Emi Health Advantage Copay

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Retiree Information

2020-2021 Plan Year Note: To ensure compliance with federal law for Medicare Advantage plans and provide for the continued similar treatment of deductibles, effective October 1, 2020, the State Health Plan for all retirees and dependents is amended to remove the practice of carrying over amounts accumulated toward deductibles for dates of service during the fourth quarter of plan years toward in-network deductibles for the following year.

2020-2021 Retiree Benefits Bulletin
2019-2020 Retiree Benefits Bulletin

Understand what co-pay in health insurance means, how it is different from co-insurance, what the features of co-pay are, why insurance companies have co-pay clauses, disadvantages of co-pay, should you buy a health insurance policy with co-pay, FAQs, etc. Read more about co-pay at BankBazaar. Advantage Co-Pay (Utah) Co-Pay & Claim Payment Sample Schedul e Effective 1/1/2019 Corporate (801)262-7475 Customer Service (800)662-5851 emihealth.com. EMI Health is pleased to continue to offer Murray School District employees Long Term Disability and Life Insurance. The following will describe what benefits you have available through EMI. We can help you find the right doctor, access mental health services, find your secure medical information online, connect for a virtual visit, talk with a registered nurse or take advantage of your member discounts. Individual Marketplace 2020 Flu Shot Incentive – A flu shot is an important part of maintaining your health. EMI Health is a nonprofit organization providing health benefits to more than 280,000 members across the country. The company has been serving the needs of employers in the Intermountain West for more than 80 years by maximizing health benefits while keeping premiums at a minimum. For more information, visit emihealth.

Below are a number of resources you may find helpful regarding the transition from the State Health Plan PPO Medicare Supplemental plan to the Medicare Advantage plan taking effect January 1, 2020. These changes do not apply to State Police Troopers and Sergeants who retired on or after October 1, 1987.

  • Medicare Advantage State of Michigan Retiree Video

Opting Out of the State Health Plan Medicare Advantage Coverage:

Retirees may opt out of the transition to the State Health Plan Medicare Advantage coverage (Medicare Plus Blue Group PPO). If a retiree (or their covered spouse or dependent) completes the Opt Out Form and does not provide proof of having other primary coverage (aside from original Medicare), they will be disenrolled from health coverage through the State of Michigan, including prescription drug coverage.

If a retiree (or their covered spouse or dependent) completes the Opt Out form and has other primary coverage, they may remain in the State Health PPO Medicare Supplemental plan by providing proof of the other primary coverage with their Opt Out Form.

CY 2021 (January 1, 2021 - December 31, 2021)

State Health Plan PPO:

  • Blue Cross Blue Shield of Michigan
    • ​Non-Medicare Retirees

HMOs:

  • Blue Care Network
    • ​Non-Medicare
  • Health Alliance Plan (HAP)
  • ​Physican's Health Plan
    • ​Non-Medicare
  • Priority Health

FY 2020–2021 (October 1, 2020 - December 31, 2020)

State Health Plan PPO:

  • Blue Cross Blue Shield of Michigan

HMOs:

  • Blue Care Network
  • Health Alliance Plan (HAP)
  • Physician's Health Plan (PHP)
  • Priority Health

FY 2019–2020 (October 1, 2019 - September 30, 2020)

State Health Plan PPO:

Emi Health Advantage Copay Schedule

  • Blue Cross Blue Shield of Michigan

HMOs:

  • Blue Care Network
  • Health Alliance Plan (HAP)
  • Physician's Health Plan (PHP)
  • Priority Health

HMO Medicare Advantage (MA) Coverage Maps

Retirees or dependents enrolled in Medicare who wish to enroll in an HMO Medicare Advantage (MA) plan, please review the maps below to determine if there is coverage available in your area.

Blue Care Network (BCN) Coverage Map (PDF)
Health Alliance Plan (HAP) Coverage Map (PDF)
Priority Health Plan Coverage Map (PDF)

Please note if you or your dependents are not enrolled in Medicare and you wish to enroll in an HMO please use the Zip Code Tool to determine if there is coverage available in your area.

