Health Plan Information for Faculty and Staff

Health Plans

The State of South Dakota offers Health Plan options that provide comprehensive medical coverage for you and your eligible dependents.

For more information on your health plan options, please visit the SD Bureau of Personnel Website.

To view your current elections, log into SNAP and click on the 'Benefits' link on the right side of the screen.

AFLAC

Board of Regents benefit-eligible employees are allowed to make voluntary deductions for various insurance products offered by AFLAC.

For more information on the AFLAC Insurance options, please visit the AFLAC Website.


Plan Changes for FY15

Health Plan

$750 DEDUCTIBLE PLAN

  • Increase $500 Deductible Plan to $750 Deductible Plan
  • Increase Out-of-Pocket Maximums
  • Add family Out-of-Pocket Maximum
  • Add MRI/CT/PET scans to Tier 1 Services
  • Expand preventive care services including contraceptives
  • Increase pharmacy copayments
  • Remove up to 90 day pharmacy refill copayment but you can still get up to 90 day supply

$1,250 DEDUCTIBLE PLAN

  • Increase $1,000 Deductible Plan to $1,250 Deductible Plan
  • Increase Out-of-Pocket Maximums
  • Add family Out-of-Pocket Maximum
  • Add MRI/CT/PET scans to Tier 1 Services
  • Expand preventive care services including contraceptives
  • Increase pharmacy copayments
  • Remove up to 90 day pharmacy refill copayment but you can still get up to 90 day supply

$1,800 DEDUCTIBLE PLAN COMPATIBLE WITH HEALTH SAVINGS ACCOUNT (HSA)

  • Increase Out-of-Pocket Maximums
  • Add MRI/CT/PET scans to Tier 1 Services
  • Expand preventive care services including contraceptives

 

Flexible Benefits

  • Expand coverage for Hospital Indemnity Protection
  • Increase Dental premiums
  • Changes to Dental benefits
  • Changes to Vision premiums
  • Changes to Vision benefits


What you need to know about the Health Plans

  • You must visit a DAKOTACARE network provider to receive the highest level of benefits.
  • If you are having a Tier 1 service, you must visit a Tier 1 provider and facility to receive the highest level of benefits.
  • In some cases, Health Management Partners must pre-authorize services or referrals. To view the Pre-authorization Listing visit http://benefits.sd.gov, scroll over Forms/Documents and choose Forms/ Documents. The Pre-authorization Listing is in the Other section.
  • Eligible preventive services are covered prior to satisfying your deductible. To view eligible preventive care services, visit http://benefits.sd.gov/preventivecare.aspx.
  • Out-of-Network provider means:
  • A DAKOTACARE network provider did not provide care;
  • You did not receive approval from Health Management Partners for a referral to an out-of-network provider; or
  • You failed to obtain pre-authorization when necessary.             
  • The following charges do NOT apply to the out-of-pocket maximum:
  • Expenses not covered by the Plan.         
  • When insured under the $1,800 Deductible Plan, all costs of prescription drugs apply to the deductible and then coinsurance. There are no prescription copayments.

Opt-Outs

  • You must provide proof of creditable coverage by June 11, 2014 to Opt-Out of coverage under the employee health plan.
  • Proof of other coverage is required for each fiscal year.
  • Acceptable proof of coverage includes a certificate of coverage that indicates coverage is continuing.
  • If you are Opting-Out in FY15 and are enrolled in TRICARE, you are required to provide proof of coverage. If you are enrolled in TRICARE and are currently an Opt-Out in FY14, proof is not required. However, documentation may be required at any time upon request.
  • Acceptable proof of coverage includes a certificate of coverage or a TRICARE identification card that indicates coverage is continuing.
  • Submit Opt-Out documentation to benefitswebsite@state.sd.us. Please include your name and current employer on the documentation.

Family Status Changes

  • Reduced time period for reporting Family Status Changes/Qualifying Events from 90 days to 60 days  


Incentive Programs

Our Healthy Baby Program – If you or your covered spouse is expecting, we encourage you to enroll in the Our Healthy Baby Program during the first three months of the pregnancy. To enroll, call 1.866.330.9886 or go online at Our Healthy Baby. The purpose of this voluntary program is to provide support to expectant parents through individual case management, educational materials, and supportive contact throughout the pregnancy. When the newborn child is added to the Health Plan, you may receive a non-tax incentive into their Health Reward and Wellness Account -- if enrolled within the first three months of the pregnancy. 

Important Note: Enrollment in the Our Healthy Baby Program does not automatically add your baby to the Health Plan. To do this, you must notify Human Resources and complete a Family Status Change form before the birth or within 60 days of the birth.