Health Insurance Coverage
through the Dirigo Health Agency

Dirigo is Open and Accepting New Enrollees
DirigoChoice provides health coverage to small businesses, self-employed, and certain groups of people buying coverage outside of a workplace. The plan is offered through the Dirigo Health Agency and Harvard Pilgrim Health Care (HPHC).

DirigoChoice – what does it cover?

• Routine preventive care
• Inpatient/outpatient services
• Prescription drug coverage
• Maternity care
• Well-child care
• Childhood immunizations
• Emergency care
• Mental health services
• Smoking cessation education programs

There is no deductible for preventive services or prescription drugs. You don’t need a referral to see a specialist. DirigoChoice has an extensive provider network throughout Maine.

DirigoChoice – how much does it cost?
Eligible enrollees receive discounts on the monthly cost, deductibles and annual out-of-pocket expenses based on income, household size, and assets. Discount levels range from 10% to 80% off the monthly premium, depending on income and family size. To view available discounts on monthly costs, deductibles, and out-of-pocket expenses, go to the DirigoChoice Discount Estimator.
Please note that the level of subsidy is changing in October of 2011.

DirigoChoice – who can apply?
DirigoChoice is available to residents of the State of Maine in the following categories:

• Small Employers (2-50 employees)
• Sole Proprietors (Self-employed of 1)
• Individuals

There are no pre-existing condition restrictions. Domestic partners can be covered as well.

There are three plan options. The benefits are the same for all options but the deductible levels and out-of-pocket maximums are different.

• Plan 1: Not Available (N/A) for Individuals and Sole Props
• Plan 2: $1,750 deductible
• Plan 3: $2,500 deductible

Discounts are applied to monthly premium payments. Those discounts then result in reductions in deductible and annual out-of-pocket expenses.

For instance, if an individual was eligible for a Group B discount (80%) the deductible and out-of-pocket costs for the plans available to individuals, effective October 2011, would be:

Group B - 80% Discount		Deductible	Out-of-Pocket
Plan 1	N/A for Individuals	N/A for Individuals	N/A for Individuals
Plan 2	Single	$750	$1,850
	Family	$1,250	$3,450
Plan 2	Single	$750	$950
	Family	$750	$1,650

To be eligible for Group B an individual would have to have income less than $16,245 and assets less than $15,000 OR a family of 3 would have to have income less than $27,465 and assets less than $30,000.

This sliding scale of monthly payments, deductibles, and out of pocket maximums helps make DirigoChoice more affordable to enrollees.

DirigoChoice Contact Information
For more information or to request an application visit the DirigoChoice website
or call the DirigoChoice office:
Toll Free #: 1-877-892-8391 / TTY: 1-207-287-4344
Fax #: 1-207-287-9922