PEIP – Frequently Asked Questions

• What’s a Cost Level?

  PEIP works with clinics throughout MN and western Wisconsin to determine the rates that will be offered. These can change from year to year, as clinics determine their costs and discounts they will offer. PEIP assigns a Cost Level to each clinic, based on the prices across the board. The clinic you choose as your Primary Care Clinic determines what costs you’ll pay for visits to the doctor, prescriptions, and other procedures.

• What’s a Primary Care Clinic?

  A primary care clinic (PCC) must be chosen as part of your open enrollment. You determine which clinic would be considered your “home” clinic. This is where you will need to do your preventative care, and the clinic from which you will get a referral for specialty services, such as MRI’s, specialty doctors, etc

• How do I know what the costs would be?

  This chart has a more detailed comparison - Click HERE

• I see that there’s a co-pay on each plan that says “after deductible”. What does that mean?

  This means that you have to pay the full cost for your visits, up to your deductible. For instance, if you visit the doctor and have bloodwork taken, and the cost of your visit is $100 – you pay the full $100, until you reach the deductible. On the “High” plan, in a Cost Level I clinic, for a single covered person, the deductible is $250. If you did that same visit 4 times, your total would be $400. However, you’d pay out of pocket the $250, plus $30 for the third visit, and $30 for the fourth visit, and $30 each visit thereafter for the same kind of services.

• Is there a difference in coverage between the two different networks?

  Is there a difference in coverage between the Blue Cross/Blue Shield and HealthPartners networks? Each of the networks offers the same level of coverage for the same procedure. The only difference is that HealthPartners has slightly better coverage for infertility.

• Can each of family members pick a different Primary Care Clinic (PCC)?

  Yes, each member can select a different primary care clinic during the open enrollment period.

• What happens if I don’t enroll in any coverage?

  EAs will default to no health or dental coverage.  Teachers and SCSP will default to single coverage in the H.S.A. (low) plan in the HealthPartners network with the HealthPartners Midway Clinic as the primary care clinic (PCC), and single dental. 

• How do I find a Primary Care Clinic (PCC)?

  The PEIP Primary Care Clinic directory can be found at this link:  http://www.innovomn.com/employeeplan.php

• I have a dependent child that lives out of state (college/under age 26) will they have coverage?

  For college students whose residence during school is in the State of Minnesota and in the Advantage Plan’s service area, they can select a Primary Care Clinic (PCC) near their home or where they are going to school. All PEIP plans cover Urgent Care and Emergency anywhere – both in and out of network. During Open Enrollment select the PCC you want starting January 1. PCC clinics can be changed monthly by calling the health plan.

  POS coverage is available for college students whose residence during school is outside both the State of Minnesota and the Advantage Plan’s service area. This coverage allows the college student to receive routine, non-emergency care where they go to school. They would enroll in coverage and select a PCC near their home in MN. POS coverage would be used when away at school and in-network services would be used when back at home.

  POS Coverage Details for High and Value Plans

  • Medical Deductible: $350 single/$700 family

  This is separate deductible for POS participants (in addition to the deductible for in-network services).

• What’s the difference between Cost Levels?

  PEIP works with clinics throughout MN and western Wisconsin to determine the rates that will be offered. These can change from year to year, as clinics determine their costs and discounts they will offer. PEIP assigns a Cost Level to each clinic, based on the prices across the board. The clinic you choose as your Primary Care Clinic determines what costs you’ll pay for visits to the doctor, prescriptions, and other procedures. Cost Level 1 is the cheapest, going through Cost Level 4 as the more expensive option. 

• Can I have an HSA account on the Advantage High Plan?

  No, HSA accounts are only legally available on the HSA Compatible plan, as it is required that you are enrolled in a high deductible plan.  Remember, you cannot contribute to a health care flexible spending account and a health savings account at the same time. 

• I’ve been seeing the same specialist for years. Do I still need a referral?

