Edited by BC 2/7/24


Employee Health Plans


Learn more about the AlaskaCare employee health plan benefits, coverages and monthly premiums.
Effective as of January 1,

The health benefits that the State of Alaska provides to its eligible employees is commonly referred to as AlaskaCare. AlaskaCare Health Plans can help you and your eligible dependents pay for medical, dental, pharmacy, and vision expenses.

Introduction

Aetna is the AlaskaCare Third-Party Administrator for the employee medical plan. A Third-Party Administrator (TPA) is a company the Division hires to process AlaskaCare medical claims. Aetna is one of America’s largest and most experienced providers of health care benefits and services. Their network includes over 690,000 primary care doctors and specialists and more than 5,700 hospitals.

Get the right care for your needs

Health care can be complicated. There’s a lot to know about doctors, hospitals, treatments and services. The resources below provide reliable information to help you make better decisions and choices when you need care.

Call your Health Concierge

The Health Concierge is your single point of contact for all claim, benefit and provider information related to AlaskaCare medical. Call or chat online when you have a problem or question. Find the right specialist. Understand how a claim was paid. Know about programs for specific health conditions and needs. Whether you need a quick answer, help with a difficult issue or someone to explain your benefits, you have an advocate dedicated to your needs.

Medical Plans at a Glance

AlaskaCare offers three medical plans to choose from: Standard, Economy, and Consumer Choice. The three options all cover the same services, including pharmacy benefits, but each option has different deductibles, coinsurance levels, copayments (if applicable) and out of-of-pocket maximums. You can choose the plan that is best for you based what will work best for your family’s needs.

You consider the monthly cost of each option and decide which benefits to purchase. Use the Health Plan Cost Comparison Tool to help you make an informed decision.

  1. Standard Plan

    The Standard Plan offers the lowest deductibles, lowest Out-of-Pocket Maximums, and highest coverage amounts (coinsurance). This option also has higher premiums than the other plans.

  2. Economy Plan

    The Economy Plan offers lower premiums than the Standard Plan, but also has slightly higher deductibles, lower coverage amounts (coinsurance) and higher Out-of-Pocket Maximums.

  3. Consumer Choice Plan

    The Consumer Choice Plan offers a lower-premium medical plan option with a higher deductible than medical plans traditionally offered by AlaskaCare. The Consumer Choice plan is a consumer driven health plan with an employer sponsored Health Reimbursement Arrangement (HRA).

Glossary of Important Terms

Preventive Care—At No Cost

All AlaskaCare employee medical plan options will pay covered preventive services in full when received from an network provider. In-network preventive care services are not subject to deductibles or coinsurance.

See the Preventive Care Coverage Information Flyer and the Women’s Preventive Care Coverage Information Flyer for additional information on covered preventive services.

All other covered medical benefits are subject to the deductible and coinsurance.

Premiums

AlaskaCare offers a menu of medical plan options so you can find the best fit for you and your family.

2024 ACTIVE EMPLOYEE MONTHLY PREMIUMS
For AVTECTA - AK Vocational Teachers (TA), APEA - Confidential (KK), APEA - Supervisory (SS),
ACOA - Correctional Officers (GC), TEAME - Mt. Edgecumbe Teachers (TM), MEBA - Marine Engineers (BB),
IBU - Inlandboatman's (MM). Employees not covered by collective bargaining (Exempt)
Plan Employee Only Employee & Family
Standard Medical Plan $125 $303
Economy Medical Plan $63 $167
Consumer Choice Medical Plan $25 $71
Standard Dental Plan $37 $102
Economy Dental Plan $0 $0
Managed Vision $15 $40
Effective: Jan. 1 - Dec. 31, 2024

Introduction

When you enroll in the AlaskaCare medical plan, you are automatically enrolled in pharmacy benefits. You will receive your pharmacy ID cards from Optum Rx in the mail separately from your medical card.

Optum Rx is the AlaskaCare pharmacy benefit manager. A pharmacy benefit manager (PBM) is a company the Division hires to process AlaskaCare pharmacy claims. Medical, vision and dental claims are processed by Aetna and Delta Dental, respectively.

You can call Optum Rx at (855) 409-6999, TTY 711, for help with:

  • finding a network pharmacy near you,
  • reviewing the drug formulary,
  • enrolling in medication home delivery,
  • setting refill reminders, and more.

Retail Pharmacies

Optum Rx’s retail pharmacy network includes most pharmacies in Alaska. For a list of participating pharmacies near you, use the Pharmacy Locator Tool on the Optum Rx app, at Optum Rx.com , or call a Optum Rx representative at (855) 409-6999, TTY 711.

Medication Home Delivery

You can receive maintenance medication through the mail through Optum Rx® home delivery. Enroll in Optum Rx® home delivery to get up to a 90-day supply of the medications you take regularly. Your medication will come right to your mailbox. To start home delivery, log in to Optum Rx.com , use the Optum Rx® App or call (855) 409-6999, TTY 711.

Optum Rx Specialty Pharmacy

Specialty medications can be important to maintaining or improving your health—and your quality of life. The Optum Rx® specialty pharmacy, provides resources and personalized, condition specific support to help you manage your condition. Using Optum Rx for your specialty needs saves you money and means the plan pays less.

Call Optum Rx at (855) 427-4682 to enroll in this specialty pharmacy program.

Variable Copay Solution Program

If you use a specialty medication you may be able to reduce your drug copayments to $0! AlaskaCare can help you eliminate your out-of-pocket costs for certain specialty medications through the Variable Copay Solution program by applying rebates that are available from drug manufacturers. If you or someone in your household has one or more specialty prescriptions, contact Optum Specialty pharmacy at (855) 427-4682 to find out if your medication is eligible for a $0 copay and to learn more about how to enroll in this program.

Maximize your AlaskaCare Pharmacy Benefits

The AlaskaCare Employee Health Plan includes a four-tier pharmacy structure featuring different coinsurance and copayments for medications based on drug type. How much you pay for a prescription is based on the tier under which your prescription drug is categorized and if you use a network pharmacy.

