Medical
Boone Health offers two medical options: Choice Plus and Choice. Both are administered by Cigna, allow access to the Cigna Open Access Plus (OAP) Network of preferred providers, and cover the same medical services.
Similarities and differences:
- Both medical options include prescription drug coverage
- In general, you will pay more out of your bi-weekly paycheck for Choice Plus, but pay considerably less in out-of-pocket costs for deductibles, copayments, and coinsurance for medical services
- With the Choice option, you will pay less per pay period, but you will pay considerably more in out-of-pocket costs when you receive medical services
There are four coverage levels within each medical option:
- Boone Health Network: You will save the most when you receive services from Boone Health facilities. Deductibles, coinsurance, and copayments are the lowest when you use the Boone Health Network.
- Health Cooperative of MO Network: Members of Boone’s medical plan may receive services from specific providers and facilities at a reduced out-of-pocket cost from Cigna In-network providers.
- Cigna Open Access Plus (OAP) Network: The Cigna OAP Network features healthcare facilities and physicians who have agreed to provide services at a reduced cost.
- Non-network: Services from healthcare providers not within the Boone Health Network or Cigna OAP Network may not be discounted.
Cigna Telehealth
For Medical Plan members, Boone Health has waived out-of-pocket expenses for Cigna Telehealth Connection. When Boone Health Medical Plan members make virtual care visits through MDLIVE, to a board-certified doctor to help with minor, non-life-threatening conditions (e.g., cold or flu, rashes, sore throat, mild fever), there will be no out-of-pocket costs for the virtual care visit. These services can also be provided to infants and children. Plan members can also access Cigna Behavioral Health Telehealth providers for covered services related to mental health and substance abuse, without incurring a copayment. For more information, log in to www.myCigna.com and search “Talk to a doctor or nurse 24/7.” You can also call MDLIVE at 888.726.3171.
Preventive Care
Many preventive services are covered at 100 percent if received from a Boone Health facility or Cigna Network OAP provider.
Medical Coverage Chart
Boone Health Medical Plan members will incur NO out-of-pocket expenses (deductibles, coinsurance, or copayments) when receiving any outpatient lab work (e. g., blood draw) and/or outpatient radiology/imaging (including physician/ technician fees) at a Boone Health facility.
This chart provides examples of your payment responsibility under each medical option. Consult the Summary Plan Descriptions (SPD) for coverage details.
| Choice Plus | ||||
|---|---|---|---|---|
| Domestic | Health Cooperative of MO | In-Network | Out-of-Network | |
| Annual Deductible | ||||
| Per Individual | $600 | $900 | $2,000 | $4,000 |
| Per Family | $2,000 | $2,700 | $4,000 | $12,000 |
| Annual Out-of-Pocket Maximum | ||||
| Per Individual | $3,000 | $5,000 | $6,000 | Unlimited |
| Per Family | $6,000 | $10,000 | $12,000 | |
| Urgent Care | $50 | |||
| Emergency Room | $250 | |||
| Wellness and Preventive Care | $0 | $0 | $0 | Deductible, then 50% |
| Cigna Telehealth | N/A* | N/A* | $0 | Not Covered |
| Diagnostic/Non-Preventive Office Visit | ||||
| Primary Care Physician (PCP) | $20 | $20 | $30 | Deductible, then 50% |
| Specialists | $50 | $50 | $60 | Deductible, then 60% |
| Outpatient Short-Term Therapy | $0 | $50 | $50 | Deductible, then 60% |
| Chiropractic Care | N/A* | $25 | $25 | Not Covered |
| Outpatient Lab & Radiology (diagnostic) | $0 | Deductible, then 20% | Deductible, then 50% | Deductible, then 50% |
| Outpatient Surgery | Deductible, then 0% | Deductible, then 20% | Deductible, then 45% | $1,750 copay + deductible, then 50% |
| Hospital Services | ||||
| Inpatient Facility | Deductible, then 0% | Deductible, then 20% | Deductible, then 50% | $2,750 copay + deductible, then 60% |
| Outpatient Facility | Deductible, then 0% | Deductible, then 20% | Deductible, then 50% | Deductible, then 50% |
| Inpatient professional | N/A | Deductible, then 20% | Deductible, then 25% | Deductible, then 50% |
| Outpatient Professional | Deductible, then 0% | Deductible, then 20% | Deductible, then 25% | Deductible, then 50% |
| Choice | ||||
|---|---|---|---|---|
| Domestic | Health Cooperative of MO | In-Network | Out-of-Network | |
| Annual Deductible | ||||
