The health benefits that the State of Alaska provides to its eligible employees are 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.

• Aetna Concierge:
• Online access: Aetna Navigator

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.

To learn more about the Consumer Choice plan and HRA, check out our Frequently Asked Questions.

Glossary of Important Terms

• Glossary of Health Coverage and Medical 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.

• 2025 Full-Time Employee Select Benefits Premium Sheet
• 2025 Part-Time Employee Select Benefits Premium Sheet

2025 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 date: January 1, 2025

See section 2.1.1 of the plan booklet for a list of coinsurance exceptions, such as 100% for in-network preventive care, or reduced coinsurance levels for receiving services at some out-of-network facilities.

Coinsurance will be 30% of covered charges for dependents that are covered by a State employee health trust and that coverage: has been waived, pays less than 70% of covered expenses, or has an individual out-of-pocket maximum, including deductibles, of more than $3,500. Please refer to the plan booklet for plan provisions.

Premiums are deducted from the first two paychecks of the month.

Programs

Enhanced Maternity

Important Documents:

• Aetna Enhanced Maternity Program Pregnancy Handbook

Effective January 1, 2025, the AlaskaCare Employee Health Plan (Plan) added the Aetna Enhanced Maternity Program to your health benefits, providing support before, during, and after your pregnancy. In addition to the current maternity benefits covered under the Plan, Aetna Enhanced Maternity offers the following:

• Phone-based genetic counseling and screening, as well as convenient, confidential, and cost-effective genetic testing
• Personalized nurse support if you have a health condition or other risk that could affect your pregnancy
• Personalized care and educational resources for improved preeclampsia outcomes
• Fertility advocacy for members struggling with infertility
• Education, resources, and support, including helpful information about:
  • prenatal care,
  • labor and delivery,
  • postpartum care,
  • and much more!

You can enroll in Aetna Enhanced Maternity by calling Aetna at (TTY: 711) weekdays from 8 a.m. to 7 p.m. Eastern Time or by visiting the Maternity Support Center on the Aetna member website .

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.

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 , TTY 711.

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.

Please note: If you use an out of network pharmacy, the coinsurance for all prescription drugs is 60%.

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!

AlaskaCare Employee Plan Formulary

• 2025 AlaskaCare Employee Plan Prescription Drug Formulary
• 2024 AlaskaCare Employee Plan Prescription Drug Formulary

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 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 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

Medication Home Delivery

You can receive maintenance medication through the mail via 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 , TTY 711.

Medication Home Delivery
Prescription Tier	Home Delivery 31-90 Day Supply: Network Pharmacy
Maintenance generic prescription drugs	$10 copay per prescription
Generic prescription drugs	$20 copay per prescription
Preferred brand-name prescription drugs	$50 copay per prescription
Non-preferred brand-name prescription drugs	$100 copay per prescription

Compound Prescription Limitation

The AlaskaCare Employee Health Plan pharmacy benefits do 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™ .

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.

Delta Dental of Alaska Dental Claim Form

Dental Plans at a Glance

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

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.

View the 2025 Standard Dental plan summary for detailed service class coverages.

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.

View the 2025 Preventive/Economy Dental plan summary for detailed service class coverages.

Premiums

AlaskaCare 2025 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%	100%
Basic	80%	10%
Major	50%	10%
Orthodontics
Eligible employees and their covered dependents	50% coinsurance up to a $1,000 lifetime maximum	N/A
Deductible waived, does not apply to annual maximum benefit. Premiums are subject to change.
Effective date: January 1, 2025

Note: 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 .

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 to 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 .

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 .

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.

Vision Service Plan

• VSP Member Services:
• Online access: VSP.com

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 2025 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 your 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 date: January 1, 2025

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.

To learn more about the coverage available under the vision plan, refer to the Vision Service Plan (VSP) Brochure .

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 have the opportunity 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 myRnB 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.

Dependent changes and enrollments must be made online.

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

Juneau:
Outside Juneau:
M-F: 8 a.m. - 4:30 p.m.
Forms, Info, 15-minute Q&As

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 myRnB:
   Navigate to myRnB and log in using your myRnB username and password


2. Click Enrollment:
   On the left-hand side of the dashboard under "Self-Service Tools", click "AlaskaCare Health Benefits Open Enrollment", and accept the terms and conditions


3. Choose Coverage:
   Under "Choose Coverage" select "Open Enrollment" and click "Choose Coverage"


4. Verify Dependents:
   Here you are able to manage your dependents. If you do not have any dependent changes from the previous benefit year, click "Next"


5. Employment Info:
   Coverage reason should say "Open Enrollment," then verify your employment information, do not change populated data, and click "Next"


6. Make Selections:
   Select your benefits: Make sure to click on EACH benefit section to make your selections (Medical, Dental, Vision, HFSA tabs). Click "Next" when you have made your selections


7. Review Selection:
   Review your benefits: Click "Back" to change your selections or "Submit" to confirm your benefit selections


8. Finish Enrollment:
   Congratulations! You have completed your benefit selections and enrollment. When you navigate back to the dashboard, you will see your updated information with your current and future benefit selections

This is a good time to consider updating your beneficiaries for all Retirement and Voluntary Supplemental Benefit accounts.

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) requires 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.) For more information about how failure to maintain minimum essential coverage for yourself and your family may impact your federal income taxes, visit IRS.gov .