  • First Tier: Maintenance Generic Drugs—lowest cost tier
    You pay the lowest cost for prescription drugs in this level. $5 copay per prescription.
  • Second Tier: Generic Drugs—lower cost tier
    Generic medications are therapeutically, and often chemically, identical to brand medications and are widely available at competitive prices. You pay a slightly higher cost for prescription drugs in this level. $10 copay per prescription.
  • Third Tier: Preferred Brand-Name Drugs—slightly higher cost tier
    Preferred brand drugs are medications for which a generic is either unavailable or offered at discounted prices. You pay a slightly higher cost for prescription drugs in this level. $35 copay per prescription.
  • Fourth Tier: Non-preferred Brand-Name Drugs—highest cost tier
    Non-preferred brand drugs are medications available in an equivalent generic form, or as a preferred brand drug. These drugs cost more to both the plan and the member. You pay the highest cost for prescription drugs in this level. 65% coinsurance with $80 minimum / $150 maximum per prescription.

How are drugs assigned to a tier? A tool called a formulary is used to assign medications to different tiers. The AlaskaCare Employee Plan Formulary is updated annually and available for you or your provider to view. The formulary guide is developed not only with overall value of the medication in mind, but based on drug safety, effectiveness and current use in therapy. You are free to choose a maintenance generic, generic, preferred brand name or non-preferred brand name medication. Choosing a lower tiered drug when it is appropriate can provide access to the necessary medications to stay healthy, at a cost that is more affordable. Remember the lower the tier, the lower the out-of-pocket costs!

Compound Prescription Limitation

The AlaskaCare Employee Health Plan pharmacy benefits does not cover bulk powders/chemicals/products or other non-FDA approved drugs used in prescription compounding. Compound medications formulated from bulk powder compounds and bioidentical hormones will not be covered prescription drugs because they are not drug products approved by the FDA. Compounds that utilize at least one non-bulk, FDA-approved legend drug may be considered for coverage. If this impacts you, talk with your doctor or pharmacist about alternative options.

Prescriptions with an Over-the-Counter Equivalent

The AlaskaCare Employee Health Plan will not pay for prescription drugs when an over-the-counter equivalent is available. This applies even if prescribed or recommended by your health care provider. Talk to your doctor or pharmacist about over-the-counter alternatives that may be less expensive. Please note this does not affect over-the-counter medications required to be covered under the Affordable Care Act, such as aspirin.

Manage Your Prescriptions from your Mobile Device!

Access your pharmacy benefits and manage your prescriptions from your smartphone or tablet with the Optum Rx App. Take care of your home delivery prescriptions at any hour, from anywhere, using the Optum Rx App. The Optum Rx application makes it easier than ever to refill and renew existing home delivery pharmacy prescriptions, sign up new prescriptions for home delivery, compare medication prices and more.

Download the Optum Rx App from the Apple® App Store or Google Play™ .

Optum Rx Access:

Website/App Tools:

  • Compare medication prices at different pharmacies.
  • Find lower-cost alternatives.
  • Locate network pharmacies.
  • Manage medication for covered dependents and spouses.
  • View real time benefits and claims history.
  • Transfer retail prescriptions to home delivery.
  • Track orders.
  • Refill home delivery prescriptions.
  • Access your ID card, if your plan allows.
  • View your claims history.
  • Manage medication reminders.

Introduction

Delta Dental of Alaska is the AlaskaCare third-party dental claim administrator.

When you enroll in dental benefits you’re part of the Delta Dental of Alaska family and have access to great dental care, close to home and when you’re traveling. Delta Dental of Alaska is part of the Delta Dental Association — the nation’s largest and most trusted dental benefits carrier.

Instructions for Submitting International Claims

  1. Members can send a completed Dental Claim Form to Delta Dental for processing:
    • Via email:
    • Physically mail the claim form and necessary paperwork to the below address:
      Moda Health
      P.O. Box 40384
      Portland, OR 97240-0384
  2. In addition to the claim form, please include the following information:
    • Receipts showing payments of services.
      • The cost of all services is required (foreign currency will be converted into USD and reimbursement to the member will be in USD).
    • A written summary of services received
      • If tooth specific services were rendered include the tooth number on which services were completed.
      • ADA Dental codes may not be used by international providers, so a detailed narrative of treatment provided will be very helpful.
      • If the narrative/treatment plan is not in English, Delta Dental may have translators who can translate the information received.
  3. If you are interested in receiving reimbursement via Direct Deposit, please complete and include the Direct Deposit Authorization Form .

Dental Plans at a Glance

AlaskaCare offers two dental plan options: the standard plan and the economy plan.

  1. Standard Plan
    The Standard Plan has greater coverage for more than just preventive dental visits, higher maximum annual benefits, includes limited orthodontic coverage, and includes Preventive services covered at 100% with no deductible for In-Network Dentists.


  2. Economy Plan
    The Economy Plan has no monthly premium, has a lower maximum annual benefit and covers Preventive services covered at 100% with no deductible for In-Network Dentists and a lower.

Premiums

AlaskaCare 2024 Dental Plan Summaries
Group Standard Economy
Monthly Plan Premiums
Employee Only $37.00 $0.00
Employee and Family $102.00 $0.00
Calendar Year Costs
Annual Maximum Benefit Per Person $1,500 $500
Deductible Per Person $25 $25
Deductible Per Family $75 $75
Service Benefit Amount Benefit Amount
Preventive 100%1 100%1
Basic 80% 10%
Major 50% 10%
Orthodontics
Eligible employees and their covered dependents 50% coinsurance up to a $1,000 lifetime maximum N/A
1 Deductible waived, does not apply to annual maximum benefit.
Premiums are subject to change.
Note that although the Preventive plan offers limited coverage for non-preventive procedures, it will still save you money by restricting the cost for those services to Delta Dental's negotiated rates. This only applies when you see a provider in the Delta Dental Premier or PPO networks.
AlaskaCare has provided the above benefit summaries. Moda Health/Delta Dental of Alaska are not responsible, in any way, for the accuracy of such information. For a more detailed description refer to your Member Handbook. If you have any questions about this information, please contact your AlaskaCare plan administrator at (800) 821-2251.
Effective: Jan. 1 - Dec. 31, 2024

Additional Programs

Oral health is an essential part of staying healthy. Studies have linked oral health to several chronic diseases, including diabetes, heart disease and stroke. Pregnant women who have periodontal disease are more likely to have a premature and underweight baby. Lower your risks by keeping up with your preventive dental services.

