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October 18, 2018

Health Plan Tiers

Below is information on health plan tiers and qualified plans to help employers respond to employee questions during the It’s Your Choice 2019 open enrollment period.

What is Tiering?

  • Tiering is a method of ranking health plans by cost and quality.
  • Tier 1 plans typically offer a lower premium than Tier 2 or Tier 3.
  • The average of the qualified Tier 1 plan rates per county are used to establish the 88% employer contribution amounts (for employers who use the 88% calculation method for the employer share of the health insurance premium).

What Makes a Plan Qualified?
A qualified plan minimally requires that the plan:

  • includes five primary care physicians who accept new patients
  • includes one hospital in the county and/or within 35 miles of the county, and
  • includes one chiropractor.

If an employee’s health plan has changed tiers, they may want to look at other health plans available to them during open enrollment. The employee should contact the health plan they are considering changing to, and may also use the health plan interactive map found on the It's Your Choice 2019 web pages, to verify providers are covered by their chosen health plan in 2019.

If the employee is concerned about a clinic, hospital or specialty care facility accepting the health plan that the employee is considering, the employee should contact those facilities directly to verify that their chosen health plan is accepted at those facilities.

The It’s Your Choice 2019 open enrollment period is October 1 - October 26, 2018.


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