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

If you are an AlaskaCare Employee Health Plan covered employee with other medical coverage, you may elect to opt out of 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.

If you want to waive any component of AlaskaCare coverage, you must elect to waive each component and do so annually during the open enrollment period.

A waiver of coverage for will not carry over to .

1. While logged into your MyRnB account, with access to the new enrollment portal: click on each benefit selection and navigate to the red opt out button. You must opt out of each election that you do not want to be a part of.
2. Once you have selected which benefits you want to opt out of, click "Next."
3. An opt-out waiver window will appear. You must review the Opt-Out Notice, then agree to the terms and conditions, and continue to the dialog box.
4. Click "Submit", and you have completed the opt out process.

If you chose to opt out of the Medical plan in , and you do not complete the opt-out process during Open Enrollment for , you will be defaulted to the Economy Employee Only Plan or the Economy Employee and Family Plan (if you have active dependents listed).

Remember: you must annually elect to opt-out of coverage.

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 .

Still have questions? Check out our Open Enrollment Frequently Asked Questions.

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 or after a qualifying status change.

You may carry forward up to $640 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

2025 Health Flexible Spending Account Rates
Minimum Monthly Amount	$25.00
Maximum Monthly Amount	$250.00
Effective date: January 1, 2025

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.

Please refer to the AlaskaCare Employee Insurance Information Booklet, section 6.7 Submitting Claims for Reimbursement , for additional information.

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 $640 of unused funds in your HFSA to the next benefit year, but unused amounts over $640 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?

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 claims multiple ways:

• Paper form: Health Flexible Spending Account (HFSA) claim form (Inspira Financial)
• Online: inspirafinancial.com
• Inspira Financial Mobile App:
  • Apple App Store
  • Google Play™

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.

Effective January 1,

• AlaskaCare Employee Insurance Information Booklet
• Your Rights and Protections Against Surprise Medical Bills

The AlaskaCare Employee Health Plan booklet reflects revisions to the previous Select Benefits Information Insurance booklet for State of Alaska employees covered under the AlaskaCare health plan.

Amendments

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

Find out More about Coalition Health Fairs in your area.

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 , or use the online DocFind tool .

It is important to use an in-network facility when you obtain services in Anchorage or outside of Alaska.

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:

2025 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
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.
Effective date: January 1, 2025

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 for assistance.

For information on network facilities options outside of Alaska contact the Aetna Concierge at 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 it's important to check before receiving services. For a list of network providers, please contact the Aetna Concierge at 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 country, 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:

• Call a Member Care Advocate:
• Enroll in Hinge Health Now!

For more information, please read the Employee Hinge Health FAQs.

Legal Notices

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.

• Aetna Provider Pricing Files
  These files are not designed as a consumer tool. Members are encouraged to use the more member-friendly price estimator tool located on the Aetna member webpage or call the Aetna Concierge at .
• Lantern (formerly Surgery Plus) Provider Pricing Files

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:

For more information, please visit the Employee Assistance Program webpage.

Find a Medicare Provider

To find a Medicare provider, visit the Medicare website , which offers an online tool to help you find and compare Medicare participating providers.

For more information, please visit the Medicare resource section of our website.

Appeals

AlaskaCare Health & Dental Appeal Guides

• Aetna Employee Health Plan Appeal Guide
• Moda Employee Dental Plan Appeal Guide
• Aetna Health Plan Appeal Form
• Moda Dental Plan Appeal Form

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.

Opioid Guidelines

Opioid Medication—Benefit Dispensing Information brochure

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 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:

Forms & Health Brochures

All forms and documents are available here.

AlaskaCare Employee Form 1095 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) or demonstrate that they qualify for an exemption 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.

Check out our Form 1095 FAQs for more information.

Supplemental Non-Emergent Surgery Coverage

AlaskaCare has partnered with Lantern 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
Procedures obtained through Lantern are covered under a bundled rate, with the plan covering 100% of the coinsurance. Additionally, services received through Lantern are exempt from the deductible.

Covered Expenses include:

• Episode of Care received through Lantern 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)

For the full list of what is covered under this benefit, please refer to the AlaskaCare Employee Plan Amendment .

How to use Lantern

If you or an eligible dependent need surgery, start by contacting Lantern:

• Call a Member Care Advocate:
• Online Portal: LanternCare.com

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

For more information, please read the Lantern FAQs.

Quality Healthcare at Your Fingertips

Register/Update your account .

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:

How to use Teladoc

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

• Online: teladochealth.com/aetna
• Mobile App: Teladoc.com/mobile
• Phone:

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.

Note: A credit or debit card is required to cover potential late-cancellation and no-show fees. It will only be charged if a late cancellation or no-show occurs.

Teladoc charges a $50 fee for no-shows and cancellations within 24 hours of a scheduled Behavioral Health visit.



• 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.

For more information, please read the Teladoc FAQs.

Juneau Crisis & Disaster Resources - This resource guide was put together in response to the flooding that recently occurred in Juneau, Alaska.

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 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 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 or toll-free at . 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 to make an appointment.

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

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

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

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

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 .

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 .

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 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

For AlaskaCare eligible employees, the Employee Assistance Program (EAP) offers a confidential counseling service, free of charge to you and your dependents, administered by Aetna.