State Employee Group Insurance Plan

Article Index
State Employee Group Insurance Plan
Cost Sharing Feature
Provider Networks
Health Plan Options
All Pages

Advantage Plan Includes Important Features

The Advantage Plan has some important notable features, including:

Uniform comprehensive set of benefits across all carriers
No co-payments charged to you for preventive care such as immunizations, well-child care, annual check-ups, etc.
Most medical care is coordinated through your Primary Care Clinic (PCC) and you will generally need a referral to see a specialist.
You may self-refer to certain specialists including obstetricians/gynecologists, chiropractors and mental health/chemical dependency practitioners. You may also self-refer for routine eye exams. How you access this specialty care depends on your plan and possibly your PCC.
Family members may elect different PCCs (even in a different cost level), but must enroll with the same carrier.
You can change clinics (within the same benefit level) every month and may change levels (within the same carrier) twice per year.
Referrals to a specialist’s office will be covered at the same cost level as your PCC.
You must choose a carrier that is available in the county in which you live or work and select a clinic in your area.

Cost Sharing Feature

The Minnesota Advantage Health Plan has "cost sharing" features that will help you and the State to better control health care costs while maintaining flexibility in access to doctors and clinics. Under Advantage, you share in the cost of specific medical services you obtain by paying "out-of-pocket" costs (deductibles, office visit copayments, coinsurance).

Health care providers have been placed into one of four cost levels, depending on the care system in which the provider participates and that care system’s total cost of
delivering health care.

The amount of cost sharing that is paid when using health care services varies depending upon the cost level of the provider that you choose.

Provider Networks

Three insurance carriers administer the Minnesota Advantage Health Plan: Blue Cross Blue Shield, HealthPartners, and PreferredOne. Each insurance carrier has a network of primary care clinics and specialty care providers. The MMB home page at www.mmb.state.mn.us offers more information on providers -- a consolidated directory of all primary care clinics and directories of physicians through links to each carrier.

To ask specific questions about clinics, call the carrier directly.

Each carrier also offers a National Preferred Provider Organization for SEGIP members who permanently live outside the State of Minnesota. It is also available for students and employees while in travel status out of the State of Minnesota.

Health Plan Options

Your Employee Benefits provides an overview of the health plan options offered through SEGIP. Your health plan options can change through collective bargaining agreements reached by management and labor unions every two years. Throughout the term of union contracts, the Joint Labor-Management Committee on Health Plans discusses issues arising with your health benefits -- examining problems of rising health insurance costs, developing ways to evaluate the quality of health plans and promoting better labor-management relationships. If you have concerns about your health coverage, please share them with your union representative or DDIR.