2022 Health Benefits Guide

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.

2 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.

3 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.

4 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). 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.

5 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

6 Dismemberment 36 Eligibility 37 When Coverage Begins ..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.

7 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. 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.

8 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.

9 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.

10 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.** 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.