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.
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. You will receive separate ID cards for medical and pharmacy.
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.
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.
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.
All Lurie Children’s medical plans through Cigna provide comprehensive benefits and share the following attributes:
All medical plan options include prescription drug coverage through CVS/Caremark, and all three plans require you to use network pharmacies.
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.
For non-preventive services you pay for a portion of your medical expenses through deductibles, copays and coinsurance.
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.
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.
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).
Coverage for most benefits including medical, dental and life insurance begins on the first of the month after hire.
You can choose to cover eligible dependents under some benefit plans. Eligible dependents include:
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 | |
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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
The money is yours to keep, even if you leave Lurie Children’s
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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 | ||||
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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 |
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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.
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
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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.
Per Pay Period Medical Plan Contributions (pre-tax effective January 1, 2023)
Contributions | Full Wellness Credit | Partial Wellness Credit | No Wellness Credit |
---|---|---|---|
Per Pay Period (26 Per Year) |
Eligible employee and spouse completed healthy activities and earned the wellness credit | Eligible employee or spouse completed healthy activities and earned the wellness credit | Employee and any eligible spouse did not complete healthy activities and earn the wellness credit |
Full-Time | Credit | EE Only | EE + Child(ren) | EE + Spouse | EE + Family |
---|---|---|---|---|---|
LocalPlus EPO | Full Wellness | $59.32 | $84.82 | $148.58 | $174.08 |
LocalPlus EPO | Partial Wellness | N/A | N/A | $162.04 | $187.54 |
LocalPlus EPO | No Wellness | $72.78 | $98.28 | $175.50 | $201.00 |
Open Access PPO | Full Wellness | $95.26 | $153.04 | $227.60 | $285.44 |
Open Access PPO | Partial Wellness | N/A | N/A | $241.06 | $298.90 |
Open Access PPO | No Wellness | $108.72 | $166.50 | $254.52 | $312.36 |
Open Access HSA | Full Wellness | $37.30 | $81.64 | $122.42 | $154.70 |
Open Access HSA | Partial Wellness | N/A | N/A | $135.88 | $168.16 |
Open Access HSA | No Wellness | $50.76 | $95.10 | $149.34 | $181.62 |
Part-Time | Credit | EE Only | EE + Child(ren) | EE + Spouse | EE + Family |
---|---|---|---|---|---|
LocalPlus EPO | Full Wellness | $113.92 | $158.56 | $280.22 | $324.86 |
LocalPlus EPO | Partial Wellness | N/A | N/A | $293.68 | $338.32 |
LocalPlus EPO | No Wellness | $127.38 | $172.02 | $307.14 | $351.78 |
Open Access PPO | Full Wellness | $176.80 | $277.90 | $418.52 | $519.74 |
Open Access PPO | Partial Wellness | N/A | N/A | $431.98 | $533.20 |
Open Access PPO | No Wellness | $190.26 | $291.36 | $445.44 | $546.66 |
Open Access HSA | Full Wellness | $75.40 | $152.98 | $234.44 | $290.90 |
Open Access HSA | Partial Wellness | N/A | N/A | $247.90 | $304.36 |
Open Access HSA | No Wellness | $88.86 | $166.44 | $261.36 | $317.82 |
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.
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.
Using in-network providers saves you money. Here’s how to find doctors in your medical plan network.
To check whether your providers participate in the network, go to Cigna and click on “Find a Doctor” and when asked to select a network, be sure to click “LocalPlus”.
To check whether your providers participate in the network, go to Cigna 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.
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.
Take advantage of these valuable resources to better manage your physical wellbeing.
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® 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®.
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: