No. PEIP is a different carrier for insurance. So, you will need to pick a new network – Blue Cross and Blue Shield, HealthPartners, or PreferredOne, and then a plan within that network.

No. The HealthPartners network under PEIP has different plans, and different coverage than the HealthPartners plan you’ve had in the past.

The plan designs under PEIP are all very different than what you have currently.  PEIP offers three tiers, called “High” “Value” and “HSA Compatible”. Each of these has different costs within the different Cost Levels for deductible, out of pocket maximums, office visits, etc.   You’ll want to look at each plan design carefully to pick the one that best meets your needs.

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.

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

This chart has a more detailed comparison - Click HERE

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 Blue Cross/Blue Shield, HealthPartners, and PreferredOne 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.

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

EAs and TAs 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. 

The 2021 PEIP Primary Care Clinic directory can be found at this link:  http://www.innovomn.com/employeeplan.php

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).

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. 

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. 

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. 

Beginning January 2021: Educational Assistants, JROTC, School and Community Service Professionals (SCSP), Teachers and Teaching Assistants voted to participate in the PEIP medical coverage. All other bargaining units (unions) will be staying with HealthPartners and will continue to be offered the current medical plans.

Please contact your union with any questions regarding the voting or decision to move to the PEIP medical plans.

Yes, you can still elect an annual contribution during Open Enrollment to a health care flexible spending account if you are enrolled in a PEIP medical plan.

New for this year, the District is adopting a rollover provision which means up to $500 of unspent health care flexible spending account dollars will be available to use in the following year as long as you make the minimum election of $100 for the upcoming year. Any unspent amounts over $500 are forfeited. 

HealthPartners will continue to be the administrator of the flexible spending accounts.

There are a few easy ways to pay for request reimbursement. Your plan includes a debit card to use when you need to pay. You can also manually submit expenses in the app, online, by mail or fax.

From the MyHP app, select, Request Reimbursement and follow the steps to submit, attach a photo of your document and hit submit when done. 

From healthpartners.com, go to the my plan tab and select My Accounts under Spending.  Select the account you are submitting an expense for and select submit a claim.

For other options visit healthpartners.com/myfsa.

I am choosing HealthPartners as my network, why will I need to submit a claim for reimbursement under my health care flexible spending account?  

In moving to PEIP you will be enrolled under the PEIP group number for medical. Your health care flexible spending account will remain under Saint Paul Public Schools group number. The system cannot automatically reimburse medical claims for a participant whose medical is in one group and the flexible spending account is under another.

Yes, if you enroll in the PEIP HSA Compatible plan you can contribute to the Optum Health Savings Account by electing an amount to contribute during Open Enrollment. Remember, you cannot contribute to a health care flexible spending account and a health savings account at the same time. You also must be enrolled in a high deductible plan

If you have funds remaining in your Health Reimbursement Account as of 1/1/2021 you will be able to utilize those funds for qualified expenses until June 30, 2021. You will receive an email in November with additional details.

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.  

With timely enrollment, ID cards are expected to arrive the last two weeks of December 2020 for January 1, 2021 effective date. You will receive two ID cards – one from your network carrier for medical coverage (HealthPartners, BCBSMN, PreferredOne) and another from CVS Caremark for prescription drugs.

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

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.

PEIP has three plan options, similar to the current HealthPartners structure for 2020 (High plan, Mid-level plan, HSA-compatible plan), however, the PEIP program is a primary care driven model that utilizes a tiered network of providers. Deductibles and out of pocket maximums can vary for each plan design based on the cost level of the primary care clinic the member chooses (Cost Level 1 – 4). Once the member chooses their primary care clinic, and determines the cost level, employees can compare deductibles and out of pocket maximums. If further assistance is needed, employees can contact Innovo at 952-746-3101 or 800-829-5601.  

PEIP is a coordination of care model. Members must choose a primary care clinic and most care is handled or referred by the clinic, based on their care system protocols. Specialists require a referral, except OBGyn, Mental Health, Chemical Dependency, Chiropractic Care and Routine Vision, provided the practitioner is part of the self-referral network of their carrier. Members choosing HealthPartners-owned clinics can go to any HealthPartners-owned clinic without a referral.

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.

Yes, for the HSA plan only. No, for the Advantage High and Value plans; these two plan do not have a deductible to meet for prescription drugs – just copayments until the prescription out of pocket maximum is reached.

For the Advantage High and Value 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.)

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

Retirees and COBRA individuals will use paper Enrollment and Change Forms found on the PEIP website (innovomn.com). Send completed forms to SPPS District HR.

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).

PEIP is a comprehensive medical benefit plan covering medically necessary services for its members. There is a uniform set of benefits across all three carrier networks (HealthPartners, BCBSMN, PreferredOne); however, HealthPartners network provides a better benefit for infertility treatment. BCBSMN and PreferredOne cover infertility treatment up to the point of diagnosis only. Referrals, prior authorization or preferred vendors may be required for some services to be covered under PEIP. Please check your plan documents or contact your network carrier customer service for more information.

With any change in health plans, Prescription Drug Formulary’s can change as well. Preferred drugs and vendor may be different than your current plan but alternative name brand medications typically have the same ingredients and are chosen for their efficacy. New prescriptions for formulary medications may be needed. Members can review the Drug Tool for covered medications, their cost and low cost alternatives at innovomn.com. All Specialty Drugs will be serviced and dispensed through CVS Caremark Specialty Services – 800-237-2767.

Look for your 2021 Active Enrollment Brochure that is being sent prior to your designated Active Enrollment period. The brochure will have plan information, pricing and more resources for you to learn about your 2021 benefit plan offerings.

For PEIP specific coverage questions, please send an email to margo@innovomn.com or visit innovomn.com.

For more information please visit spps.org/benefits.

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

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