LocalPlus EPO
Reduce your out-of-pocket costs when you need care through a lower deductible and out-of-pocket maximum, but higher premiums than the Open Access PPO and the Open Access HSA.
Medical insurance helps you stay healthy and assists in the payment for care in the event of illness or injury. You have a choice of three medical plan options: LocalPlus EPO, Open Access PPO and Open Access HSA through Cigna Healthcare.
Your share of the costs for medical and pharmacy expenses will differ based on premium rates, deductible, coinsurance and out-of-pocket maximums for the plan option you choose.
All Cigna Healthcare medical plan ID cards are electronic. Your Cigna Healthcare medical plan ID card is available digitally for easy access on the go.
Visit mycigna.com or download the Cigna app to access your card. You can also print or email your card for easy access. For more details, read how to access your electronic ID card or review frequently asked questions
2024 Medical Plan Options
Open Access PPO
Reduce your out-of-pocket costs when you need care through a lower deductible and out-of-pocket maximum, but higher premiums than the Open Access HSA.
Open Access HSA
Enjoy initial savings through lower premiums for the Open Access HSA than the LocalPlus EPO and the Open Access PPO.
The Open Access HSA has a tax-free Health Savings Account (HSA) with automatic contributions from Lurie Children’s.
How the plans are the same
All Lurie Children’s medical plans through Cigna provide comprehensive benefits and share the following attributes:
Prescription drug coverage.
All medical plan options include prescription drug coverage through CVS/Caremark, and all three plans require you to use network pharmacies.
Free in-network preventive care.
Services like annual physicals, recommended immunizations, and routine cancer screenings are fully covered at 100% in-network, so you pay nothing. See a full list of covered preventive care services.
Cost sharing.
For non-preventive services you pay for a portion of your medical expenses through deductibles, copays and coinsurance.
Out-of-pocket maximum.
While the out-of-pocket maximum amounts vary, each plan protects you by capping the total amount you’ll pay each year for medical care. Once you meet your out-of-pocket maximum, the plan pays 100% of eligible expenses for the rest of the year.
What’s covered and who can be covered.
All three of the plans cover the same healthcare conditions and services. Eligibility for you and your dependents is the same under each plan option. Refer to eligibility details below.
Employee Eligibility
As an employee of Lurie Children’s you are eligible for benefits if you are budgeted to work at least 40 hours per pay period (.5 FTE or greater).
- Full-time Regular: budgeted at a 0.75 to 1.0 (FTE) status or above (60 – 80 hours per pay period)
- Part-time Regular: budgeted at a 0.5 to 0.74 (FTE) status (40 – 59 hours per pay period)
Coverage for most benefits including medical, dental, and life insurance begins on the first of the month after hire.
Dependent Eligibility
You can choose to cover eligible dependents under some benefit plans. Eligible dependents include:
- Your lawful spouse (if your spouse is also a Lurie Children’s employee, make sure not to duplicate coverage)
- Your own and/or your spouse’s dependent child through the end of the month in which they turn 26
- A child who you or your spouse are required to provide coverage for under a legal guardianship or court order
- A child who is dependent upon you for lifetime care and supervision because of a disabling condition, regardless of age, as long as they were covered prior to reaching the limiting age
Verification of Eligibility
Verification of eligibility will be requested for all dependents newly added to the health or dental plans within 30 days. Please expect to receive a request for documents (i.e., marriage or birth certificates) within one month of completing the election. If you cover a disabled child, you’ll be asked to provide documentation of the disabling condition at the time they reach age 26.
The payroll contributions and benefits costs such as deductibles, coinsurance and copayments when you seek care are different for each of the plans and are summarized below. You can also use the Medical Plan Cost Estimator at medplancompare.com/LurieChildrens to see which plan is right for you.