Flu Shots - Participating Locations
(For State Health Plan PPO Enrollees)

Every year, as much as 20% of the U.S. population comes down with the flu. As a result, the Centers for Disease Control (CDC) recommends an annual flu vaccine for everyone over the age of six months. OptumRx provides resources for Medicare and non-Medicare eligible retirees enrolled in the State Health Plan PPO to find locations for an annual flu shot and other routine vaccinations in their Make Your Health a Priority flyer.

Behavioral Health and Substance Abuse Administrator

Effective October 1, 2019, Blue Cross Blue Shield of Michigan, in partnership with New Directions, will be replacing Magellan Health as the State Health Plan (SHP) PPO Behavioral Health/Substance Abuse carrier. Current SHP PPO enrollees will be automatically transitioned with no gap or changes in coverage. New SHP PPO membership ID cards will be mailed in September.

Prescription Drug Plan Information

Formularies:

Active Employees and Non-Medicare Retirees
866-633-6433

Medicare Eligible Retirees
866-635-5941

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Dental, Vision, and Life Benefits

Retiree Benefit Booklets

  • 20-21 Dental Retiree Benefit Booklet
  • ​20-21 Vision Retiree Benefit Booklet
  • 20-21 Vision Retiree Benefit Summary

Retiree Benefit Rates
HMO Retiree Eligibility
Blue Cross Blue Shield of Michigan (BCBSM) Information
BCBSM Preventive Services Booklet
Medical Resources

Life Insurance Beneficiary Designation: Change your life insurance beneficiary by submitting the Life Insurance Beneficiary Designation (R0782GHB) to the Office of Retirement Services

Additional Benefits

Benefits for Life
Long Term Care Insurance

Other Retirement Information

  • Office of Retirement Services (ORS) Information:

INDIVIDUAL & FAMILY PLANS

Emi health advantage copay schedule

Special Open Enrollment Period Happening Now – On January 28, President Biden signed an executive order opening Healthcare.gov for a special enrollment period (SEP) to help uninsured Americans get access to health care coverage. The SEP is from February 15, 2021 to August 15, 2021. Get A Quote >

Emi Health Advantage Copay Schedule

Our plans are designed to cover essential health benefits including inpatient, outpatient, emergent, maternal, mental, behavioral, prescription drugs, lab tests, preventive, pediatric care services and much more.

Take control of your healthcare experience with our member benefits package. We can help you find the right doctor, access mental health services, find your secure medical information online, connect for a virtual visit, talk with a registered nurse or take advantage of your member discounts.

Individual Marketplace 2020 Flu Shot Incentive – A flu shot is an important part of maintaining your health. Receive a $100 Gift Card for each University of Utah Health Plans member who receives their flu shot between August 1 and December 31, 2020. Learn More >

On This Page

Member Benefits

ACCESS ASSISTANCE

Help finding & scheduling providers

TELEHEALTH

Care when and where
you need it most

NURSE LINE

24 Hours a day,
7 Days a Week

Emi Health Advantage Ppo

MEMBER PERKS

Additional benefits
& discounts

Nexen forklift

BEHAVIORAL HEALTH & CRISIS PREVENTION

Emi Dental Plan

You are not alone.