No cost for preventive care from network dentists!

Seeing your dentist regularly can help you avoid serious and expensive services down the road. To help you avoid costly dental care in the future, both dental plan options cover preventive care at no cost to you if you use a network provider:

  • Preventive (Class I) services, such as cleanings, periodontal maintenance, and routine oral exams, are covered at 100% when using a network provider.
  • Preventive services do not count towards your maximum annual dental benefit, giving you more to spend each year on other services that you may need.

Reduce your costs by using a network dentist!

Your dental plan lets you see any licensed dentist you want. But when you see a network provider, you’ll save money. AlaskaCare members have access Delta Dental’s broad Premier network of providers, AND to an additional, narrower network of dental providers: Delta Dental’s PPO network.

When you visit a PPO dentist, you’ll pay less out-of-pocket. You do not need to do anything to enroll in this benefit, but if you want to take advantage of the discounted services, use the dentist locator tool to search for providers who participate in the PPO network, or call Delta Dental of Alaska toll-free at (855) 718-1768.

Oral Health, Total Health Program and Benefits

If you are diabetic or pregnant in your third trimester, the Oral Health, Total Health program offers more ways to care for your teeth and mouth—and keep the rest of your body healthy, too.

If you have diabetes

Diabetes increases the risk of cavities, periodontal (gum) disease, tooth loss, dry mouth and infection. If you have been diagnosed with this disease you may be eligible for four prophylactic (preventive) cleanings or periodontal maintenance visits per year through the Oral Health, Total Health program. Protect your teeth and gums by enrolling today.

If you’re pregnant

Pregnant women who have periodontal (gum) disease are more likely to have a premature and underweight baby. Bacteria can enter the bloodstream through the mouth, and the body’s response to the infection can trigger early labor. If you are expecting, you can enroll in the Oral Health, Total Health program to help prevent gum disease. If you’ve already had two cleanings for the year, you may be eligible for another cleaning or checkup during your third trimester. This added preventive (prophylactic) visit is covered regardless of normal plan frequency limits. That way, you can receive a dental cleaning during the third trimester, no matter what.

To learn more or to enroll, call Delta Dental of Alaska (MODA) toll-free at (855) 718-1768.

Vision is an optional plan offered to AlaskaCare members and their families. Vision Service Plan (VSP) is the administrator for the employee vision plan. If you enroll in the vision plan, the VSP information is located on the back of your Aetna ID card.

VSP

Most experts estimate that over 64% of adults need some sort of vision correction. Depending on how often you need new lenses, getting vision insurance may be a good financial fit.

Many hidden medical problems can be detected through an eye exam, so even those with perfect vision should have regular eye exams. If this routine exam is all you need, the vision plan may not be the right financial fit for you.

Review the premiums and the coverage offered under the vision plan before making a decision if this vision coverage is the right fit for you.

AlaskaCare 2024 Vision Plan Summary
-- Description Copay Frequency
Monthly Employee Contribution
Employee Only $15.00 --
Employee and Family $40.00 --
Well Vision Exam
WellVision Exam Focuses on your eyes and overall wellness. $10 Every calendar year
Prescription Glasses
Frame
  • $130 allowance for frames
  • 20% off amount over your allowance
  • $70 allowance at Costco
$25 (Prescription Glasses Benefit) Every other calendar year
Lenses
  • Single vision, lined bifocal, and lined trifocal
  • Polycarbonate lenses for dependent children
Included in prescription glasses Every calendar year
Lens Options
  • Anti-reflective coating – covered in full
  • Polycarbonate lenses – covered in full
  • Progressive lenses – covered in full
  • Scratch-resistant coating – covered in full
  • Average 35-40% off other lens options
Included in prescription glasses Every calendar year
Contacts
Contacts
(instead of glasses)
  • $130 allowance for contacts; copay does not apply
  • Contact lens exam (fitting and evaluation)
Up to $60 Every calendar year
Diabetic Care
Diabetic Eyecare Plus Program Services related to diabetic eye disease, glaucoma and age-related macular degeneration (AMD). Retinal Screening for eligible members with diabetes. Limitations and coordination with medical coverage may apply. Ask you VSP doctor for details. $20 As Needed
Extra Savings and Discount
Glasses & Sunglasses 30% off additional glasses and sunglasses, including lens options, from the same VSP doctor on the same day as your WellVision exam. Or, get 20% off from any VSP doctor within 12 months of your last WellVision exam.
Effective: Jan. 1 - Dec. 31, 2024

Your Coverage with Out-Of-Network Providers

Get the most out of your benefits and greater savings with a VSP network doctor. Call VSP Member Services for out-of-network plan details.

  • Exam - up to $100
  • Frame - up to $70
  • Single Vision Lenses - up to $75
  • Lined Bifocal Lenses - up to $115

  • Lined Trifocal Lenses - up to $130
  • Progressive Lenses - up to $115
  • Contacts - up to $105
  • Tints - up to $5

Coverage with a retail chain may be different or not apply. Log in to VSP.com to check your benefits for eligibility and to confirm in-network locations based on your plan type. VSP guarantees coverage from VSP network providers only. Coverage information is subject to change. In the event of a conflict between this information and your organization’s contract with VSP, the terms of the contract will prevail. Based on applicable laws, benefits may vary by location. In the state of Washington, VSP Vision Care, Inc., is the legal name of the corporation through which VSP does business.

What Plan Am I In?

AlaskaCare

The following employee groups are entitled to the AlaskaCare Health Benefits provided by the State:

  • AVTECTA – AK Vocational Teachers Union (TA)
  • CEA – Confidential Union (KK)
  • APEA – Supervisory Union (SS)
  • ACOA – Correctional Officers Union (GC)
  • MEBA – Marine Engineers Union (BB)
  • TEAME – Mt. Edgecumbe Teachers Union (TM)
  • IBU – Inlandboatman’s Union (MM)
  • Employees not covered by collective bargaining (Exempt)

Union Health Trusts

The following employee groups are covered by Union health trusts and should contact the trust for details and enrollment in health benefits. Please note all trusts, except Labor Trades and Crafts, are eligible to enroll in Voluntary Supplemental Benefits provided by the state.
  • General Government (GGU)
  • Labor, Trades and Crafts (LTC)
  • Public Safety Employees Association (PSEA)
  • Masters, Mates & Pilots

New To Plan

As an active employee your State of Alaska employee benefits include health insurance and life insurance, as well supplemental insurance options that you can decide if you want to take advantage of.