| Per Individual | $1,000 | $2,000 | $3,000 | $6,000 |
| Per Family | $3,000 | $4,500 | $9,000 | $18,000 |
| Annual Out-of-Pocket Maximum | ||||
| Per Individual | $4,000 | $5,000 | $6,000 | Unlimited |
| Per Family | $9,200 | $10,000 | $12,000 | |
| Urgent Care | $60 | |||
| Emergency Room | $300 | |||
| Wellness and Preventive Care | $0 | $0 | $0 | Deductible, then 75% |
| Cigna Telehealth | N/A* | N/A* | $0 | Not Covered |
| Diagnostic/Non-Preventive Office Visit | ||||
| Primary Care Physician (PCP) | $25 | $25 | $40 | Deductible, then 75% |
| Specialists | $60 | $60 | $70 | Deductible, then 75% |
| Outpatient Short-Term Therapy | $0 | $50 | $50 | Deductible, then 80% |
| Chiropractic Care | N/A* | $25 | $25 | Not Covered |
| Outpatient Lab & Radiology (diagnostic) | $0 | Deductible, then 35% | Deductible, then 70% | Deductible, then 75% |
| Outpatient Surgery | Deductible, then 15% | Deductible, then 35% | Deductible, then 70% | $3,500 copay + deductible, then 75% |
| Hospital Services | ||||
| Inpatient Facility | Deductible, then 15% | Deductible, then 35% | Deductible, then 50% | $5,550 copay + deductible, then 75% |
| Outpatient Facility | Deductible, then 15% | Deductible, then 35% | Deductible, then 50% | Deductible, then 75% |
| Inpatient professional | N/A | Deductible, then 35% | Deductible, then 50% | Deductible, then 75% |
| Outpatient Professional | Deductible, then 15% | Deductible, then 35% | Deductible, then 50% | Deductible, then 75% |
* The Boone Health Facility Network does not include physicians; Boone Health Medical Group and Washington University physicians are included in the Cigna OAP Network.
** Billed by Facility. Technical charges for the tools and services that a professional use to provide health care services, such as equipment, supplies, operating room time, radiology, general nursing care, etc.
*** Billed by Physician. Professional charges for a physician or other licensed health care professional’s time and expertise to provide health care services to an individual.
Understanding Benefit Terms
Both medical options, Choice Plus and Choice, cover the same medical services, such as a visit to a primary care physician or specialist, a trip to the emergency room, or outpatient surgery. What is primarily different about the two options is the amount you pay for services, as well as the bi-weekly deductions from your paycheck (contributions), copayments, deductibles, and coinsurance.
For more information, call Cigna 800.244.6224 or log in to your myCigna account.
This chart provides a few examples of your payment responsibility under each medical option. Consult the Summary Plan Descriptions (SPD) for coverage details.
Employee Costs for Medical Coverage
The costs below are pre-tax, per-pay-period deductions, based on 26 pay periods a year.
| Full-Time | Part-Time | |
|---|---|---|
| Choice Plus | ||
| Employee Only | $87.63 | $131.44 |
| Employee + Children | $147.38 | $221.07 |
| Employee + Spouse | $210.36 | $315.53 |
| Employee + Family | $269.91 | $404.87 |
| Choice | ||
| Employee Only | $46.04 | $69.06 |
| Employee + Children | $84.03 | $126.05 |
| Employee + Spouse | $122.73 | $184.09 |
| Employee + Family | $161.44 | $242.16 |
Annual Wellness Incentive
Eligible Boone Health employees can earn a wellness incentive of $225 in December by completing two steps.
To be eligible, you must be actively enrolled as the main subscriber in the Boone Health Medical Plan on January 1, 2023 and actively enrolled as the main subscriber in the plan at the time of the payment, December 8, 2023.
To earn your incentive, complete both of the following steps between August 1, 2022 and July 31, 2023:
- Step 1: Get preventive care (defined by Cigna’s standard guidelines for preventive care) at all locations or service sites. Examples include annual check-up, routine mammogram, or routine colonoscopy.
- Step 2: Complete the Cigna Health Risk Assessment (HRA) on mycigna.com.
You must complete both steps 1 and 2 to earn the $225 Annual Wellness Incentive. Spouses are not eligible. No documentation is required to prove that you completed the requirements – this will be validated through Cigna and reported to Boone Health. The wellness incentive will be awarded to eligible employees on the December 8, 2023 paycheck, as a credit to the bi-weekly cost for medical coverage.
To view or print your Cigna HRA confirmation statement, log in to www.myCigna.com and choose My Health Assessment from the Wellness section or call Cigna at 800-244-6224