2021 On & Off Marketplace Benefit Highlights

DESCRIPTIONGOLD COPAYSILVER 2300SILVER COPAYSILVER COPAY (OFF)BRONZE 3 COPAYBRONZE HSAEXPANDED BRONZEEXPANDED BRONZE HSA
FEATURES
Annual Deductible (individual/family)$1,500/$3,000$2,300/$4,600$3,500/$7,000$4,500/$9,000$7,800/$15,600$7,000/$14,000$5,650/$11,300$5,750/$11,500
Prescription Drug Deductible (individual/family)$500/$1,000$1,000/$2,000$2,000/$4,000Included with MDIncluded with MDIncluded with MD$1,650/$3,300Included with MD
Annual Out-of-Pocket Maximum (individual/family)$7,000/$14,000$8,300/$16,600$8,000/$16,000$8,150/$16,300$8,550/$17,100$7,000/$14,000$8,550/$17,100$7,000/$14,000
BENEFITS
Emergency and Urgent Care
Emergency Room$200 copay AD$600 copay AD$500 copay AD$500 copay AD40% Co AD0% Co AD50% Co AD35% Co AD
Urgent Care$25 copay DW$35 copay DW$30 copay DW$30 copay DW$45 copay/ first 3 visits then 40% AD0% Co AD$50 copay DW$30 copay AD
Office Visits
Preventive Care/Screening/
Immunizations/Well-Child Visits/ Family Planning 		No Charge
Primary Care$25 copay DW$35 copay DW$30 copay DW$30 copay DW$45 copay/ first 3 visits then 40% AD0% Co AD$50 copay DW$30 copay AD
Mental Health/Substance Abuse Services$25 copay DW$35 copay DW$30 copay DW$30 copay DW$45 copay/ first 3 visits then 40% AD0% Co AD$50 copay DW$30 copay AD
Specialty Care$40 copay DW$60 copay DW$75 copay DW$75 copay DW40% Co AD0% Co AD$80 copay AD$50 copay AD
Other Practitioner Care$40 copay DW$60 copay DW$75 copay DW$75 copay DW40% Co AD0% Co AD50% Co AD35% Co AD
Habilitative Care20% Co AD$60 copay AD40% Co AD40% Co AD40% Co AD0% Co AD50% Co AD35% Co AD
Rehabilitative Care20% Co AD$60 copay AD40% Co AD40% Co AD40% Co AD0% Co AD50% Co AD35% Co AD
Vision Services
Adult Annual Routine Vision ExamNo Charge
Pediatric Vision ExamNo Charge
Corrective LensesNo Charge0% Co ADNo Charge0% Co AD
Prescription Drugs
Formulary Generic Drugs$15 copay DW$15 copay DW$15 copay DW$15 copay DW$30 copay DW0% Co AD$30 copay DW35% Co AD
Formulary Preferred Brand Drugs$30 copay DW$30 copay DW$30 copay DW$30 copay DW$45 copay DW0% Co AD$50 copay DW35% Co AD
Formulary Non Preferred Brand Drugs50% Co AD25% Co AD50% Co AD50% Co AD50% Co AD0% Co AD50% Co AD35% Co AD
Specialty Drugs25% Co AD50% Co AD25% Co AD25% Co AD40% Co AD0% Co AD25% Co AD35% Co AD
Outpatient Hospital/Facility Services
Laboratory Services20% Co AD50% Co AD40% Co AD40% Co AD40% Co AD0% Co AD50% Co AD35% Co AD
Radiology Services20% Co AD50% Co AD40% Co AD40% Co AD40% Co AD0% Co AD50% Co AD35% Co AD
Specialized Scanning Services (CT, MRI, PET Scans)20% Co AD50% Co AD40% Co AD40% Co AD40% Co AD0% Co AD50% Co AD35% Co AD
Medical / Surgical Services20% Co AD50% Co AD40% Co AD40% Co AD40% Co AD0% Co AD50% Co AD35% Co AD
Inpatient Hospital Services
Medical/Surgical, Maternity Care, Mental Health, Substance Abuse, Skilled Nursing Care20% Co AD50% Co AD40% Co AD40% Co AD40% Co AD0% Co AD50% Co AD35% Co AD
Hospice Care20% Co AD50% Co AD40% Co AD40% Co AD40% Co AD0% Co AD50% Co AD35% Co AD
Transportation Assistance
Emergency Transportation - Ambulance$250 copay/ trip AD50% Co AD$250 copay/ trip AD$250 copay/ trip AD40% Co AD0% Co AD50% Co AD35% Co AD
Non-Emergency Medical and Non-Emergency Non-Medical Transportation to & from Medical AppointmentsNot Covered
SUPPLEMENTAL BENEFITS
MD Live 24/7 TelehealthNo Charge0% Co ADNo Charge0% Co AD
Virtual Visits - Instant Online CareNo Charge0% Co ADNo Charge0% Co AD
24-Hour Nurse LineNo Charge
U Baby Care - Prenatal & Postnatal CareNo Charge
Tobacco Counseling, Smoking Cessation ProgramNo Charge

2021 Cost Sharing Reduction (CSR) Plans

CSR Plans available through Marketplace Only.

