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Last updated date: 10/28/2024

CHOC provides valuable benefits to help you and your family stay well and access quality health care when you need it.

Overview

Your medical plan options include a range of coverage levels and costs, so you can choose the one that’s best for you. You can enroll as a new hire, newly eligible for coverage, during Open Enrollment, or if you have a qualifying life event. To enroll, log in to the Workday website.

Key features

All of our medical plans provide:

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Comprehensive, affordable coverage

for a wide range of health care services.

Free in-network preventive care

with services such as annual physicals, recommended immunizations, and routine screenings all 100% covered.

Prescription drug coverage

provided by Cigna.

Financial protection

through annual out-of-pocket maximums that limit how much you’ll pay each year.

2024 medical plans

HDHP 2000 and HDHP 6000

Administered by: Cigna

The HDHP 2000 and HDHP 6000 offset a high deductible with a tax-free Health Savings Account (HSA) (with contributions from CHOC).

Details

Cigna PPO

Administered by: Cigna

Reduce your out-of-pocket costs for care through a lower deductible and higher premiums.

Details

Cigna Select Network HMO

Administered by: Cigna

Receive coverage for in-network care only, coordinated by your primary care provider (PCP). The Cigna Select Network HMO plan provides access to a narrow network of providers compared to the Cigna Full Network HMO plan. However, you’ll have a lower deductible if you enroll in the Cigna Select Network HMO plan.

Details

Cigna Full Network HMO

Administered by: Cigna

Receive coverage for in-network care only, coordinated by your primary care provider (PCP). The Cigna Full Network HMO plan comes with a higher deductible than the Cigna Select Network HMO plan, but you’ll have access to the Cigna Full HMO Network of providers.

Details

How much does CHOC medical coverage cost?

CHOC pays a generous portion of the cost of your medical coverage. You’ll pay the remaining amount through pre-tax premiums from your paycheck. The amount you pay will depend on which plan you choose and whether you cover just yourself or family members, too. You can view your plan costs on the Workday website.

Plan Comparison

Use this interactive side-by-side plan comparison to understand key differences between the plans.

HDHP 2000 HDHP 6000 Cigna PPO Cigna Select Network HMO Cigna Full Network HMO
HSA features
HSA-eligible Yes Yes No No No
CHOC contribution to HSA $500 for employee-only coverage or $1,000 if you cover dependents $500 for employee-only coverage or $1,000 if you cover dependents None None None
Annual deductible
In-network Individual: $2,000
Individual in a family: $3,200
Family: $4,000		 Individual: $6,000
Individual in a family: $6,000
Family: $12,000		 Individual: $1,000
Individual in a family: N/A
Family: $2,000		 Individual: $250
Individual in a family: N/A
Family: $500		 Individual: $500
Individual in a family: N/A
Family: $1,000
Out-of-network Individual: $4,000
Individual in a family: $3,200
Family: $8,000		 Individual: $10,000
Individual in a family: $10,000
Family: $20,000		 Individual: $1,000
Individual in a family: N/A
Family: $2,000		 N/A N/A
Coinsurance
In-network You pay 20%, plan plays 80% You pay 30%, plan plays 70% You pay 20%, plan plays 80% You pay 20%, plan plays 80% You pay 20%, plan plays 80%
Out-of-network You pay 40%, plan pays 60% You pay 50%, plan pays 50% You pay 40%, plan pays 60% N/A N/A
Annual out-of-pocket maximum 
In-network Individual: $4,000
Individual in a family: N/A
Family: $8,000		 Individual: $7,500
Individual in a family: $7,500
Family: $15,000		 Individual: $4,000
Individual in a family: N/A
Family: $8,000		 Individual: $1,500
Individual in a family: $3,000
 Individual: $1,500
Individual in a family:$3,000
Out-of-network Individual: $8,000
Individual in a family: N/A
Family: $16,000		 Individual: $15,000
Individual in a family: $15,000
Family: $30,000		 Individual: $6,000
Individual in a family: N/A
Family: $12,000		 N/A N/A
Health care visits: Your costs
Preventive care You pay nothing in-network, covered 100% You pay nothing in-network, covered 100% You pay nothing in-network, covered 100% You pay nothing in-network, covered 100% You pay nothing in-network, covered 100%
Primary care (in-network) You pay 20% after deductible You pay 30% after deductible You pay 20% after deductible $25 copay* $30 copay*
Primary care (out-of-network) You pay 40% after deductible You pay 50% after deductible You pay 40% after deductible N/A N/A
Specialist (in-network) You pay 20% after deductible You pay 30% after deductible You pay 20% after deductible $40 copay* $50 copay*
Specialist (out-of-network) You pay 40% after deductible You pay 50% after deductible You pay 40% after deductible N/A N/A
Behavioral health – outpatient (in-network) You pay 20% after deductible You pay 30% after deductible You pay 20% after deductible $25 copay* $30 copay*
Behavioral health – outpatient (out-of-network) You pay 40% after deductible You pay 50% after deductible You pay 40% after deductible N/A N/A
Telehealth (in-network) You pay 20% after deductible You pay 30% after deductible You pay 20%, after deductible $25 copay primary care / $40 copay specialist* $30 copay primary care / $50 copay specialist*
Urgent care (in-network) You pay 20% after deductible You pay 30% after deductible $50 copay* $50 copay (waived if admitted)* $50 copay (waived if admitted)*
Urgent care (out-of-network) You pay 20% after deductible You pay 30% after deductible $50 copay* N/A N/A
Emergency room (in- and out-of-network) You pay 20% after deductible You pay 30% after deductible $200 copay (waived if admitted)* $200 copay (waived if admitted)* $200 copay (waived if admitted)*
Physical, Occupational & Speech Therapy
You pay 20% after deductible
You pay 30% after deductible
You pay 20% after deductible$25$30
Chiropractic
You pay 20% after deductible
You pay 30% after deductibleYou pay 20% after deductible$10 (20 visits max per year)$10 (20 visits max per year)
Prescriptions – 30-day supply at retail pharmacy: Your costs
Generic $10 copay after deductible $10 copay after deductible $15 copay* $15 copay* $15 copay*
Brand $30 copay after deductible $30 copay after deductible $30 copay* $40 copay* $50 copay*
Non-formulary $50 copay after deductible $50 copay after deductible $45 copay* $60 copay* $75 copay*
Specialty $50 copay after deductible $50 copay after deductible $45 copay* $60 copay* $75 copay*
Prescriptions – 90-day supply (mail order or retail pharmacy): Your costs
Generic $20 copay after deductible $20 copay after deductible $30 copay* $40 copay* $40 copay*
Brand $60 copay after deductible $60 copay after deductible $60 copay* $115 copay* $145 copay*
Non-formulary $100 copay after deductible $100 copay after deductible $90 copay* $175 copay* $220 copay*
Specialty N/A N/A N/A $175 copay* $220 copay*

