What you need to know
Want access to a great network of doctors? You can’t go wrong with either of the Cigna medical plans. Check out the highlights below to find the plan that makes the most sense for you. And BTW, you can always see an out-of-network provider—but going rogue doesn’t come cheap.
Wanna get smart?
Set aside pretax dollars in a Health Savings Account (HSA). Get free money from Workday. Feel secure in knowing you and your family are covered. What more could you want from a medical plan? Learn how a plan with an HSA works.
Cigna Smart Plan With HSA
- Your per-paycheck contributions are the lowest of the Cigna plans ($0 for employee-only coverage!).
- You can go to any provider you like; however, you will benefit from negotiated rates and higher benefit levels when you use Cigna Open Access Plus (OAP) network providers.
- Note: Workmates in Utah use PPO network providers.
- For in-network preventive care services, the plan pays 100% (no copay or deductible).
- Flu shots are preventive, so your Workday medical plan has you covered all year long. Visit your doctor’s office or use our flu shot voucher to get a free flu shot at a CVS near you.
- For in-network doctor visits or services: The plan pays 80% after you meet the $1,600 individual / $3,200 family deductible.
- Out-of-network services: The plan pays 50% after you meet the $3,200 individual / $6,400 family deductible.
Bonus! There’s a reason they call this the Smart Plan. When you enroll in it, you’re eligible for a Health Savings Account (HSA), and that lets you set aside pretax dollars to pay for eligible medical expenses. Can you say “ka-ching”? Plus, Workday chips in, so you get free money: $1,000 for employee-only coverage or $2,000 if you're also covering dependents. Pretty smart, huh?
What you pay for care
Calendar-year deductible
| Coverage | In-Network | Out-of-Network |
|---|---|---|
| Employee Only | $1,600 | $3,200 |
| Employee + Dependent(s) | $3,200 | $6,400 |
Calendar-year out-of-pocket maximum
| Coverage | In-Network | Out-of-Network |
|---|---|---|
| Individual | $3,200 | $10,000 |
| Individual in Family | $3,200 | $10,000 |
| Entire Family | $6,400 | $20,000 |
Select medical services
This is what you pay for care for certain services. For other medical expenses and more information, review the medical plan comparison chart.
| Service | In-Network | Out-of-Network |
|---|---|---|
| Preventive Care | $0 | $0 |
| Office Visits | 20% after deductible | 50% after deductible* |
| Emergency Room (ER) | 20% after deductible | 20% after deductible |
| Urgent Care | 20% after deductible | 20% after deductible |
| Outpatient Surgery | 20% after deductible | 50% after deductible |
| Behavioral Health | 20% after deductible | Office visits: 20% after in-network deductible* Other services: 50% after out-of-network deductible* |
| Physical Therapy | 20% after deductible | 50% after deductible |
| Family Planning Services | Infertility coverage available.** | Infertility coverage available.** |
* Member is responsible for any amount billed by their provider that exceeds the plan’s maximum reimbursable charges (MRC). Billed amounts in excess of MRC do not apply toward the deductible or out-of-pocket maximum.
** Please contact Cigna for coverage details. Family planning benefits are administered for Workday by Maven Wallet and include reimbursement allowance for IVF or IUI, egg freezing, adoption, or surrogacy.
Your first step to free money
If you enroll in the Cigna Smart Plan, you need to elect the HSA during enrollment to receive the company contributions (even if you don't want to contribute to your account right now). Then, be sure to open your account with Fidelity.
Cigna Core Plan
- Your per-paycheck contributions are moderate.
- You can go to any provider you like; however, you will benefit from negotiated rates and higher benefit levels when you use Cigna Open Access Plus (OAP) network providers.
- Note: Workmates in Utah use PPO network providers.
- For in-network preventive care services, the plan pays 100% (no copay or deductible).
- Flu shots are preventive, so your Workday medical plan has you covered all year long. Visit your doctor’s office or use our flu shot voucher to get a free flu shot at a CVS near you.
- For in-network doctor visits, you pay a copay—$20 primary care visits, $30 specialist visits.
- In-network services: The plan pays 80% after you meet the $500 individual / $1,000 family deductible.
- Out-of-network services: The plan pays 60% after you meet the $1,000 individual / $2,000 family deductible.