Your plan is determined by what bargaining unit you are in and you are responsible to know and manage your benefits.

Getting Started

You must elect benefits within 30 days of your hire date or after a Qualified Status Change. You may also enroll or change your benefits during the annual Open Enrollment period.

Before enrolling in your new Employee Benefits or changing your current benefits, please review the different options and latest changes to the benefits and plan premiums. Then decide which benefits will be most appropriate for you and your family.

You may add, change or delete dependents covered under your health plan at any time by logging into your myAlaska account. Be sure to add eligible dependents when you are first hired and then review the dependents anytime you make future changes to your benefits; adding any necessary updates as your dependents change.

If you experience technical difficulties while trying to enroll, contact the Member Education Center at:

Juneau: (907) 465-4460
Outside Juneau: (800) 821-2251
Monday - Thursday: 8:30 a.m. to 4 p.m.
Friday: 8:30 a.m. to 3 p.m. (Alaska Time)

Qualified Status Change

A Qualified Status Change is a change in your family or employment status which allows you to make changes to your coverages.

If you have a "qualified status change" during the year, you can make changes to your coverages (subject to limitations). Changes must be made within 30 days of the event. Examples of qualified status changes include the following:

  • You gain or lose a dependent, through birth or adoption, marriage, divorce, or death.
  • Your dependent is no longer eligible.
  • Your spouse terminates employment, begins an extended period of leave or layoff without pay, or begins new employment.
  • Your spouse or you change employment status from full-time to part-time or from part-time to full-time.
  • Your spouse has a significant change in his or her health coverage caused by their employment.

You may also change benefits if you move from an AlaskaCare participating group to a non-participating group.

Getting Prepared Before You Enroll

  • Review your options, including any changes in premiums or benefits. Think about what options will work best for you and your family in the upcoming year.
  • Review your dependents to ensure your dependent information is accurate. Use the AlaskaCare online enrollment system to make any necessary changes to your Health benefits.
  • Use the Benefitfocus online enrollment system to make any necessary changes to your Voluntary Supplemental Benefits.
  • You must annually elect to opt-out of medical coverage, or you will be defaulted into the Economy medical plan. You must annually elect to enroll in a HFSA.

Enrollment Instructions

  1. Log in to your myAlaska account:
    • Go to myRnB.alaska.gov . This is the myRnB portal.
    • On the right side of the page, choose Login using myAlaska. You will be directed to the myAlaska login page, where you will login using your myAlaska ID and password. This is the same ID and password you use to register for your PFD. After you login to myAlaska, you will be redirected back to myRnB.
    • On the myRnB page, under Self-Service Tools, choose Online Benefits Enrollment, or if during an Open Enrollment period click on Open Enrollment.
  2. Review your dependents enrolled under the health plan. Click “Health Dependent Enrollment”.
    • Make sure all your eligible dependents are listed. If not, click Add Dependent, fill in the blanks, and click Save Changes.
    • If there are ineligible dependents listed, select the dependent from the list on the left side of the page. Click Edit, then Terminate Dependent.
    • If you have not yet provided the Social Security number (or other tax identification number) for each of your dependents that you have enrolled, please do so now. Select the dependent from the list on the left, then choose Addition of Missing SSN from the drop-down menu. Be sure to click Save Changes once you have added the information.
    • Once your review is complete, click Back to Benefits Enrollment at the top of the page.
  3. Check your elections and make new elections as needed.
    • Under Change Reason, select Open Enrollment from the drop-down menu, then click Change Elections.
    • Use the drop-down menus to make new elections. Certify your eligibility, then press Continue.
    • Review these elections and the updated premiums, then either click Back to edit your elections, or Submit Elections to enroll.

Opting Out of Coverage

If you are an AlaskaCare Employee Health Plan covered employee with other medical coverage, you may elect to opt-out, or waive, coverage for yourself and your family for one or more of the medical, dental, and vision plans offered through AlaskaCare. You may also elect employee-only coverage while opting-out of coverage for your family from one or more of the AlaskaCare benefits. Example: You can choose Employee Only economy medical, and Employee and Family Standard Dental.

Coverage That Matches What You Need

This change gives you the broadest choice of options to best suit your family’s needs. But take caution when considering your elections. The option to opt-out of AlaskaCare medical coverage is only available if you or your family maintains coverage under another medical plan. There are financial and tax consequences if you opt-out and do not have other medical coverage. These restrictions do not apply to the dental or vision plans.

The decision to opt-out is irrevocable for the benefit year (January 1 through December 31)!

Think Twice! An opt-out election cannot be changed mid benefit year unless you have a qualified status change (such as your spouse has an employment change and is no longer eligible for medical coverage). Before opting out, make sure you understand your other health coverage benefits to ensure you are not surprised by unanticipated costs. Will you be adequately covered under your other health insurance in the event of an unforeseen event? Make sure you can answer yes, before making a decision to opt-out of AlaskaCare.

You are required to have health insurance. The Patient Protection and Affordable Care Act (PPACA) require most individuals to obtain and maintain medical plan coverage that meets the minimum essential coverage requirements. (The AlaskaCare Employee Health Plan meets the minimum essential coverage requirements.) Failure to maintain minimum essential coverage for yourself and your family may result in you or your dependents being subject to penalties on your federal income taxes.

Additional information on qualified status change events that would allow you to opt-out or rescind an opt-out election during the benefit year can be found in the AlaskaCare Employee Insurance Information booklet .

