Understanding PEHP Insurance and Its Benefits

PEHP insurance is a healthcare plan that provides coverage for government employees in the state of Utah. As a self-funded, non-profit organization, PEHP offers comprehensive medical, dental, and vision benefits to its members. This article aims to provide an overview of PEHP insurance, its features, benefits, and how it can be acquired.

What is PEHP Insurance?

PEHP or Public Employees’ Health Plan is a group benefit plan established by the Utah Legislature to serve the healthcare needs of government employees, retirees, and their dependents. PEHP offers a variety of healthcare coverage options, including medical, dental, vision, and behavioral health services.

PEHP is a self-funded healthcare plan, which means the money used to pay for healthcare services comes from a trust fund created by the contributions of participating employers and employees. Unlike traditional insurance plans, PEHP directly contracts with healthcare providers to negotiate and manage the cost of medical treatments.

PEHP is administered by the Utah Retirement Systems, but its policies and procedures are governed by a board of directors made up of public employees and appointed by the Governor and the Legislature.

Who is eligible for PEHP insurance?

PEHP insurance is available to public employees who are employed by the state of Utah, counties, cities, school districts, or other government entities. Eligible individuals include full-time and part-time employees, retirees, and their dependents.

PEHP offers different plans based on the employee’s status and employment category. For example, active employees may select from a variety of health plans, while retirees have access to a separate set of plans with different coverage options.

What are the benefits of PEHP?

PEHP offers several benefits to its members, including:

How to enroll in PEHP insurance?

Enrolling in PEHP insurance is easy and can be done online through the PEHP website or through the employer’s human resources department. Employees who are eligible for PEHP insurance will be notified by their employer during the open enrollment period, usually held in the fall of each year.

During open enrollment, employees can choose from several health plans offered by PEHP, each with different coverage options, premiums, and out-of-pocket costs. Employees can also enroll in dental, vision, and other optional coverage options.

FAQ

What is the difference between a copay and coinsurance in PEHP insurance?

A copay is a fixed amount that a member pays for a medical service or prescription drug, while coinsurance is a percentage of the cost of the service or drug that the member is responsible for paying. For example, if a member has a 20% coinsurance for a medical procedure that costs $1000, the member would be responsible for paying $200, and PEHP would pay the remaining $800.

Can PEHP members see any healthcare provider?

PEHP has a wide network of healthcare providers, but members can see any provider that accepts their plan. Members are encouraged to use in-network providers to get the highest level of coverage and minimize their out-of-pocket costs.

What happens if a member loses eligibility for PEHP insurance?

If a member loses eligibility for PEHP insurance, such as by leaving their job, retiring, or no longer meeting the eligibility requirements, they may qualify for continuation of coverage under COBRA or another state or federal program. Members should contact PEHP or their employer for more information about their options.

Can family members be covered under PEHP insurance?

Yes, eligible dependents of PEHP members can be covered under the plan, including spouses, domestic partners, and children up to age 26.

Are there any exclusions or limitations under PEHP insurance?

Yes, like any healthcare plan, PEHP has exclusions and limitations on certain medical services, treatments, and procedures. Members should review their plan documents or contact PEHP for more information about these limitations.

Conclusion

PEHP insurance is an affordable and comprehensive healthcare plan that provides coverage to government employees and their dependents in Utah. With its low out-of-pocket costs, wide provider network, and wellness programs, PEHP is an excellent option for individuals who want quality healthcare coverage without breaking the bank. If you are eligible for PEHP insurance, take advantage of this opportunity to safeguard your health and well-being.