*Deductible does not apply.

HDHP Plans

The HDHP 2000 and HDHP 6000 pair high-deductible coverage with a tax-free Health Savings Account (HSA) that helps you save money and plan ahead for future medical expenses. This combination gives you more control over your money and rewards you for making healthy, cost-conscious choices.

As an added bonus, CHOC will contribute to your HSA — $500 for employee only coverage or $1,000 if you cover dependents. With these plans, you can see any provider you wish, but you will pay less when you stay in network.

How the HDHP 2000 and HDHP 6000 work

You pay the plan premiums from your paycheck to have coverage. When you receive in-network preventive care, you pay nothing — it’s covered in full! If you need non-preventive care, it works like this:

You pay 100% of your medical and prescription costs until you meet the annual deductible.*

Deductible

After meeting the deductible, you and the plan share the cost of covered medical care and prescriptions, with the plan paying the majority.

Coinsurance

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

Out-of-Pocket Maximum

Remember to use your tax-free HSA to pay for eligible expenses and plan ahead for future costs. CHOC contributes money to your account, too!

HSA

*Each individual in a family must meet their own individual deductible until the total amount of expenses paid by all family members meets the overall family deductible.

Use your HSA to save money and plan ahead!

Contributing to your HSA is a great way to budget for deductibles and other out-of-pocket expenses while also saving money — your HSA contributions are tax-free!*

Keep in mind:

  • You can only spend HSA money already deposited into your account. If you don’t have enough money in your HSA when you need it, you can pay another way and reimburse yourself later to take full advantage of your HSA’s tax savings
  • You will never forfeit any money left in your HSA — it rolls over each year. To save for your health care costs in retirement or prepare for future expenses, set aside a little extra each paycheck to grow your balance
  • You can change your HSA contribution amount throughout the year, if needed
  • You can pair your HSA with a tax-free Limited Purpose Flexible Spending Account (FSA) to save even more

*HSA contributions are not subject to federal income tax, but are currently subject to state income tax in CA and NJ. Consult with your tax advisor to understand the potential tax implications of enrolling in an HSA. Money in an HSA can be withdrawn tax-free as long as it is used to pay for qualified health-related expenses. If money is used for ineligible expenses, you will pay ordinary income tax on the amount withdrawn, plus a 20% penalty tax if you withdraw the money before age 65.