Opting Out Process

  1. Log in to your myAlaska account:

    • Go to myRnB.alaska.gov . This is the myRnB portal.
    • On the right side of the page, choose Login using myAlaska. You will be directed to the myAlaska login page, where you will login using your myAlaska ID and password. This is the same ID and password you use to register for your PFD. After you login to myAlaska, you will be redirected back to myRnB.
    • On the myRnB page, under Self-Service Tools, select Opt-Out.
    • Complete and sign this Opt-Out form , then scan and email it to or fax it to (907) 465-3086.
      • If you chose to opt-out of the Medical plan in , and do not complete the opt-out process (re-enroll) for , you will be defaulted to the Medical Economy Employee Only plan or the Medical Economy Employee and Family Plan (if you have active dependents listed).
      • If you fail to re-enroll in the opt-out Dental plan or make elections during open enrollment, you will be defaulted in the Dental Economy Employee Plan or Dental Economy Employee and Family Plan (if you have active dependents listed).
      • If you have dependents listed and chose the Managed Care Employee Only Vision plan in and you would like to keep the same election for , you must make a new election to opt your family out of the Vision plan for . If you fail to make a new election (opt-out again) during open enrollment, you will be defaulted into the Managed Care Employee and Family plan for .
      • If you elected not to have a Vision plan in , you will be defaulted to no vision plan again for .

Open Enrollment

Open Enrollment is the annual time of year when you can make changes to your current benefits. Typically, Open Enrollment occurs during the first three weeks of November. Unless you are a new hire or have had a Qualified Status Change, then this is the only time during the year where you may make changes to your current benefit. Open Enrollment for employees includes the following:

  • AlaskaCare Benefits: For eligible State of Alaska employees who participate in the AlaskaCare health plan to choose medical, dental, and vision benefits as well as to choose to participate in a Health Flexible Spending Account (HFSA).
  • Voluntary Supplemental Benefits (VSB): For any eligible employee of the State of Alaska or participating Political sub-divisions to choose VSB, including Life insurance, Critical Illness, and Disability insurances.

If you are unsure what plan you participate in, click here.

For more information, please refer to the AlaskaCare Employee Open Enrollment Guide .

Introduction

The Health Flexible Spending Account (HFSA) provides an opportunity for you to save by setting aside money for health care on a pre-tax basis. You can then use these funds to pay for qualified health care expenses not covered by the plan.

Each benefit year, you decide if you would like to enroll in a HFSA and determine the amount you want to contribute, within the limit, on a pretax basis. During the benefit year, you file claims for eligible medical expenses, and are reimbursed with tax-free dollars from the account. You benefit from reduced taxes because you don’t pay taxes on the dollars you contribute to your account. The federal government imposes certain restrictions on HFSA plans to give you these pre-tax advantages, such as you cannot enroll in, cancel, or change your HFSA amount at any time during the year except during Open Enrollment.

You may carry forward up to $610 from year to year (amount subject to change). Otherwise, you must spend down the account for qualified expenses in each benefit year. You have until March 31 of the following year to file claims for the current benefit year.

Premiums

2024 Health Flexible Spending Account Rates
Minimum Monthly Amount $25.00
Maximum Monthly Amount $250.00
Effective: Jan. 1 - Dec. 31, 2024

Streamlining

If you do not have any other health coverage, you can elect to have your HFSA set up to “streamline”. This means that any unpaid portion of a claim you incur during the plan year (deductible, your portion of the coinsurance, etc.) is directed to your HFSA account for reimbursement.

You may not elect streamlining if you have other coverage that will coordinate with AlaskaCare.

Your Choice: Once a Year, Every Year!

A HFSA might be a great choice for you – but here are some things to keep in mind:

  • You cannot enroll in, cancel, or change your HFSA amount at any time during the year except during Open Enrollment or a qualifying status change.
  • You must elect these benefits each open enrollment period. Your HFSA does not automatically continue from one benefit year to the next.
  • The benefit year runs from January 1 to December 31. You must budget contributions carefully.
  • You may carry over up to $610 of unused funds in your HFSA to the next benefit year, but unused amounts over $610 are forfeit. Please note that the carry over amount is subject to change.
  • Any amount you carry over to the next year will be added to any HFSA contributions you choose to make in the new benefit year.
  • Services for eligible expenses must be received while you are covered by the plan—coverage stops during most periods of leave without pay (LWOP) (your coverage will not stop if you are on FMLA and are in LWOP status) and at termination. Under HFSA, coverage also stops when you move to a bargaining unit which does not participate in the Select Benefits/AlaskaCare health plan.
  • Claims for the benefit year must be filed within 90 days of the end of the benefit year.

Did you know you can use your HFSA for the following common items?

  • Allergy Medicine
  • Analgesics
  • Antibiotics
  • At-home COVID-19 tests
  • Birth control
  • Cold medicine
  • Feminine hygiene products- include, but are not limited to: sanitary napkins, pads, liners, tampons, cups, sponges.
  • Fever reducing medicine
  • Hand sanitizer
  • Masks
  • Pain relievers
  • Sanitizing wipes
  • Sleep deprivation treatment

Visit inspirafinancial.com and find the entire list of eligible expenses categorized by eligible, eligible with a letter of medical necessity, and not eligible.

Submitting a Claim

You can submit HFSA claim multiple ways:

You can submit claims for any approved expenses by filling out the claim information and providing the Explanation of Benefits (EOB) or receipts. Eligible reimbursements will be paid directly to you, not your provider. You have until March 31 after the benefit year ends in which you incurred the claims to request reimbursement.

Find a Provider

Facilities

Coalition Health Centers

The Coalition Health Centers welcome AlaskaCare Employee Health Plan eligible members and dependents in Anchorage and Fairbanks. The Centers offer wellness and preventive care, as well as walk-ins for acute care (unexpected illness or injury.) Appointments are required for wellness and preventive care.

Services received at Coalition Health Centers are not subject to your plan’s annual deductible; you will only be charged a $25 co-pay for the office visit. Do not submit claims for these services. Coordination of benefits does not apply. See the AlaskaCare Employee Health Plan amendment effective March 1, 2018 for additional information.