In addition to the differences in contributions and benefit cost share, one of the most notable differences among the three medical plans are the providers (physicians, hospitals, and facilities) in the network that you select and whether the plan provides coverage for out-of-network providers. The table below highlights some of the differences in the networks and other key features of the plans.
| LocalPlus EPO | Open Access PPO | Open Access HSA | |
|---|---|---|---|
| In-Network Providers | Utilizes a narrow select group of Cigna providers and limited to the Chicagoland area (including surrounding suburbs and northwest Indiana) | Utilizes Cigna’s largest network of providers | |
| Out-of-Network Providers | Not covered except for emergencies | Covered | |
| How to Check Whether your Providers Participate in the Network | Go to cigna.com and click on “Find a Doctor” and when asked to select a network, be sure to click “LocalPlus” | Go to cigna.com and click on “Find a Doctor” and when asked to select a network, be sure to click the “Open Access Plus, OA plus, Choice Fund OA Plus” option | |
| Compatible with a Health Savings Account (HSA)? | No | Yes
|
|
| Compatible with a Healthcare Flexible Spending Account (FSA)? | No | Yes, but limited to an FSA for dental and vision expenses only | |
| LocalPlus EPO | Open Access PPO | Open Access HSA | ||||
|---|---|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | |
| HSA Funding | Not applicable | Not applicable | $400 EE only coverage / $800 all other coverage levels |
|||
| Deductible | ||||||
| Individual | $500 | NO COVERAGE | $1,000 | $2,000 | $2,000 | $4,000 |
| Family | $1,000 | NO COVERAGE | $2,000 | $4,000 | $4,000 | $8,000 |
| Individual Ded w/ Family Coverage | $500 | NO COVERAGE | $1,000 | $2,000 | $4,000 | $8,000 |
| Coinsurance | 20% | NO COVERAGE | 20% | 40% | 20% | 40% |
| Out-of-Pocket Maximum (Includes Deductible) | ||||||
| Individual | $3,000 | NO COVERAGE | $3,500 | $7,000 | $4,500 | $9,000 |
| Family | $6,000 | NO COVERAGE | $7,000 | $14,000 | $9,000 | $18,000 |
| Individual Max w/ Family Coverage | $3,000 | NO COVERAGE | $3,500 | $7,000 | $9,000 | $18,000 |
| Preventive Care | Covered at 100% | NO COVERAGE | Covered at 100% | 40% after deductible | Covered at 100% | 40% after deductible |
| Inpatient Hospitalization | 20% after deductible | NO COVERAGE | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible |
| Outpatient Services | 20% after deductible | NO COVERAGE | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible |
| Lab Services | 20% after deductible | NO COVERAGE | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible |
| Office Visit | $25 PCP $50 SCP |
NO COVERAGE | $25 PCP $50 SCP |
40% after deductible | 20% after deductible | 40% after deductible |
| MDLive (Telemedicine Visit) | $25 PCP $50 SCP |
NO COVERAGE | $25 PCP $50 SCP |
40% after deductible | 20% after deductible | 40% after deductible |
| Infertility | 4 attempts* | NO COVERAGE | 4 attempts* | 4 attempts* | ||
| Urgent Care | $50 | $50 | $50 | $50 | 20% after deductible | 20% after deductible |
| Emergency Room Visit | $175 | $175 | $175 | $175 | 20% after deductible | 20% after deductible |
*An additional 2 attempts if a successful pregnancy occurs.
Pharmacy Benefits
When you enroll in one of Lurie Children’s medical plans, you automatically receive prescription drug coverage through CVS/Caremark. What you pay for your prescriptions depends on the medical plan you choose, the type of medication and where/how your prescription is filled. Please note that all three plans require you to use in-network pharmacies.
| LocalPlus EPO | Open Access PPO | Open Access HSA | |
|---|---|---|---|
| Deductible | No deductible | No deductible |
Preventive Generics: No deductible All Other: After medical deductible
|
| Out-of-Pocket Maximum | |||
| Individual | $1,200 | $1,200 | Integrated with medical out-of-pocket maximum |
| Family | $3,600 | $3,600 | Integrated with medical out-of-pocket maximum |
| Individual Max w/ Family Coverage | $1,200 | $1,200 | Integrated with medical out-of-pocket maximum |
| Retail and Mail Order (30/90 Day) | |||
| Generic | $7 Copay / $14 Copay | ||
| Brand Preferred | 30% ($30/$60 min / $100/$200 max) | ||
| Brand Non-Preferred | 50% ($50/$100 min / $125/$250 max) | ||
| Specialty Drugs | 30% ($75/$150 min / $200/$400 max) | ||
Find all the details of your medical plan coverage.
