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Town of Hilton Head Island Health & Dental Benefits

State Health Plan

The State Health Plan provides employees and dependents with valuable medical coverage when needed. Coverage under the State Plan generally begins the first of the month following the date of hire. Employees may choose from two types of coverage:

The Standard Plan is a traditional PPO and offers a $350 individual ($700 family) deductible and 20% co-pay for in-network services. This plan has an annual in-network coinsurance maximum of $2000/individual or $4000/family. Prescription Drug coverage is included in the plan. The copay is $9 for generics, $30 for preferred brands, and $50 for non-preferred brands (31 day supply). Mail-order available (up to 90 day supply) with copay of $22 for generics, $75 preferred brands, and $125 for non-preferred brands. There is a $2500/person annual co-payment maximum for prescriptions.

The Savings Plan is a High Deductible Health Plan (HDHP) and offers a $3000 individual ($6000 family) deductible and 20% co-pay for in-network services. This plan has an annual in-network coinsurance maximum of $2000/individual or $4000/family. Prescription drugs are subject to the deductible, coinsurance and coinsurance maximum applicable to other services under the plan. Employees enrolled in the Savings Plan may utilize a Health Savings Account to save money on a pre-tax basis to fund expenses not covered by the plan.

Health Maintenance Organizations

As an alternative to the State Health Plan options, two Health Maintenance Organizations (HMOs) are available. Both Cigna HealthCare HMO and BlueChoice HMO offer no deductible for physician office visits. Cigna has a $15 co-pay for Primary Care Physician visits and a $30 co-pay for specialist visits. BlueChoice has a $15 co-pay for Primary Care Physician visits and $40 co-pay for specialist visits. The prescription drug coverage under the HMOs differs slightly. Cigna’s co-pay is $7 for generic prescriptions, $25 for preferred brand names and $50 for non-preferred brand names while BlueChoice's co-pay is $8/$15 for generic prescriptions, $35 for brand names, $55 for non-preferred brand names and $80/$125 for Specialty Pharmaceuticals (31 day supply).

State Dental Plan

The State Dental Plan offers coverage for a variety of services at a reasonable cost. Services include diagnostic & preventative, basic (fillings, extractions, etc.), prosthetics (crowns, bridges, etc.) and orthodontia.

Dental Plus

This supplemental, optional plan offers a higher level of dental coverage for the same services covered under the Standard Dental Plan (SDP) except for orthodontia. Dental Plus premiums are in addition to SDP premiums. The level of coverage (e.g. employee only, family) under the SDP must be maintained under Dental Plus.

State Vision Plan

The State Vision Plan is provided through EyeMed Vision Care and offers coverage for eye exams, eyeglasses and contact lenses. Some highlights of the program include: $10 copay for a comprehensive eye exam once a year; $140 allowance for any frame, with a 20% discount on the balance over $140; $10 copay on standard lenses and fixed pricing on premium options; and $130 allowance for conventional and disposable contact lenses, instead of eyeglass lenses. You may choose to use a network or non-network provider for your vision needs. Using a non-network provider may result in you paying more for covered services.

Vision Care Discount Program

The Vision Care Discount Program is a no cost alternative to the State Vision Plan.  Under the discount program, participating ophthalmologists and optometrists throughout the state have agreed to charge no more than $60 for a routine, comprehensive eye examination. Fittings for contact lenses may result in additional charges. Participating providers including opticians have also agreed to give a 20% discount on all eyewear (excluding disposable contact lenses).

Monthly Employee Rates for the above Health, Dental, and Dental Plus and Vison Plans are as follows:

Payments may be made on a pre-tax basis

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