PPO Plan

The Cigna PPO offers slightly lower out-of-pocket costs in exchange for higher premiums, making your costs more predictable. You can see any provider, but you’ll pay less by staying in network.

How the Cigna PPO works

You pay the plan premiums from your paycheck to have coverage. When you receive in-network preventive care, you pay nothing — it’s covered in full! If you need non-preventive care, it works like this:

You pay a small fee for prescriptions. Copays do not count toward your deductible.

Copay

You pay 100% of your medical costs until you meet the annual deductible.

Deductible

After meeting the deductible, you and the plan share the cost of certain services, with the plan paying the majority.

Coinsurance

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

Out-of-Pocket Maximum

Save money with an FSA!

Take advantage of tax-free savings for health care payments with a Health Care Flexible Spending Account (FSA). However, plan your FSA contributions carefully: you can only carry over up to $570 of unused money in your FSA to the next year. You will forfeit any remaining amount above $570.

HMO Plans

The Cigna Select Network HMO and Cigna Full Network HMO plans provide coverage only when you receive care from providers within the HMO network. The Cigna Select Network HMO plan provides access to a narrow network of providers in exchange for lower deductible, copays and lower per-paycheck premium. The Cigna Full Network HMO plan provides access to a wider network of providers. To find an in-network provider in either the Select network or Full network, visit Cigna.

With both plans, your in-network primary care provider (PCP) will coordinate your care to help manage costs.

How Cigna Select Network HMO and Cigna Full Network HMO plans work

You pay the plan premiums from your paycheck to have coverage. When you receive in-network preventive care, you pay nothing — it’s covered in full! If you need non-preventive care, it works like this:

You pay a small fee at the time of service for doctor visits and prescriptions. Copays do not count toward your deductible.

Copay

For care that doesn’t charge a copay, you pay 100% of the costs until you meet the annual deductible.

Deductible

After meeting the deductible, you and the plan share the cost of certain services, with the plan paying the majority.

Coinsurance

You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.

Out-of-Pocket Maximum

Do you have a PCP?

An HMO requires you to select a primary care provider (PCP) who will manage your care and provide referrals if you need to see a specialist. Find a doctor>>

Save money with an FSA!

Take advantage of tax-free savings for health care payments with a Health Care Flexible Spending Account (FSA). However, plan your FSA contributions carefully: you can only carry over up to $570 of unused money in your FSA to the next year. You will forfeit any remaining amount above $570.

Retiree Medical Plan

The CHOC Retiree Medical Plan provides associates who retire from CHOC with the option of continuing their medical plan coverage. Eligibility for the Retiree Medical Plan requires retirement at age 62 or later with at least 10 years of service for associates who are enrolled in a CHOC medical plan at the time of retirement. Retiree Medical coverage ceases at age 65. Retirees will continue with the same plan they were enrolled in at the time of retirement.

Spouse/domestic partner

Coverage is offered provided they were dependents prior to the associate’s retirement and enrolled in the associate’s coverage. Coverage for the spouse/domestic partner ceases either at age 65, one year after the death of the retiree or upon remarriage, whichever is earlier.

For more information, please email benefits@choc.org.

Prescription Drugs

When you enroll in a CHOC medical plan, you automatically receive prescription drug benefits through Cigna.

Drug tiers

The cost of your prescription drugs under each medical plan depends on the tier of the medication — generic, preferred brands, or non-preferred brands. All prescription carriers have a formulary, or list of drugs based on effectiveness and cost. This list will determine how your prescriptions are covered. Keep in mind that the formulary may change as a result of regular reviews and updates.

Learn about the drug tiers

Tier 1: Generic drugs
Tier 2: Preferred Brand drugs
Tier 3: Non-Preferred Brand drugs

You pay: $

Generic drugs have the same active ingredients as brand-name equivalents and meet the same standards for quality and effectiveness, but usually cost much less.

You pay: $$

Preferred Brand drugs are medium-cost, brand-name medications included on the plan’s formulary and favored by Cigna.

You pay: $$$

Non-Preferred Brand drugs are highest-cost, brand-name medications not preferred by Cigna. These medications usually have generic and/or preferred brand alternatives that are used to treat the same condition.

Pay less for your prescriptions

Ask your doctor about generic medications.

They’re generally just as effective as brand-name medications, but typically cost 80-85% less.

Use the home delivery feature.

Save time and money on maintenance medication for chronic conditions — such as an allergy, high blood pressure, or diabetes — with the convenient, cost-saving home delivery prescription programs through Cigna.