Full Time Employees
As a full-time employee of Lurie Children’s, you are eligible for benefits if you are budgeted to work at least 40 hours per pay period (.5 FTE or greater). Full Time = 60 - 80 hours per pay period (0.75 - 1.0 FTE).
Per Pay Period Medical Plan Contributions (pre-tax effective January 1, 2024)
Full Wellness Credit
Eligible employee and spouse completed healthy activities and earned the wellness credit.
| Full-Time | EE Only | EE + Child(ren) | EE + Spouse | EE + Family |
|---|---|---|---|---|
| LocalPlus EPO | $62.26 | $88.78 | $155.60 | $182.12 |
| Open Access PPO | $99.58 | $159.70 | $237.80 | $297.92 |
| Open Access HSA | $39.34 | $85.42 | $128.42 | $161.96 |
Partial Wellness Credit
Eligible employee or spouse completed healthy activities and earned the wellness credit.
| Full-Time | EE Only | EE + Child(ren) | EE + Spouse | EE + Family |
|---|---|---|---|---|
| LocalPlus EPO | N/A | N/A | $169.06 | $195.58 |
| Open Access PPO | N/A | N/A | $251.26 | $311.38 |
| Open Access HSA | N/A | N/A | $141.88 | $175.42 |
No Wellness Credit
Employee and any eligible spouse did not complete healthy activities and earn the wellness credit.
| Full-Time | EE Only | EE + Child(ren) | EE + Spouse | EE + Family |
|---|---|---|---|---|
| LocalPlus EPO | $75.72 | $102.24 | $182.52 | $209.04 |
| Open Access PPO | $113.04 | $173.16 | $264.72 | $324.84 |
| Open Access HSA | $52.80 | $98.88 | $155.34 | $188.88 |
Part-Time Employees
As a part-time employee of Lurie Children’s, you are eligible for benefits if you are budgeted to work at least 40 hours per pay period (.5 FTE or greater). Part-Time = 40 - 59 hours per pay period (0.50 - 0.74 FTE).
Per Pay Period Medical Plan Contributions (pre-tax effective January 1, 2024)
Full Wellness Credit
Eligible employee and spouse completed healthy activities and earned the wellness credit.
| Part-Time | EE Only | EE + Child(ren) | EE + Spouse | EE + Family |
|---|---|---|---|---|
| LocalPlus EPO | $119.02 | $165.46 | $292.52 | $338.96 |
| Open Access PPO | $184.42 | $289.54 | $436.34 | $541.58 |
| Open Access HSA | $78.94 | $159.64 | $244.88 | $303.62 |
Partial Wellness Credit
Eligible employee or spouse completed healthy activities and earned the wellness credit.
| Part-Time | EE Only | EE + Child(ren) | EE + Spouse | EE + Family |
|---|---|---|---|---|
| LocalPlus EPO | N/A | N/A | $305.98 | $352.42 |
| Open Access PPO | N/A | N/A | $449.80 | $555.04 |
| Open Access HSA | N/A | N/A | $258.34 | $317.08 |
No Wellness Credit
Employee and any eligible spouse did not complete healthy activities and earn the wellness credit.
| Part-Time | EE Only | EE + Child(ren) | EE + Spouse | EE + Family |
|---|---|---|---|---|
| LocalPlus EPO | $132.48 | $178.92 | $319.44 | $365.88 |
| Open Access PPO | $197.88 | $303.00 | $463.26 | $568.50 |
| Open Access HSA | $92.40 | $173.10 | $271.80 | $330.54 |
To learn more, review the Wellness Incentive Overview or contact Cigna OneGuide Advocate by calling 800.244.6224, “Click to Chat” on mycigna.com or through myCigna Mobile App.
Tobacco Use Surcharge
Employees who are tobacco users will have a surcharge of $25 per pay-period ($650 annually) applied to their medical plan premiums. Employees enrolling in a medical plan for the first time, will be required to complete a tobacco attestation. Lurie Children’s is committed to your health and offers Tobacco Cessation Programs through Cigna.
