Directly Invoiced Members
Directly Invoiced Members Overview
Individual members are a special category under the State Health Plan that includes surviving spouses, surviving dependents, Reduction in Force (RIF) members and former legislators. These members are not part of an employment group and must enroll, make payments and maintain coverage status individually. See below for details on plan options, rates and billing.
Health Plan Options
Individual members are eligible for the following two health plans. Click each link for more information:
Rates
- 80/20 & 70/30 Plans for COBRA
- Active Subscribers Who Are Medicare Primary Due to Upcoming Retirement
- 12-Month RIF Subscribers
- Active Subscribers Who Are Medicare Primary Due to ESRD
- Active Subscribers Whose Dependent is Medicare Primary Due to ESRD
- Active Subscribers Who Are Medicare Primary Due to ESRD and Have an ESRD Medicare Primary Dependent
- Active Employees, Eligible Part-Time, Job Share and Leave of Absence Subscribers
- Non-Medicare Subscribers who are in the Direct Bill & Sponsored Dependent Groups
- 100% Medicare Primary Subscribers who are in the Direct Bill & Sponsored Dependent Groups
- 100% Medicare Primary Subscribers who are in COBRA
Billing
When members elect and pay to continue coverage, they are enrolled and billed to a current date. Subsequently, members are billed on a monthly basis, 20 days prior to the period for which premiums are due.
When members are in a status that requires them to receive an invoice directly, an invoice is generated immediately to reflect all charges through the end of the current billing period. Subsequently, members are billed on a monthly basis, 20 days prior to the period for which premiums are due.
Members can monitor their account online at www.mycobra.info. Bank draft is available too, and more information regarding that option is available at www.mycobra.info.
Medical Policies
Although your Benefits Booklet provides a good overview of what services and products are available to you under the PPO plans, the medical policies provide detailed information around the circumstances under which certain services and products are and are not covered. Medical policies can be found here on the Aetna website*.
* If any of the State Health Plan medical policies conflict with the Aetna medical policies, the State Health Plan medical policies will prevail.
Prior Authorization
Certain services require prior review and certification before they can be covered by your plan. Providers are responsible for submitting the required documentation. Providers can visit the links below for more information.
Appeals
If you disagree with the way a claim has been handled, you can request an appeal or grievance review. For the complete appeals process, please click here.