Medical
Monte Nido & Affiliates offers three medical plan options through Cigna.
Before you enroll in medical coverage, take some time to fully understand how each plan works. See page 6 for an overview of the plan benefits.
ASK YOURSELF THESE QUESTIONS:
Can you set aside money from your paycheck to save for out-of-pocket health care costs?
Consider the Cigna HDHP OAP plan. You will have the option to fund a health savings account (HSA) that can save you money on your health care costs.
Do you prefer to pay less when you visit the doctor’s office?
Consider the Cigna PPO 1500 OAP or EPO 500 plan. While you will pay more from your paycheck each month for coverage, you will only be responsible for a small copay or cost share when you need care.
Do you or your covered family members prefer to use in-network providers?
Consider choosing the Cigna EPO 500 plan. This plan offers in-network benefits only. You’ll pay less from your paycheck each month for coverage if you plan to use in-network providers only.
MEDICAL COSTS
Listed below are the per pay period costs for medical insurance. The amount you pay for coverage is deducted from your paycheck on a pre-tax basis, which means you don’t pay taxes on the amount you pay for coverage.
The Cigna HDHP and PPO plans offer in- and out-of-network benefits, providing you the freedom to choose any provider. However, you will pay less out of your pocket when you choose a Cigna Open Access Plus (OAP) provider.
The Cigna EPO 500 plan offers in-network benefits only. Services received by a non-network provider will not be covered by the plan, except in the case of a true emergency situation. Locate a Cigna OAP provider at cigna.com.
The table below summarizes the benefits of each medical plan. The coinsurance amounts listed reflect the amount you pay. Please refer to the official plan documents for additional information on coverage and exclusions.
ARE YOU COVERING YOUR SPOUSE AND/OR CHILDREN?
- If you are enrolled in the EPO 500 or the PPO 1500 OAP medical plan, once one family member meets the individual
deductible, the deductible is satisfied for that member. - If you are enrolled in the HDHP OAP at the employee level, once you meet the $2,700 individual deductible, benefits begin to be paid for you.
- If you are enrolled in the HDHP OAP at the Employee + Spouse, Employee + Child(ren), or Employee + Family level, once one family member meets the $2,800 “individual within a family” deductible, benefits begin to be paid for that individual.
- Once one family member meets the individual out-of-pocket maximum, the plan pays covered benefits in full for that individual.
PREVENTIVE CARE
In-network preventive care is 100% free for medical plan members.
You won’t have to pay anything out of your pocket when you receive in-network preventive care. Practice preventive care and reap the rewards of a healthier future.
Preventive care helps keep you healthier long-term.
An annual preventive exam can help IDENTIFY FUTURE HEALTH RISKS and treat issues early when care is more manageable and potentially more effective.
Preventive care helps keep your costs low.
With a preventive care exam each year, you can TARGET HEALTH ISSUES EARLY when they are less expensive to treat. You can also effectively manage chronic conditions for better long-term health.
Preventive care keeps your health up to date.
Yearly check-ins with your doctor keeps your health on track with AGE-AND GENDER-SPECIFIC EXAMS, VACCINATIONS, AND SCREENINGS that could save your life.
Some services are generally not considered preventive if you get them as part of a visit to diagnose, monitor, or treat an illness or injury. Please be aware that you will be responsible for the cost of any
non-preventive care services you receive at your preventive care exam based on your plan design.
Learn more about preventive care at mycigna.com.
VIRTUAL CARE
You have access to virtual care through MDLIVE. Get the care you need when and wherever you need it. Whether you’re on the go, at home, or at the office, care comes to you in the form of virtual care.
Get care for non-emergency conditions.
Virtual care can connect you to a doctor, without an appointment, from your phone, computer, or tablet. Receive care for common health issues like allergies, asthma, sore throat, fever, headache, rashes, and much more.
Receive mental health support and counseling.
Licensed counselors and psychiatrists can help diagnose, treat, and even prescribe medication when needed for depression and anxiety, substance abuse and panic disorders, PTSD, men and women’s issues, grief and loss, and more.
Talk with a doctor by phone or video, 24/7.
Use virtual care to prioritize your health by getting the care you need when you need it. Visit mycigna.com, download the myCigna mobile app, or call 888-726-3171 to get started.
Know where to go for care.
Where you go for medical services can make a big difference in how much you pay and how long you wait to see a health care provider. Use the chart below to help you choose where to go for care.
CIGNA TOOLS AND RESOURCES
CIGNA HEALTHY REWARDS
You and your covered dependents have access to the Cigna Healthy Rewards discount program AT NO COST. Get discounts on the health products and programs you use every day such as weight management and nutrition programs, vision and hearing care, alternative medicine, fitness clubs, and more!
For more information visit mycigna.com.
OMADA
Omada combines the latest technology with ongoing support so you can make the changes that matter most—whether that’s around eating, activity, sleep, or stress. If you or your covered adult dependents are at risk for type 2 diabetes or heart disease, Omada is available AT NO COST.
Visit omadahealth.com/omadaforcigna to find out if you are eligible to enroll.
CIGNA ONE GUIDE
Cigna One Guide provides a personalized member experience that can help you make smarter, more informed choices, and get the most from your medical plans. Access Cigna One Guide for help understanding your plan, finding providers, estimating out-of-pocket costs, navigating claims and explanations of benefits, searching for medication, and more.
For more information, call 800-244-6224, visit mycigna.com, or download the myCigna mobile app.
PRICE A MEDICATION
When you and your doctor are considering the right medication for your treatment, knowing how much the medication will cost can help you avoid surprises at the pharmacy. The Price a Medication feature lets you compare prices, view lower-cost alternatives, see which medications your plan covers or if it needs approval, and more.
For more information, download the myCigna app and click “Price a Medication.”
CIGNA 90 NOW
The Cigna 90 Now program makes it easier for you to fill your maintenance medications. Maintenance medications are taken regularly, over time, to treat an ongoing health condition such as diabetes, high blood pressure, high cholesterol, or asthma.
The Cigna 90 Now program offers convenient options for your 30- or 90-day supply of your medications through select in-network retail pharmacies or Express Scripts home delivery.
For more information, visit cigna.com/rx90network or call 800-835-3784.
Resources
PLAN SELECTOR TOOL
- Please download and unzip the Plan Selector Tool.
- If you're using a PC
- Right-click on the Plan Selector Tool where you downloaded the file and choose extract all.
- Follow the instructions to extract the Excel file.
- Open the Excel file and allow macros to be enabled for the tool to work.
- If you're using a Mac
- Double-click on the Plan Selector Tool where you downloaded the file to extract the file automatically.
- Open the Excel file and allow macros to be enabled for the tool to work.
HOW TO ENROLL
Self-enroll in your benefits through ADP.
Review the available plan options and log into www.workforcenow.adp.com.
To start the enrollment process, navigate to Myself > Benefits > Enrollments.
Add or edit your dependents and beneficiaries.
You will need a social security number and date of birth to add a dependent or beneficiary.
Elect or decline coverage.
Review your elections before you submit.
Once you have finalized your enrollment, print your confirmation statement or send it to yourself via email and keep for your records.