What you pay for care
Calendar-year deductible
| Coverage | In-Network | Out-of-Network |
|---|---|---|
| Individual | $500 | $1,000 |
| Individual in Family | $500 | $1,000 |
| Family | $1,000 | $2,000 |
Calendar-year out-of-pocket maximum
| Coverage | In-Network | Out-of-Network |
|---|---|---|
| Individual | $3,000 | $8,000 |
| Family | $6,000 | $16,000 |
Select medical services
This is what you pay for care for certain services. For other medical expenses and more information, review the medical plan comparison chart.
| Service | In-Network | Out-of-Network |
|---|---|---|
| Preventive Care | $0 | $0 |
| Office Visits | $20 PCP / $30 specialist | 40% after deductible* |
| Emergency Room (ER) | $150 (waived if admitted) | $150 (waived if admitted) |
| Urgent Care | $50 (waived if admitted) | $50 (waived if admitted) |
| Outpatient Surgery | 20% after deductible | 40% after deductible |
| Behavioral Health | Office visits: $30 copay Other services: 20% after deductible | Office visits: 20% after in-network deductible* Other services: 40% after out-of-network deductible* |
| Physical Therapy | $20 PCP / $30 specialist / $30 cardiac | 40% PCP / 40% specialist |
| Family Planning Services | Infertility coverage available.** | Infertility coverage available.** |
* Member is responsible for any amount billed by their provider that exceeds the plan’s maximum reimbursable charges (MRC). Billed amounts in excess of MRC do not apply toward the deductible or out-of-pocket maximum.
** Please contact Cigna for coverage details. Family planning benefits are administered for Workday by Maven Wallet and include reimbursement allowance for IVF or IUI, egg freezing, adoption, or surrogacy.
CVS Caremark prescription drug coverage
With both Cigna medical plans, you have prescription drugs covered through CVS Caremark. The two plans cover prescription drugs differently.
- Cigna Smart Plan: After you meet your deductible, you pay 20% of the cost of your prescription. Before then, you pay the full cost.
- Cigna Core Plan: You pay a flat copay (deductible doesn't apply).
The other factor that determines your out-of-pocket cost is—surprise!—the type of drug you need. CVS Caremark divides drugs into three tiers.
- Generic drugs have all of the same science behind them as other prescriptions plus approval from the U.S. Food and Drug Administration. The only difference? They cost you less out of pocket.
- Preferred brand drugs are brand-name drugs covered by CVS Caremark at a higher level than other brand-name drugs.
- Non-preferred brand drugs aren't on CVS Caremark's preferred list and cost you the most.
To fill a 30-day supply of your prescription, visit any retail pharmacy in the CVS Caremark network. That includes all of the big dogs like CVS, Walgreens, and Rite Aid. For prescriptions you take regularly, order a 90-day supply from the CVS Caremark Mail Service Pharmacy and save money.
| Type of drug | Cigna Smart Plan | Cigna Core Plan |
|---|---|---|
| Generic | Retail and mail-order 20% after deductible | Retail (30-day supply) $10 copay Mail-order (90-day supply) $25 copay |
| Preferred brand | Retail and mail-order 20% after deductible | Retail (30-day supply) $30 copay Mail-order (90-day supply) $75 copay |
| Non-preferred brand | Retail and mail-order 20% after deductible | Retail (30-day supply) $60 copay Mail-order (90-day supply) $150 copay |
Need to know which prescription drugs are covered? Check the CVS Caremark formulary (aka a list of covered prescriptions). There's a separate list for specialty drugs that treat complex or chronic conditions.
Your one-stop health-management tool
Once you’re enrolled in a Cigna plan, be sure to register on myCigna. Here are just a few of the tasks you can handle—anytime, anywhere—through myCigna:
- Find doctors and compare cost and quality ratings
- Manage and track claims
- Track account balances and deductibles
- Access your temporary ID card while you wait for the printed ID card to arrive. ID cards can take up to two to three weeks to be printed and mailed.
A second look never hurts
Get peace of mind from your living room with access to expert physicians through Cleveland Clinic’s Virtual Second Opinions program. After collecting and reviewing your medical records, Virtual Second Opinions matches you with a physician to discuss your care—all at no cost to you.
Premise Health
Being a Workmate comes with some great perks. Like Premise Health. You can connect 24/7/365 with a board-certified primary care doctor or behavioral health specialist via your computer, tablet, or smartphone. How convenient is that? It's great for non-emergency issues, or when you can't see your regular doctor.
Register by visiting Premise Health online.
Sky-high-quality care
Cloud Care, the health clinic just for Workmates, is available at our onsite health center in Pleasanton. We also have free virtual visits available to all U.S. Workmates. These services are for everyone enrolled in a Workday medical plan.
FYI
Learn more about your plan by reviewing the Cigna Benefit Summaries and other plan documents. Reach out to your Onsite Client Service Partner, Olga Reyna, to learn more about either Cigna plan.
It's required: Pricing information for covered items and services.
This link— www.ticmrf.com/20-2480422—leads to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.