Take advantage of additional savings.

With the Cigna 90 Now program, you can save when you choose to fill a 90-day supply of your long-term medications at CVS pharmacies. You’ll take fewer trips to the pharmacy and pay for your prescriptions only once every three months.

Why use home delivery?

  • Free shipping on prescriptions
  • No waiting in line at the pharmacy
  • Reduced cost for a three-month supply
  • Convenient, automatic refills

Prescription programs

Your pharmacy benefits include several programs aimed at ensuring your safety and making sure you receive the most clinically appropriate and cost-effective medication.

Specialty medication

All prescriptions for specialty medication used to treat certain conditions (such as rheumatoid arthritis, multiple sclerosis, or psoriasis) must be filled through the Cigna specialty pharmacy, Accredo.

Dispense as written (DAW)

If your doctor writes DAW on a brand-name prescription when a generic alternative is available, you will pay the brand cost. Without DAW, you would also pay the price difference between the brand and generic drug.

Prior authorization

Some medications may require prior authorization from your doctor before receiving approval for coverage. This is done to ensure the medication is the best option for you.

Step therapy

Step therapy requires that you try the most cost-effective medications appropriate for your condition before more expensive medications can be approved for coverage.

Prescription tools

Visit your prescription plan website or download the mobile app to manage your prescriptions, order refills, sign up for home delivery, and more. Get started by creating an online account on the Cigna website.

Find a Doctor

Using in-network providers saves you money. Here’s how to find doctors in your medical plan network.

Cigna

If you are already a Cigna member, log into Cigna to search your plan’s network. Otherwise, follow these steps to find a doctor:

  • Visit the Cigna website and click on “Find a Doctor” at the top of the screen
  • Under “How Are You Covered,” select “Employer or School”
  • Change the geographic location to the city/state, or ZIP code where you want to search
  • Select the search type and enter a name, specialty, or other search term
  • You may also choose to search by distance, years in practice, specialty, languages spoken, and more
  • Click on one of the suggestions or click on the magnifying glass to see your results
  • Answer any clarifying questions
  • Select your plan’s network
  • That’s it! Choose the provider you’d like to see and contact them to schedule an appointment

Don’t have a personal doctor? You should. Here’s why.

  • Better health. Yearly health screenings can reduce your risk for many serious conditions. Preventive care is free, so there’s no excuse to skip it
  • Greater savings. Having a doctor you can call helps you avoid costly trips to the emergency room
  • Peace of mind. Your personal doctor gets to know you and your health history, provides advice you can trust, and helps coordinate your care

Telehealth

Your medical plan gives you access to telehealth services through MDLIVE through Cigna. Consider using telehealth for non-emergency medical or behavioral health care — it’s available from the comfort of your home or wherever you are.

Telehealth is a great option when:

  • You don’t feel up to going to the doctor’s office
  • You can’t get to your doctor because you’re traveling
  • You need care after hours (nights, weekends, holidays)

Try telehealth for fast, affordable care

MDLIVE through Cigna provides convenient telehealth services anytime, anywhere. You have 24/7 access to board-certified doctors by phone or video using the MDLIVE through Cigna mobile app or website. Doctors can diagnose, treat, and prescribe medication when needed for many common conditions. The cost for a telehealth appointment varies by medical plan, but is typically less than going to an urgent care center.

Talkspace

If you are enrolled in a Cigna medical plan, you have access to Talkspace online therapy. Choose a therapist from a list of recommended, licensed providers and receive support day or night from the convenience of your smart device. You can exchange unlimited messages (talk, voice, and video) with your personal therapist immediately after registration for help with issues like:

  • Stress
  • Anxiety
  • Depression
  • Trauma and grief
  • Sleep
  • And more

To get started, visit Talkspace and complete a QuickMatch survey to review your matches and choose your personal therapist.

Ginger

If you are enrolled in a Cigna medical plan, you also have access to Ginger virtual mental healthcare. With Ginger, coaches, therapists, and psychiatrists work as a team to coordinate the best, personalized care right from your smartphone, whenever you need it.

Ginger offers confidential mental healthcare through behavioral health coaching via text-based chats, self-guided learning activities and content, and, if needed, video-based therapy and psychiatry. Support is available 24/7/365 from anywhere.

To get started, visit Ginger.

Tools & Resources

Your medical plan offers additional features to help you get the most from your coverage.

Cigna Transparency in Coverage

Click here to download Cigna’s legal compliance documents.

Online tools

Log in to your medical plan website to:

  • Find a doctor
  • Compare costs
  • Manage claims
  • And much more

Get started by setting up an online account for your plan — Cigna.