2026 Open Enrollment Information: Individual Members

2026 Open Enrollment Information: Individual Members (COBRA/Directly Invoiced)

Open Enrollment will take place Oct. 13-31, 2025. The choices you make during that time will be for benefits effective Jan. 1-Dec. 31, 2026. Once you choose your benefit plan, you may not switch plans until the next Open Enrollment period. The coverage type you select (for example, subscriber-only) will remain in effect until the next benefit year, unless you experience a qualifying life event. 

The State Health Plan (Plan) continues to offer two Preferred Provider Organization (PPO) plans.

All members will be automatically enrolled into the Standard PPO Plan (formally known as the 70/30 Plan). If you would like to enroll in the Plus PPO Plan (formally known as the 80/20 Plan), you will need to TAKE ACTION during Open Enrollment.

An important message from Treasurer Briner

2026 Rate Sheets

2026 Open Enrollment Resources (More Coming Soon)

Important Notes About Your 2026 Benefits

  • There have been increases to copays and out-of-pocket costs.
  • Completing a tobacco attestation is no longer required to lower your monthly premium.
  • The Clear Pricing Project is ending Dec. 31, 2025. In 2026, the Plan is introducing Preferred Providers. These providers have been identified by the Plan as providers who are committed to improved access to high-quality, affordable health care. When you select and see one of these providers in 2026, you will pay the lowest copay for an office visit.
  • If you would like to change your selected Primary Care Provider (PCP) to a Preferred Provider, you will need to wait until after Jan. 1, 2026, to make that change. If your selected PCP is already noted as a Preferred Provider, you do not need to take any action. As a reminder, PCPs can be changed anytime, and ID cards typically arrive 7-10 days after the change is made.
  • The Plan is excited to be partnering with Lantern, a trusted provider that helps connect Plan members to a high-quality, carefully selected surgeon when you need a planned, non-emergency procedure. There will be no cost ($0) for the surgery for members who use a Lantern provider —no deductibles and no copays. Members will be getting more information directly from Lantern on this benefit. Medicare Primary members are not eligible.
  • The formulary (drug list), which determines what medications are covered and what tier they fall under, changes on a quarterly basis, so there is a possibility that you will have changes in your prescription coverage in 2026.
  • Preferred and non-preferred insulin continues to have a $0 copay for a 30-day supply.
  • Preventive Services remain covered at 100% – no copay or deductible – on either plan.

Pharmacy Resources

CVS Caremark is the State Health Plan’s Pharmacy Benefit Manager.

The State Health Plan utilizes a custom, closed formulary (drug list). The formulary indicates which drugs are excluded from the formulary and not covered by the Plan. All other drugs that are on the formulary are grouped into tiers. Your medication’s tier determines your portion of the drug cost.

These documents and tools include information based on the 2025 formulary and are subject to change prior to January 1, 2026.

Find a Doctor

Online resources to help you find a provider.

Open Enrollment Events

The State Health Plan is hosting several Open Enrollment events prior to and during Open Enrollment. Click here to view a complete list of events.

Need Help?

For questions or help regarding your enrollment, call the Plan’s Eligibility and Enrollment Support Center at 855-859-0966.