Medical Insurance

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.

2023 Medical Plan Options

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 (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

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.

*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.

Find all the details of your medical plan coverage.

• LocalPlus EPO
  • Benefits Summary
  • SBC
• Open Access PPO
  • Benefits Summary
  • SBC
• Open Access HSA
  • Benefits Summary
  • SBC

Per Pay Period Medical Plan Contributions (pre-tax effective January 1, 2023)

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.

You can also contact the Cigna OneGuide Pre-Enrollment Assistance Line by calling 888.806.5042.

Resources

Take advantage of these valuable resources to better manage your physical wellbeing.

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:

1. 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.
2. 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.
3. 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 $610 of unused money in your FSA to the next year; you will forfeit amounts above $610. Unused FSA dollars will be forfeited if you enroll in an HSA the following year.
4. 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.
5. 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!
6. Use your medical plan’s website. Log in to Cigna to see how much of your deductible you’ve met, review claims, find in-network providers, use helpful cost-estimating tools, and more.
7. 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.