Payment for services at the Centers is as follows:

  • Acute/Unexpected Illness/Injury: Co-Pay $25/Office Visit
  • Wellness & Preventive Care: Preventive $0/Office Visit

Coalition Health Center schedule

  • Monday through Friday
    7:30 a.m. – 6:30 p.m. (By appointment)
    8:30 a.m. – 4:30 p.m. (Walk-ins welcome for acute care)

Coalition Health Center locations

  • Anchorage Coalition Health Center
    Ages 5 and up
    701 East Tudor Road
    Anchorage, AK 99503
    (907) 264-1370
  • Fairbanks Coalition Health Center
    Ages 2 and up
    Ridgeview Business Park
    575 Riverstone Way, Unit #1
    Fairbanks, AK 99709
    (907) 450-3300
  • Wasilla Coalition Health Center
    North Fork Professional Building
    1700 East Bogard Road, Building A, Suite 103
    Wasilla, Alaska 99654
    (907) 206-4601
  • Online: coalitionhealthcenter.com

Anchorage Network Hospitals

Providence Alaska Medical Center and Alaska Regional Hospital are part of the AlaskaCare network beginning January 1, 2021!

AlaskaCare is committed to providing benefits to help you affordably access the care you need and stay healthy, when and where you need it. Your health care keeps getting better and better! AlaskaCare expanded the Anchorage-area network to include Providence Alaska Medical Center, Alaska Regional Hospital—offering you more convenience and choices in your area! By having both hospitals in-network, you will save no matter where you go. Preferred hospitals and facilities have partnered with the State to control health care costs by setting a fair rate for medical services. By visiting in-network facilities, you keep your out-of-pocket maximum low, and the plan will pay for more on your behalf.

It doesn’t stop there—this network expansion also adds a host of ambulatory surgical and imaging centers, helping you find the right fit for the services you require.

Providence Alaska Medical Center

Providence Alaska Medical Center, a nationally recognized trauma center and Magnet hospital, is part of Providence St. Joseph Health, a not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health services, affiliated services, and educational facilities.

Visit Providence.org for more information.

Alaska Regional Hospital

Alaska Regional Hospital is proud of the partnership with the State of Alaska and its AlaskaCare health plan members. From providing preventive healthcare and treatment to hosting free health fairs, seminars, and screenings, we are committed to providing plan members and all Alaskans with high quality, cost effective healthcare.

Visit AlaskaRegional.com for more information.

You will also have network access to many more Anchorage-area ambulatory surgical centers. To find an in-network provider, or to see if your provider is in-network, call the Aetna Concierge at (855) 784-8646, or use the online DocFind tool .

Out-of-Network Information

When you use an out-of-network facility, the plan benefit percentage for most facility fees at the out-of-network facility will be reduced by 20%, and in most cases, your annual out-of-pocket limit will double. The plan benefit percentage (coinsurance) is the allowed amount that the plan will pay after you meet your deductible.

The allowed amount for out-of-network facilities services will be 185% of Medicare rates. Remember, out-of-network facilities can charge any amount they choose. So, if the facility does not accept the 185% of Medicare rate, they can balance bill you for the rest.

Below is an example of the difference in out-of-pocket costs between using an in-network, preferred provider facility, and an out-of-network (OON) facility in Anchorage for someone who has elected the AlaskaCare economy medical plan:

2024 OUT-OF-NETWORK COSTS EXAMPLES
-- In Network Facility OON Facility
Billed Charges $27,000 $27,000
Network Facility Rate in-network or Plan Allowed $22,950 $22,950
185% of Medicare for OON
Deductible $600 $600
Coinsurance 70% 50%
Plan Coinsurance Total $15,645 $11,175
Member’s coinsurance 30% 50%
Member Coinsurance Total $6,705 $11,175
Out of Pocket Maximum (includes deductible) $2,850 $5,700
Potential Balance Bill (Billed charges – Plan Allowed) $0 $4,050 *
Member Pays $2,850 $9,750
Plan Pays $20,100 $17,250
Effective: Jan. 1 - Dec. 31, 2024

* In addition to your cost share portion of the plan allowed amount, OON facilities may balance bill you the difference between their billed charges and the plan’s Medicare-based rate for the services.

If you need emergency treatment, please go to the nearest emergency room without regard to the network. Penalties are not applied in the case of emergency treatment or for services not offered at Alaska Regional. Before receiving services in Anchorage that you believe are not offered at Alaska Regional, or if an out-of-network facility sends you a balance bill for the emergency services, contact the Aetna Concierge at (855) 784-8646 for assistance.

Information on network facilities options outside of Alaska contact the Aetna Concierge at (855) 784-8646 or visit the custom DocFind tool online. It is important to use the custom AlaskaCare DocFind tool tool when searching for facility options; Aetna’s public DocFind tool will not accurately reflect AlaskaCare’s preferred facilities.

Most Alaska hospitals and facilities outside of the Anchorage area are network providers, but outside of Alaska there are some out-of-network facilities, so its important to check before receiving services. For a list of network providers, please contact the Aetna Concierge at (855) 784-8646 or visit the custom DocFind tool to help you find a provider that is part of the AlaskaCare network.

Why out-of-network facilities are paid at 185% of Medicare

We use Medicare as our base because they are the largest payer in the county, and they have established a standard measure that accounts for differences like size, location, and the types of patients treated. The Medicare rate is set to pay facilities for their costs plus a profit.

Conquer Back and Joint Pain with Hinge Health!

Whether you have chronic or sudden joint pain, are recovering from an injury, or just want more strength and flexibility—Hinge Health can help. Hinge Health offers innovative digital care programs that connect you with a physical therapist or personalized health coach to help you manage musculoskeletal conditions such as back, knee, hip, neck and shoulder pain. The exercise therapy programs are designed to help you get back to the activities you love.

Hinge Health’s programs are available at no cost to you and your family members age 18+ who are covered by the AlaskaCare Employee Health Plan.

Hinge Health has tailored programs to help you with:

  • Conquering musculoskeletal pain or limited movement—Whether you have an occasional dull ache or frequent sharp pain, Hinge Health can help you move freely again.
  • Recovering from an injury—Whether you were injured yesterday or years ago, get expert help and recover better than ever.
  • Keeping your joints healthy and pain free—Get expert support tailored to your specific needs.

Hinge Health provides the tools you need to get moving again from the comfort of your home. When you enroll, you will receive the Hinge Health welcome kit which, based on your care program, may include:

  • A tablet computer
  • Wearable sensors that give live feedback in the Hinge Health app
  • Access to personalized exercises

You will also be connected with a personal care team including a physical therapist or health coach who will tailor your program to your needs and work with you along the way.

