Medical Plan

The Medical Plan provides high-quality coverage for enrolled employees and their eligible family members. It includes comprehensive benefits, including preventive care; hospital, medical/surgical, and behavioral health benefits; prescription drug coverage; and special features to improve your health and well-being. The following information is intended to help plan members understand and use their medical benefits.

Man on the phone smiling

Connect with Quantum Health

For members enrolled in the PPO, EPO, and HDHP, care navigation through Quantum Health provides a personal support team to guide you on your healthcare journey.

Read more about care navigation

Medical options

Depending on the benefits offered by your employer, you may elect one of three medical options. All three options cover the same types of medical care and treatment except where otherwise noted.

Preferred provider organization (PPO)

Exclusive provider organization (EPO)

High deductible health plan (HDHP), which may be offered with a health savings account (HSA)

Here's a comparison of all three options.  

Updates related to COVID-19

Starting January 1, 2024, the Medical Plan will no longer cover over-the-counter home COVID-19 tests and members will no longer be able to get these tests through Express Scripts home delivery pharmacy service. The plan continues to cover COVID-19 vaccinations and booster shots approved by the U.S. Food and Drug Administration, diagnostic and antibody testing ordered by a physician, hospitalizations, and inpatient and outpatient services related to COVID-19, subject to plan provisions (copays, deductibles, and/or coinsurance).

Medical Plan special features

In addition to providing benefits when you’re sick or injured, the Medical Plan through the Board of Pensions includes many features and resources to help you maintain and improve your health and well-being:   

Preventive care

Care navigation


Call to Health

Employee Assistance Plan

Vision exam benefit

Centers of Excellence

Livongo for Diabetes Program

Medical care during international travel

Nicotine-free living     

Using medical coverage

You can get the most from your medical coverage by choosing network providers, using the emergency room only when appropriate, and getting advance approval, when required, for non-urgent hospital admissions and certain tests.

Locating network providers

Emergency care and urgent care

Precertifying care      

Working with a Personal Care Guide nurse     

How to enroll in the Medical Plan

You and your eligible family members may enroll in the Medical Plan when you first become eligible or during annual enrollment in the fall.

Enrolling for medical benefits

Medical costs

Member couples

Waving medical coverage

Continuing coverage after eligibility is lost

If your coverage under the Medical Plan is ending, you and/or your eligible family members may be able to extend your coverage for a limited time.

Medical continuation

Transitional participation coverage