The following frequently asked questions about premiums are not meant to be exhaustive. Refer to your health benefits plan book or contact the SEIB for more information.
The State Employees’ Health Insurance Plan (SEHIP) is funded by contributions from the state and through employee premiums, deductibles, and copays.
The state funding rate is a funding mechanism established by the Alabama Legislature to help fund the state health plan. The rate is a dollar amount paid monthly by state agencies for each active employee. For FY2020, the state funding rate is $930 per employee per month.
No, it is not the equivalent of an employee premium. The state funding rate is paid by the employer to cover the cost of an active employee and subsidizes retiree and dependent coverage.
The employer contribution is the amount state agencies pay for each active employee based on the state funding rate. The employer contribution can be broken down into an equation: the state funding rate x number of active employees x 12 months = annual employer contribution.
The employee premium is the amount the SEIB establishes for employees and retirees to contribute to the cost of their coverage. The 2020 single employee premium is $115 per month. This can be reduced by participating in the wellness program ($25 discount per participant per month) and refraining from using tobacco products ($60 discount per member per month), which brings the total single employee premium to $30 per month when all of the discounts are applied. For a complete listing of the employee premium rates visit rates for 2021.
In addition to the employee premium, members are also responsible for out-of-pocket expenses such as copays and deductibles. Members should refer to the employees’ health benefits plan book to determine what your out-of-pocket expenses will be prior to receiving services from your health care provider.
Yes. Employees and retirees whose spouse is enrolled in the SEHIP will be charged a $50.00 per month surcharge if that spouse is eligible for other group health benefits through his/her employer.
To apply for a spousal surcharge waiver you must submit a Spousal Surcharge Waiver Application (Form IB25) to the SEIB. The waiver is on a prospective basis only and the SEIB will not make refunds for previous health premiums. The effective date of the waiver of the spousal surcharge will be the first day of the month following approval of the waiver. The waiver will be effective for 12 months. Thereafter, re-certification must be made annually.
New employees have 60 days from their date of hire to apply for the spousal surcharge waiver. Covered spouses of active employees, non-Medicare retirees and non-Medicare covered spouses of retirees have 60 days from their initial effective date of coverage to apply for the spousal surcharge waiver. There is no grace period to submit the spousal surcharge waiver application if you or your spouse re-enroll in the SEHIP during the year or if you have ever been covered as a state employee.
The following frequently asked questions about premium discounts are not meant to be exhaustive. Refer to your health benefits plan book or contact the SEIB for more information.
The non-tobacco user premium discount is a deduction from your monthly health insurance premium available to subscribers and/or their covered spouses who have not used tobacco products in the last 12 consecutive months.
Yes. A separate non-tobacco user premium discount is available to both the subscriber and the covered spouse. If you and your covered spouse both use tobacco products, you and your covered spouse will each be subject to a separate tobacco user premium of $60.
Here’s how the premium structure will be applied:
To obtain the discount, you and/or your covered spouse must complete and submit a non-tobacco user premium discount application to the SEIB verifying that the applicant has not used tobacco products in the last 12 consecutive months. Applications are available from the SEIB or the website. No refunds are allowed for failure to submit an application.
New employees have 60 days from their date of hire to apply for the non-tobacco user premium discount. Covered spouses of active employees, non-Medicare retirees and non-Medicare covered spouses of retirees have 60 days from their initial effective date of coverage to apply for the non-tobacco user discount. There is no grace period to submit the non-tobacco user premium discount application if you or your spouse re-enroll in the SEHIP during the year or if you have ever been covered as a state employee.
For those who were not eligible for the premium discount at the date of hire, you or your spouse may apply for the discount when the applicant has not used tobacco products in the last 12 consecutive months.
It is your responsibility to notify the SEIB immediately if you or your covered spouse starts using tobacco products while the premium discount is in place. If you fail to notify the SEIB, you could be subject to disciplinary action and be required to repay all discounts, claims, and expenses related to the tobacco usage by you and/or your covered spouse, plus interest.