How to use Hinge Health

If you or an eligible dependent would like to enroll, start by contacting Hinge Health:

  1. Transparency in Coverage
  2. Children’s Health Insurance Program (CHIP)
  3. COBRA Coverage Reminder
  4. Creditable Coverage Notice - Prescription Drug Coverage and Medicare
  5. HIPAA Privacy Practices
  6. Newborns’ and Mothers’ Health Protection Act Notice
  7. Primary Care Provider Designation
  8. Special Enrollment Rights
  9. Summary of Benefits and Coverage (SBC)
  10. Surprise Medical Bills - Your Rights and Protections
  11. Taxpayer Identification Number (TIN) or Social Security Number (SSN) of Each Enrollee in a Health Plan
  12. Women’s Health and Cancer Rights Act of 1998 (WHCRA)

Transparency in Coverage

The Departments of Health and Human Services, Labor and the Treasury finalized the Transparency in Coverage Rule that requires health insurers and group health plans to create a member-facing price comparison tool and post publicly available machine-readable files that include in-network negotiated payment rates and historical out-of-network charges for covered items and services. This machine-readable price transparency file is intended to comply with the CMS price transparency rules at 45 C.F.R. § 180.50. The rules apply to the AlaskaCare Employee Health plan, the AlaskaCare Retiree Health Plan is exempt.

Publicly Available Machine-Readable Files: The files disclose detailed information on the costs of covered items and services such as negotiated rates for in-network providers, historical allowed amount and billed charges for out-of-network providers.

Employee Assistance Program

The AlaskaCare Employee Assistance Program (EAP), administered by Aetna, provides responsive, caring and effective services to help balance your personal and professional life. Some of the areas the EAP can help with include:

  • Personal balance
  • Emotional wellness
  • Marital/relationship issues
  • Family issues
  • Communication skills
  • Stress management
  • Alcohol and drug issues
  • Work-related issues
  • Grief issues
  • Financial and legal concerns

Appeals

AlaskaCare Health & Dental Appeal Guides

The AlaskaCare health and dental plans provide members with the right to appeal claims and precertifications that have been denied by claims administrators. If your health plan denies payment for a treatment that you believe should be covered, you have the right to challenge that decision through the appeal process. AlaskaCare has added a new level to the appeals process for services or supplies received on or after January 1, 2018. Under the new appeal process, if the third party claims administrator or external review organization uphold their original denial of your appeal, you have the right to appeal to the Division of Retirement and Benefits. Should the Division also uphold the denial, you retain the legal right to take the appeal to superior court.

Appeals Process Part 1

Appeals Process Part 2

Opioid Guidelines

State and federal guidelines were developed to address the opioid epidemic in the United States and Alaska. Safety guidelines were adopted for the AlaskaCare plans on January 1, 2018 and were further enhanced on January 1, 2019. The guidelines limit the dispensing of opioids as follows:

  • For patients that don’t normally use opioids:
    • The plan limits the maximum dosage per day to 50 mme (morphine milligram equivalent) and only allows up to a 7-day supply every 91-days.
    • A pre-authorization is required to obtain more than a 7-day supply within any 91-day period.
  • For patients that regularly use opioids:
    • The plan limits the maximum dose per day to 90 mme and only allows up to a 30-day supply.
    • A pre-authorization is required periodically.
  • For patients age 19 or under:
    • A pre-authorization is required for cough medications that contain opioids, and the prescription is limited to a 3-day supply.

Members are encouraged to discuss the effect of the AlaskaCare opioid dispensing policy with their providers and to contact Optum Rx at (855) 409-6999 for support.

Opioids are a type of narcotic pain medication. They can have serious side effects if you don't use them correctly. For people who have an opioid addiction, their problem often started with a prescription. Opioid drugs include:

  • Codeine (only available in generic form)
  • Hydromorphone (Dilaudid, Exalgo)
  • Meperidine (Demerol)
  • Methadone (Dolophine, Methadose)
  • Morphine (Kadian, MS Contin, Morphabond)
  • Fentanyl (Actiq, Duragesic, Fentora, Abstral)
  • Oxycodone (OxyContin, Oxaydo)
  • Oxycodone and acetaminophen (Percocet, Roxicet)
  • Oxycodone and naloxone
  • Hydrocodone (Hysingla, Zohydro ER)
  • Hydrocodone and acetaminophen (Lorcet, Lortab, Norco, Vicodin)

Forms & Health Brochures

AlaskaCare Employee Form 1095-B Information

State of Alaska employees eligible for health benefits will receive a Form 1095-C, and in some cases a Form 1095-B. These forms contain information about your healthcare coverage and whether your dependents were covered. It is important to keep these forms for your records.

The Affordable Care Act (ACA) includes both an individual mandate and an employer mandate. Under the individual shared responsibility provision of the ACA, individuals must indicate their enrolled dependents, as well as themselves, have had a full year of qualifying healthcare coverage (called minimum essential coverage), qualify for an exemption, or pay a penalty when filing their income taxes. The employer mandate requires that large employers like the State of Alaska, offer affordable healthcare coverage that provides minimum value to most of their full-time equivalent employees or pay a penalty.

Form(s) 1095 are the mechanism that the Internal Revenue System (IRS) will use to determine if these mandates have been met.

Supplemental Non-Emergent Surgery Coverage

AlaskaCare has partnered with SurgeryPlus to offer employees covered by the AlaskaCare Employee Health Plan and their eligible dependents convenient travel benefits for non-emergent surgeries. You get access to a network of top quality medical providers with proven experience in more than 350 procedures types across 40 states.

What’s included with this new benefit?

Surgeons of Excellence
Each board-certified provider has undergone rigorous screening, including specialized training and fellowships, reducing your risk of complications and preventable costs.

Full-Concierge Service
Your dedicated Care Advocate will locate the best-fitting provider, schedule all appointments, coordinate medical record transfers, and follow up with you post-procedure to ensure top satisfaction with your procedure experience.

Low Cost
Each procedure is covered under a bundled rate, and the only cost to you is the remaining balance on your deductible, if applicable. 100% of the coinsurance is waived.

