Medical

Last updated date: 1/24/2024

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.

All of our medical plans provide:

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

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 deductible	You 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:

*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.

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

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

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.

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.

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.

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.

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

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)

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.