary program available to all enrolled employees, non-Medicare eligible retirees, and enrolled non-Medicare eligible spouses of these respective employees and retirees.

8 The plan is administered according to federal rules permitting employer-sponsored wellness plans that seek to improve employee Health or prevent disease, including the Americans with Disabilities Act of 1990, the Genetic Information Nondiscrimination Act of 2008, and the Health Insurance Portability and Accountability Act, as applicable, among others. If you choose to participate in the wellness plan, you will be asked to complete a voluntary Health risk assessment or HRA that asks a series of questions about your Health -related activities and behaviors and whether you have or had certain medical conditions ( , cancer, diabetes, or heart disease). You will also be asked to select a primary care physician (PCP) and complete any age/gender appropriate preventive screenings for the plan year. You are not required to complete the HRA or to participate in the other wellness , employees who choose to participate in the wellness plan and complete all of the wellness plan activities will receive the following incentives for the remainder of the 2022 plan year: $0 copays for PCP visits and a $5 reduction in Specialist copaysAlthough you are not required to participate in the wellness plan activities, only employees who do so will receive copay information from your HRA and the results from an annual physical may be used to provide you with information to help you understand your current Health , potential risks and may also be used to offer you services through the wellness plan, such as free video visits with your PCP lab screens for certain chronic conditions at no charge, Health coaching, and/or disease management assistance , etc.

9 Protections from Disclosure of medical InformationWe are required by law to maintain the privacy and security of your personally identifiable Health information. Although the wellness plan under the Program may use aggregate information it collects to design a program based on identified Health risks in the workplace, the Program will never disclose any of your personal information either publicly or to the employer, except as necessary to respond to a request from you for a reasonable accommodation needed to participate in the wellness plan, or as expressly permitted by law. medical information that personally identifies you that is provided in connection with the wellness plan will not be provided to your supervisors or managers and may never be used to make decisions regarding your Health information will not be sold, exchanged, transferred, or otherwise disclosed except to the extent permitted by law to carry out specific activities related to the wellness plan, and you will not be asked or required to waive the confidentiality of your Health information as a condition of participating in the wellness plan or receiving an incentive.

10 Anyone who receives your information for purposes of providing you services as part of the wellness plan will abide by the same confidentiality requirements. The only individual(s) who will receive your personally identifiable Health information are your PCP and associated personnel and Health coach as appropriate and if elected in order to provide you with services under the wellness wellness activities will carryover through Plan Year Plan52022 Health Benefits GuideIn addition, all medical information obtained through the wellness plan will be stored electronically and encrypted. Health information obtained through the wellness plan will be maintained separate and apart from any personnel records unrelated to the Program. Appropriate precautions will be taken to avoid any data breach, and in the event a data breach occurs involving information you provide in connection with the wellness plan, we will notify you may not be discriminated against in employment because of the medical information you provide as part of participating in the wellness plan, nor may you be subjected to retaliation if you choose not to you have questions or concerns regarding this notice, or about protections against discrimination and retaliation, please contact Employee Benefits Division at or information concerning the 2022 Wellness Plan activities, go to the Employee Benefits Wellness website at and click on the Wellness tab at the top of the screen.