Medical & prescription drugs

Medical coverage, administered by Cigna, is bundled with dental/vision/hearing coverage under the Certificated Employee Health Plan. The medical plan covers a wide range of services, including preventive care, office visits, surgery, hospital stays and prescription drugs. Your cost for coverage is lowest when you take the Cigna health assessment.

 

How the plan works

The medical plan centers around Cigna’s Open Access Plus (OAP) network of health care providers. When you use OAP network providers and facilities, you receive in-network benefits and generally pay less out of your own pocket.

 

You also have the flexibility to use providers outside the OAP network and still receive benefits; however, you will receive lower out-of-network benefits and likely pay more out of your pocket. Out-of-network benefits are also subject to Cigna’s maximum reimbursable charge; if your out-of-network provider’s charges exceed this limit, you will be responsible for paying the difference.

 

Choosing a provider

You don’t have to select a primary care physician, and you don’t need a referral to see a specialist. However, your out-of-pocket costs will be lower if you use Cigna in-network providers. To find network providers, call 1-800-24Cigna (1-800-244-6224) or:

• If currently enrolled in an MNPS Cigna plan, visit myCigna.com.

• If not yet enrolled, visit cigna.com and search for a provider under Open Access Plus.

 

How much you pay

The amount you pay depends on the service or product you receive. Office visits and prescription drugs are covered with a copay. A copay is a set dollar amount you pay for a service or product provided. If a copay is charged, the deductible does not apply; the plan pays benefits even if your deductible is not satisfied. Copays do not count toward your deductible.

 

Other services require you to meet a deductible first, then pay a percentage of the cost (coinsurance). Only the cost of covered services apply toward the deductible. The family deductible is three times the amount of the individual on your the health plan.

 

Once you reach the out-of-pocket maximum in a calendar year, the plan will pay 100% for covered expenses for the remainder of that calendar year. Amounts paid toward the deductible, coinsurance and medical copays do apply toward your medical out-of-pocket maximum.

 

Medical benefits ... at a glance

Click on chart to view or download a pdf file.

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Medical In-network Out-of-network Lifetime maximum medical benefits Unlimited Unlimited Y ou pa y ... Annual deductible $300/person; $900/family $800/person; $2,050/family Annual medical out-of-pocket maximum $2,500/person $7,500/family $5,000/person W ellness Preventive care/immunizations $0 40% after deductible Office/routine care MNPS Employee & Family Healthcare Center visits $0 Primary care visits/convenient care clinics $30 40% after deductible Mental health/substance abuse o f fice visit $0 40% after deductible Specialist visits $40 40% after deductible Lab and x-ray in physician s o f fice $0 40% after deductible Urgent care facility $30 $30 Chiropractic (up to 24 visits/year) $40 Not covered Physical, occupational and speech therapy 10% after deductible 40% after deductible Durable medical equipment 10% after deductible 40% after deductible Maternity/fertility Prenatal care Y ou pay $30 copay for initial visit 40% after deductible Delivery 10% after deductible 40% after deductible Fertility Call 1-855-507-63 1 1 Not covered Hospital care/outpatient facility Inpatient hospitalization 10% after deductible 40% after deductible Outpatient surgery 10% after deductible 40% after deductible Outpatient/diagnostic facility 10% after deductible 40% after deductible Emergency (copay waived if admitted) $150, then 10% after deductible Ambulance 10% after deductible Skilled nursing facility 10% after deductible 40% after deductible Home health care 10% after deductible 40% after deductible Mental health and substance abuse Inpatient treatment 10% after deductible 40% after deductible Outpatient therapy (individual and group) 10% after deductible 40% after deductible

Prescription drugs

The medical plan covers prescription drugs for a flat dollar amount called a copay. The amount you pay depends on the drug’s tier, as shown in the chart below. Certain preventive drugs have a $0 copay. Visit cigna.com/mnps to see the list of no-cost preventive drugs, as well as a list of covered brand name drugs in the preferred tier. Prescription drug copays do apply to your pharmacy out-of-pocket maximum, which is separate from the medical out-of-pocket maximum.

 

Brand name vs. generic

If you choose a brand name drug when a generic is available, you will pay the brand name copay, plus the cost difference between the brand name and the generic. There is one exception: If your doctor specifies that the brand name drug is medically necessary and gets required authorization from Cigna, you will pay only the brand name copay.

 

Cigna Home Delivery

Through Cigna Home Delivery, you can save money on 90-day supplies of medication you take regularly. Standard delivery is available at no additional cost. Call 1-800-285-4812 to get started.

 

Prescription drug benefits ... at a glance

Click on chart to view or download a pdf file.

Fertility benefits

MNPS has partnered with Progyny, the leading fertility benefits provider, to provide an all-inclusive family-building benefit for every unique path to parenthood. This comprehensive, new benefit includes:

  • Coverage for IUI, IVF and more

  • Access to the largest national network of premier fertility specialists

  • Unlimited guidance and personalized support from a Patient Care Advocate throughout your fertility journey

 

The Progyny benefit is available to certificated employees and their spouses/partners covered by the MNPS Cigna medical plan. To learn more and get started, call 1-855-507-6311, or view an overview flier or the Progyny Member Guide.

Questions and more information

If you have questions about the medical plan, call Cigna Customer Service at 1-800-Cigna24 (1-800-244-6224) 24 hours a day, 7 days a week. TTY/TDD users should call 1-800-987-8816.

 

Summary of Benefits and Coverage

In accordance with the Patient Protection and Affordable Care Act (ACA), MNPS and Cigna have created a Summary of Benefits and Coverage (SBC), which provides additional information about your MNPS medical plan. You can find the SBC online at Benefit Express. Or you may request a free, printed copy by contacting Employee Benefit Services at 615-259-8607 or benefits@mnps.org.

Want to save hundreds of dollars on health care? Spend 15 minutes and take the confidential health assessment at myCigna.com. You’ll qualify for the lowest coverage premiums.

Cigna programs

If you have Cigna medical coverage, you and your family members have access to these valuable Cigna programs at no additional cost to you:

 

24-Hour Health Information Line

This service gives you 24/7 telephone access to a registered nurse. Get after-hours advice about symptom management, when to seek treatment and more by calling 1-800-244-6224.

 

Televisits with AmWell and MDLIVE

Have you ever been faced with a sick child in the middle of the night? Or needed care while traveling or when your regular doctor is not available? You have a convenient alternative to convenience care clinics, urgent care centers or the ER for minor conditions such as sore throat, headache, stomachache, fever, colds and flu, allergies, rashes, UTIs, etc. You can connect with a board-certified doctor via secure video chat or phone. Register for one or both services so you’ll be ready when you need telehealth services:

 

myCigna.com

On myCigna.com, once you register for a user ID and password, you can access a secure members-only website and:

  • View details about your plan, including claims information

  • Find wellness discounts

  • Search for doctors and medical services

  • Manage and track claims

  • See cost estimates for medical procedures

  • Compare quality of care ratings for doctors and hospitals

  • Access health and wellness tools and resources

  • Download the myCigna app

  • And more!

This page provides a summary of benefits covered by the medical plan, but does not outline every limitation or exclusion of the Certificated Employee Health Plan. The plan document is the legal publication that defines eligibility, enrollment, benefits and administrative rules. A copy of the plan document can be found at Benefit Express.

EMPLOYEE BENEFIT SERVICES

615-259-8607

2601 Bransford Avenue

Nashville, TN 37204

benefits@mnps.org

615-214-8665 (fax)

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