Emi Health Dental

Plans available through Marketplace OnlySILVER COPAY 73% CSRSILVER COPAY 87% CSRSILVER COPAY 94% CSRSILVER 2300 73% CSRSILVER 2300 87% CSRSILVER 2300 94% CSR
FEATURES
Annual Deductible (individual/family)$3,000/$6,000$400/$800$0/$0$2,300/$4,600$400/$800$0/$0
Prescription Drug Deductible (individual/family)$500/$1,000$150/$300$0/$0$500/$1,000$200/$400$0/$0
Annual Out-of-Pocket Maximum (individual/family)$6,550/$13,100$2,850/$5,700$1,600/$3,200$6,500/$13,000$2,850/$5,700$1,500/$3,000
BENEFITS
Emergency and Urgent Care
Emergency Room$250 copay AD$250 copay AD$100 copay AD$500 copay AD$250 copay AD$100 copay AD
Urgent Care$30 copay DW$10 copay DW$10 copay DW$30 copay DW$20 copay DW$10 copay DW
Office Visits
Preventive Care/Screening/
Immunizations/Well-Child Visits/ Family Planning 		No Charge
Primary Care$30 copay DW$10 copay DW$10 copay DW$30 copay DW$20 copay DW$10 copay DW
Mental Health/Substance Abuse Services$30 copay DW$10 copay DW$10 copay DW$30 copay DW$20 copay DW$10 copay DW
Specialty Care$60 copay DW$30 copay DW$20 copay DW$60 copay DW$35 copay DW$15 copay DW
Other Practitioner Care$60 copay DW$30 copay DW$20 copay DW$60 copay DW$35 copay DW$15 copay DW
Habilitative Care30% Co AD25% Co AD10% Co AD$60 copay AD$35 copay AD$15 copay AD
Rehabilitative Care30% Co AD25% Co AD10% Co AD$60 copay AD$35 copay AD$15 copay AD
Vision Services
Adult Annual Routine Vision ExamNo Charge
Pediatric Vision ExamNo Charge
Corrective LensesNo Charge
Prescription Drugs
Formulary Generic Drugs$15 copay DW$15 copay DW$10 copay DW$15 copay DW$15 copay DW$10 copay DW
Formulary Preferred Brand Drugs$30 copay DW$30 copay DW$25 copay DW$30 copay DW$30 copay DW$25 copay DW
Formulary Non Preferred Brand Drugs50% Co AD50% Co AD50% Co AD25% Co AD15% Co AD5% Co AD
Specialty Drugs25% Co AD20% Co AD20% Co AD50% Co AD25% Co AD15% Co AD
Outpatient Hospital/Facility Services
Laboratory Services30% Co AD25% Co AD10% Co AD50% Co AD20% Co AD10% Co AD
Radiology Services30% Co AD25% Co AD10% Co AD50% Co AD20% Co AD10% Co AD
Specialized Scanning Services (CT, MRI, PET Scans)30% Co AD25% Co AD10% Co AD50% Co AD20% Co AD10% Co AD
Medical / Surgical Services30% Co AD25% Co AD10% Co AD50% Co AD20% Co AD10% Co AD
Inpatient Hospital Services
Medical/Surgical, Maternity Care, Mental Health, Substance Abuse, Skilled Nursing Care30% Co AD25% Co AD10% Co AD50% Co AD20% Co AD10% Co AD
Hospice Care30% Co AD25% Co AD10% Co AD50% Co AD20% Co AD10% Co AD
Transportation Assistance
Emergency Transportation - Ambulance$250 copay/trip AD$250 copay/trip AD$250 copay/trip AD50% Co AD50% Co AD50% Co AD
Non-Emergency Medical and Non-Emergency Non-Medical Transportation to & from Medical AppointmentsNot Covered
SUPPLEMENTAL BENEFITS
MD Live 24/7 TelehealthNo Charge
Virtual Visits - Instant Online CareNo Charge
24-Hour Nurse LineNo Charge
U Baby Care - Prenatal & Postnatal CareNo Charge
Tobacco Counseling, Smoking Cessation ProgramNo Charge