The wellness premium discount is a deduction from your monthly health insurance premium available to those individuals who complete the wellness requirements established under the SEIB’s Wellness Program.
The SEIB Wellness Program is voluntary and you are not required to participate in the wellness program or any components of the biometric screening. If you choose to participate, you will be asked to complete a biometric screening, which includes measuring your height, weight, and waist size, taking your blood pressure and a blood sample. The blood sample checks your cholesterol (total, HDL (good), LDL (bad), and triglycerides) and glucose. You will be asked if you have or have had high cholesterol, high blood pressure, or diabetes and if you take medicine for those conditions. The screening intends to let you know if you are at risk for certain medical conditions resulting from obesity, high blood pressure, high cholesterol, or diabetes.
Yes. A separate wellness premium discount is available to both the eligible subscriber and the eligible covered spouse. If you and your covered spouse both fail to meet the SEIB’s Wellness Program requirements, you and your covered spouse will each be subject to a separate premium of $25.
Eligible individuals who are deemed by the SEIB to be at risk for any of the above health risk factors are eligible for an office visit referral with no office visit copay.
The effective date of the wellness premium discount depends on when the screening results and/or other documentation is submitted to the SEIB. However, for the wellness premium discount to be effective on January 1 of a succeeding year, you must qualify no later than October 31 of the preceding year.
New employees will have 60 days from their date of hire to apply for the wellness premium discount. Covered spouses of active employees, non-Medicare retirees and non-Medicare covered spouses of retirees have 60 days from their initial effective date of coverage to apply for the wellness premium discount. There is no grace period to submit the wellness premium discount application if you or your spouse re-enroll in the SEHIP during the year or if you have ever been covered as a state employee.
The Federal Poverty Level (FPL) Premium Discount is a percentage discount off your monthly health insurance premium based on your total household income and household size.
Active and retired employees whose combined family income is less than or equal to 300% of the FPL, as defined by federal law, may be eligible for a percentage discount off the approved premium.
To obtain the discount, you and your spouse must submit a completed FPL Premium Discount Application to the SEIB and furnish acceptable proof of total annual household income by providing your current (i.e. immediately preceding year) federal income tax return transcript. The discount will be effective on the first day of the second month after SEIB’s receipt and approval of the application and transcript. The discount will expire on June 30th. You must reapply every year. No refunds will be allowed for late or incomplete applications. No refunds will be allowed for failure to submit an application.
The discount does not apply to members on Leave of Absence, COBRA, or surviving dependent coverage.
You must provide a copy of your current (i.e. immediately preceding year) federal income tax return transcript when you send the application to the SEIB. If you are married and file taxes separately, you must also include a copy of your spouses’ current (i.e. immediately preceding year) federal income tax return transcript. Include all pages of the transcript(s). There is no charge to get your transcript from the Internal Revenue Service (IRS). To receive your free federal income tax return transcript, visit IRS Get Transcript or call 800-908-9946. You should receive your transcript within 7-10 business days.
The SEIB will use the number of dependents shown on your federal income tax return transcript to determine your household size for purposes of calculating your potential premium discount.
SEIB is offering, through BCBS, a gap in care premium discount program that encourages healthy habits to support and improve your overall health. You might ask, “What is a gap in care?” National guidelines for managing certain disease processes are recommended to better manage your health. If you are identified as having a “gap in care”, it simply means that you are missing one or more of the recommended guidelines, such as a lab test, examination, or prescription medication, necessary to manage your health. The program focuses on the following five healthcare standards:
This program applies to all active employees, covered spouses of active employees, non-Medicare retirees, and non-Medicare spouses of retirees enrolled in the SEHIP (Group 13000)
If previous claims reveal that you have not met the required guidelines for any of the healthcare standards listed above, you will receive a letter from BCBS outlining the necessary steps required to close your identified gap(s) in care. Members will have until October 31st to close their identified gap(s) in care. If you do not meet the requirements, your monthly premium will increase by $25 per month beginning January 1st of the following year. However, you are not required to pay the $25 per month premium for the entire year if you take the necessary actions to close the gap(s) anytime during the year.