Covered Expenses include:

  • Episode of Care received through SurgeryPlus benefits
  • Airfare for the eligible patient and a companion
  • Hotel or other approved accommodations
  • Transportation to/from airports
  • Pre-loaded debit card with $25 per diem per patient per day (or $50 per patient and companion per day)

How to use SurgeryPlus

If you or an eligible dependent needs surgery, start by contacting SurgeryPlus:

You will be assigned a dedicated Care Advocate who will assist you with:

  • Selecting a surgeon
  • Scheduling appointments
  • Coordinating and booking travel and accommodations
  • Providing a pre-loaded debit card with per diem for expenses
  • Transferring medical records
  • Reviewing benefits

Quality Healthcare at Your Fingertips

Talk to a doctor by phone or video, anywhere, anytime.

Teladoc® is already part of your AlaskaCare Employee Health Plan. You can talk to a doctor in minutes. AlaskaCare Employee Health Plan members have 24/7/365 access to health care for non-emergency conditions by web, phone or mobile app. For example, if you have symptoms of the flu, you can contact Teladoc® and a doctor can evaluate and help with next steps when necessary.

The AlaskaCare Employee Health Plan has partnered with Teladoc® since September 1, 2018 to provide you with a convenient and affordable way to receive quality medical care.

All Teladoc® doctors are board-certified, state-licensed and can treat many health issues, including:

  • Cold and flu symptoms
  • Allergies
  • Bronchitis
  • Skin problems
  • Respiratory infections
  • Sore throat
  • Sinus problems
  • Dermatology
  • Caregiving
  • Behavioral Health
  • ...and more!

How to use Teladoc®

To utilize the benefit, begin by registering your Teladoc® account. There are three ways to register:

During registration, you’ll complete your medical history so when you need Teladoc®, it will be fast and easy. Watch a short video to discover more.

Services Offered

  • General Medical Consultation

    Teladoc® is another alternative to accessing medical care for your non-emergent symptoms 24/7/365. Teladoc® is a convenient and affordable healthcare alternative to expensive and time-consuming E.R. visits or after-hour periods where care is difficult to find. All Teladoc® doctors are board-certified, state-licensed, and can even send a prescription straight to your nearest pharmacy when medically necessary!

    Fee: For General Medical Consultation, the copay is $0.


  • Behavioral Health Consultation

    Feel like yourself again. Choose a therapist or psychiatrist who fits your needs and schedule visits 7 days a week from wherever you're most comfortable. Experts specialize in and support a wide range of needs:

    • Anxiety, stress, overwhelmed
    • Negative thought patterns
    • Depression
    • Not feeling like yourself
    • Not wanting to get out of bed
    • Relationship conflicts
    • Trauma and PTSD
    • Mood swings
    • Medication management

    Fee: For Behavioral Health Consultation, the copay is $0.


  • Dermatology Consultation

    There’s no reason to wait weeks for the skin care you need. Teladoc® can resolve your skin issues within days by web or mobile app. Licensed dermatologists can treat ongoing or complex skin conditions like psoriasis, skin infection, rosacea, suspicious moles, and many more—quickly, conveniently, and discreetly.

    Fee: For Dermatology Consultation, the copay is $0. The first follow-up within 7 days of initial dermatology consultation also has a copay of $0.


  • Caregiver Consultation

    As a caregiver for a loved one, you have enough to worry about. That’s why Teladoc® gives you a convenient and affordable way to provide care, letting you arrange a 2- or 3-way video or phone visit with a licensed doctor 24/7 for just $45/visit. Add the individual you care for to your Teladoc® account, even if they’re not covered by your health plan.

    Fee: $45 for Caregiver Consultation Fee. This optional service is not covered under the plan and is the members responsibility to pay in full.

Do you have questions about your AlaskaCare health plan, or do you need assistance with your benefits? Here are some helpful resources that can provide you with more information and make navigating through the health care maze easier.

Division of Retirement and Benefits Member Education Center

The Division of Retirement and Benefit’s Member Education Center provides essential support to our membership which includes employees, retirees, and other benefit recipients. We provide assistance relating to retirement, medical, and other optional benefits.

The Division’s Member Education Center team has comprehensive knowledge of the retirement systems and has dedicated team members that are experts on the AlaskaCare health plans. We are here to answer questions ranging from benefit enrollment for newly hired employees, to application for retirement, to the AlaskaCare health plan and beyond.

You can reach us at (907) 465-4460 or toll-free at (800) 821-2251. The hours of operation are Monday through Thursday 8:30 a.m. to 4 p.m., and Friday 8:30 a.m. to 3 p.m., Alaska Time.

Aetna Local Offices in Juneau and Anchorage

Want to talk to an Aetna representative in person? Aetna has a local office in Anchorage and in Juneau dedicated to assisting AlaskaCare members with questions. Members are welcome to stop by during the open office hours or contact the Aetna Concierge at (855) 784-8646 to make an appointment.

Hours: Tuesday, Wednesday, and Thursday from 9-11 a.m. and 12-4 p.m.

Juneau Office
One Sealaska Plaza, Suite 305
Juneau, Alaska 99801

Anchorage Office
2525 C Street, Suite 205
Anchorage, Alaska 99503


The Aetna local representatives can assist you with questions about your benefits, and with services such as paper claim submissions, travel precertification, appeals assistance, understanding your explanation of benefits, coordination of benefits and more…

Free Aetna Nurse Advice Line

You can talk to a nurse whenever you have health questions. You can call the Aetna nurse line 24 hours a day, 7 days a week. Even better, this service is provided at no cost to you. Simply call the nurse line number at (800) 556-1555.

The nurses can be a resource in considering options for care or helping you decide whether you or your dependent needs to visit your doctor, an urgent care facility or the emergency room. The nurse can help you with:

  • Deciding whether to visit a doctor or urgent care center
  • Understanding your symptoms
  • Managing chronic conditions
  • Learning about treatment options and medical procedures

You can call the nurse line anytime to discuss any health concerns at (800) 556-1555.

Wellbeing Resources

Aetna Behavioral Health

Need help finding a virtual or in-person mental health provider? Login to your Aetna.com member portal or call the Aetna Concierge at (855) 784-8646 and get connected with a behavioral health care advocate who can help you find a counselor, psychologist or psychiatrist who meets your needs.

Employee Assistance Program

Page Last Modified: 03/03/24 22:48:13