Find a Doctor
Using in-network providers saves you money. Here’s how to find doctors in your medical plan network.
LocalPlus EPO
To check whether your providers participate in the network, go to Cigna Healthcare and click on “Find a Doctor” and when asked to select a network, be sure to click “LocalPlus”.
Open Access PPO and Open Access HSA
To check whether your providers participate in the network, go to Cigna Healthcare and click on “Find a Doctor” and when asked to select a network, be sure to click “Open Access Plus, OA plus, Choice Fund OA Plus” option.
You can also contact the Cigna OneGuide Pre-Enrollment Assistance Line by calling 888.806.5042.
Pharmacy
For prescription drug questions or to confirm specific prescription drug costs, contact a Lurie Children’s dedicated CVS/Caremark representative at 855.566.8402 or log onto CVS/Caremark.
Don’t have a personal doctor? You should. Here’s why.
- Better health. Getting the right health screenings each year can reduce your risk for many serious conditions. Preventive care is free, so there’s no excuse to skip it.
- A healthier wallet. Having a doctor you can call helps you avoid costly trips to the emergency room and decide when you really need to see a specialist.
- Peace of mind. Advice from someone you trust ... it means a lot when you’re healthy, but it’s even more important when you’re sick. Your personal doctor gets to know you and your health history and can help coordinate any care you need.
Resources
Take advantage of these valuable resources to better manage your physical wellbeing.
WINFertility
If you enroll in medical coverage, we offer additional benefits like direct access to infertility resource through WINFertility, as well as during and after pregnancy resources through Cigna Healthy Pregnancies, Healthy Babies® program via Cigna OneGuide. For details, contact a Cigna One Guide Advocate at 877.864.8004.
Omada®
Omada® is a digital lifestyle change program that can help you lose weight, feel fantastic and develop long-term healthy habits. Employees and their covered adult dependents receive the program at no additional cost if you meet eligibility criteria to participate in the program, including being enrolled in the Lurie Children’s medical plan through Cigna, are at risk for diabetes or heart disease, and are accepted into the program. See if you’re eligible at Omada®.
Money-Saving Tips
When you carefully consider the financial impact of your health care choices, you can help lower costs for yourself and the entire company. Get the most from your medical benefits by following these tips to be well and buy smart:
- Use in-network providers. They’ve agreed to charge only up to negotiated rates and bill your insurance company directly, which saves you money and time. Also, check with your insurance company to ensure that a service is covered before you receive care.
- Keep up with preventive care. It’s covered in full by all of our medical plans and can help detect and prevent potentially costly health issues early. You pay nothing for annual physicals, recommended immunizations, routine cancer screenings, and more when you see in-network providers.
- Use tax-free money to pay for eligible health expenses. Contributing to a Health Savings Account (HSA) or a Health Care Flexible Spending Account (FSA) is easy and saves you money. You can set aside pretax dollars from your paycheck to use for your out-of-pocket costs. Keep in mind that with an HSA, you can only spend contributions that have actually been deposited into your account. And with an FSA-HC, you can only carry over up to $640 of unused money in your FSA to the next year; you will forfeit amounts above $640. Unused FSA dollars will be forfeited if you enroll in an HSA the following year.
- Shop smart for prescriptions. Using generic alternatives will almost always save you money — and they’re just as effective as brand-name prescriptions. Also, try calling a few local pharmacies to compare prices before deciding where to fill a prescription. For your ongoing prescriptions, log onto CVS/Caremark.
- Take advantage of the Lurie Children’s Medical Plan Wellness Incentive. It offers valuable resources to help you improve your health, which could prevent the need for costly care. Plus, you’ll earn rewards when you participate in wellness activities!
- Use your medical plan’s website. Log in to Cigna Healthcare to see how much of your deductible you’ve met, review claims, find in-network providers, use helpful cost-estimating tools, and more.
- Choose the right place to get care. Facilities charge different amounts for the same services, so think about your options when you or a family member needs medical attention.