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General Description of Medical Plans

Please click here for 2006-2007 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 Health Maintenance Organization (HMO). 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 MLH Eagle	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 MDIPA Preferred	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 who must pre-authorize specialist care to receive full In-Network benefits.	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.
HMO BCBS Blue Choice HMO Kaiser Optimum Choice	Must choose a Primary Care Physician and receive all services from this physician. Your Primary Care Physician will refer you for Specialist Care if necessary.	Lowest Premium	Primary Care Physician must pre-authorize all care	$15 Primary Care $25 Specialist Care	No coverage for Out-of-Network services, unless services are result of a medical emergency.

Special Information on HMOs:

Some state employees may be interested in knowing an HMO's corporate status before choosing a medical plan. The following is a chart illustrating for-profit and not-for-profit HMOs in the State of Maryland benefits program, along with their payment methods for primary care physicians (PCP) and specialists. This chart is provided for your information only, and is not a recommendation for any specific type of HMO. Please call your plan for more information.

HMO	Corporate Status	Payment Method(s) for Physicians
BlueChoice (BC/BS)	For-Profit	PCPs: Capitation, Discounted Fee-for-Service in rural areas where there are fewer PCPs Specialists: Capitation or Discounted Fee-for-Service, depending on region of state.
Kaiser Permanente	Not-for-Profit	Salaried Employees
Optimum Choice (MAMSI)	For-Profit	PCPs: Capitation based upon age and sex of PCP's patients. Specialists: Negotiated Fee Maximums

HMO Report Cards:

The Maryland Health Access Commission develops an annual "HMO Report Card." This "HMO Report Card" provides results of a survey of Maryland residents evaluating the quality of care received from their HMOs. You may obtain a copy of the "HMO Report Card" by calling the MD Health Access Commission at (410) 764-3460.