Medical

The Manatee YourChoice Health Plan is the self-funded medical, dental and health management plan for the employees and their eligible dependents of Manatee County Government, including all of the Constitutional Agencies. What does self-funded or self-insured mean? It means Manatee County Government, through its own Health Plan, "Manatee YourChoice," uses their own plan design and pays for all health care directly instead of paying an insurance company to handle it. Although the Plan was created and designed by the Employee Benefits Division and is managed by the Employee Health Benefits Manager, the plan hires a "Third Party Administrator" (Aetna) to process claims, provide customer service support to members, and to run the Provider Network.

The YourChoice Health Plan has a very unique model that provides on-site, individualized and personalized clinical resources for employees. The clinical staff who support the Health Plan include Registered Nurse Case Managers, Clinical Pharmacist, Wellness/Fitness Coaches, Registered Dietitian, Diabetes Educator, and Behavioral Health Staff, all working as an integrated multi-disciplinary team under the direction of the County.

Four Health Plan Levels

Participants have the choice to enroll in one of four Health Plan Levels based upon completing specific Qualifying Events. The only difference among the four plans is the Level of Reimbursement. The level is determined by the co-pay, deductible or co-insurance, and the maximum out of pocket expense not including the deductible.

• ULTIMATE - Highest Level of Reimbursement ($25 co-pay, no deductible, no co-insurance)
• BEST - Middle to Highest Level of Reimbursement ($25 co-pay, $250 deductible & 20% co-insurance)
• BETTER - Middle Level of Reimbursement ($500 deductible & 25% co-insurance applies)
• BASIC - Lowest Level of Reimbursement ($1,000 deductible & 50%co-insurance applies)

All four plans have:

• Identical Medical, Prescription, and Behavioral Health covered services with identical monthly premiums.
• Choice to utilize the Network or Non-Network Providers.
• Choice to utilize or not to utilize Manatee YourChoice Qualifying Guidelines.
• Choice to utilize Wellbeing Programs.

Qualifying Events

A Qualifying Event is a specific course of action to be completed by a Member to determine which YourChoice Health Plan Level each Member is enrolled in for the Plan Year until the next Qualifying Event period. The Qualifying Event period is September 1 thru August 31.