  Yes, PEIP is structured in that you need a referral for any kind of specialist appointment, in order for that appointment to be covered. You’ll need to contact your Primary Care Clinic (PCC) to get a referral to the clinic that you have used in the past, in order that those costs be covered. No referrals are needed for emergency room or urgent care visits. You can also self-ref to OBGYN, Chiropractors, Routine Vision, Mental Health/Chemical Dependency, as long as the doctor is within the carrier’s self-referral network. 

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• How do I change my primary care clinic after Active Enrollment? Do I need to notify SPPS?

  Once initial enrollment is complete; all future clinic changes are made by the member contacting their network carrier customer service (the phone number on the back of ID card). The change will be handled over the phone. This includes annual enrollments in subsequent years, if no network carrier change is made. The member does not notify SPPS or Innovo. Members can change clinics monthly. Note: It is considered a new enrollment if an employee changes network carriers at open enrollment, so the primary care clinic choice would be required and captured during the enrollment process.  

• What happens if I don’t select a primary care clinic at enrollment?

  Enrollment in PEIP is not complete without the member choosing their primary care clinic for themselves and any covered family members. This is very important as plan benefits and specialist referrals are based on member’s choice of primary care, so this selection is required for all members. If enrollment is not complete, enrollment will be delayed. The clinic directory can be found at innovomn.com. (2021 clinic directory will be available October 15th.)

  If you elect or default into core coverage and do not select a Primary Care Clinic you will default into HealthPartners Midway Clinic as your PCC.

  HealthPartners Midway Clinic

  451 N Dunlap St,

  St Paul, MN 55104

• Who is CVS Caremark?

  CVS Caremark is the pharmacy benefit manager for PEIP and provides prescription services for all three networks. Caremark has a nationwide network of more than 68,000 participating retail pharmacies. You do not need to go to a CVS retail pharmacy for your prescriptions. With CVS Caremark, members will have convenient access to a large network of retail pharmacies, specialty services and mail order services. The Pharmacy Locator and Drug Formulary tools are available at innovomn.com.

• What happens if I don’t get a referral to see a specialist?

• Except for OBGyn, Mental Health, Chemical Dependency, Chiropractic Care and Routine Vision, there is no coverage for specialists or specialty services without a referral from your primary care. This does not include Emergency or Urgent Care and online visits; these services are covered both in and out of network and do not require a referral.

• Do I have to meet the deductible before the copays apply for prescription drugs?

  Yes, for the HSA plan only. No, for the Advantage High plan; this plan does not have a deductible to meet for prescription drugs – just copayments until the prescription out of pocket maximum is reached.

• How does the separate Rx out-of-pocket maximum work?

  For the Advantage High plans, members only pay the copayment amount for prescription drugs (or the cost of the drug, whichever is lower). Once the member’s copayments total a certain amount (see N. Plan Maximum for Prescription Drugs on Summary), the member has 100% coverage for eligible prescription drugs for the remainder of the plan year. (For the HSA, the deductible and out of pocket maximum is combined. Once the combined out of pocket maximum is met, member has 100% coverage for eligible medical and prescription drugs for the remainder of the year.)

• I see on the Innovo (PEIP) website an Employee Enrollment Form. Do I need to complete this?

  No, all enrollments for active employees will be handled through the District’s online enrollment system.

• Are eye exams covered under the PEIP Advantage program?

  Yes, routine eye exams are covered under the preventive benefit at 100%. Members must use a vendor within their carrier’s self-referral network for coverage. To find an in-network provider visit (innovomn.com).

• Does Cost Level 2, 3, or 4 mean that my premiums cost more money?

  No. Cost Levels only affect the costs you pay for care, including your deductible, out of pocket maximum, cost for office visits, or prescriptions.

• Does my Cost Level change if I choose a different network?

  Cost levels may be different depending on the network you choose (Blue Cross or HealthPartners). You will want to find your primary care clinic, and review the cost levels between each network.