MEDICAL_DESKTOP

Medical

Full-time employees who actively work at least 30 hours per week are eligible for medical benefits, along with their legal spouse, dependent children up to age 26, and children of any age if they depend on the employee for support due to a disability. Coverage for new hires begins on the first of the month following their date of hire.

866-494-2111  |  www.myCigna.com  |  Group #: 00655755

Home / Core Benefits / Medical

Employee Premiums

Medical premiums for both traditional and high-deductible health plans (HDHP) are based on 24 pay period deductions per year.

Plan & Wellness Program Participation
Single (Per Pay Period)
Two-Party (Per Pay Period)
Family (Per Pay Period)
Traditional OAP
$69.50
$141.00
$198.00
Traditional PPO
$89.00
$180.00
$253.00
HDHP OAP
$51.00
$104.00
$146.00
HDHP PPO
$66.00
$134.50
$188.50
Plan & Wellness Program Participation

Traditional (Not Participating in Wellness Program)

Single (Per Pay Period): $83.50
Two-Party (Per Pay Period): $169.25
Family (Per Pay Period): $237.75

Traditional (Participating in Wellness Program)

Single (Per Pay Period): $59.75
Two-Party (Per Pay Period): $121.00
Family (Per Pay Period): $170.25

HDHP (Not Participating in Wellness Program)

Single (Per Pay Period): $66.50
Two-Party (Per Pay Period): $135.00
Family (Per Pay Period): $189.50

HDHP (Participating in Wellness Program)

Single (Per Pay Period): $45.00
Two-Party (Per Pay Period): $91.25
Family (Per Pay Period): $128.25

Plan Information

Stampin’ Up! offers two types of health plans: a Traditional Plan and a High-Deductible Health Plan. Within each plan we offer two different networks, the OAP network (provides access to non-Intermountain Health facilities and providers) and the PPO network (a buy-up network that provides access to Intermountain Health facilities and providers). It is up to you and your family to determine which plan is best suited for your healthcare needs.

Traditional Plan
In-Network Services from out-of-network providers are not covered (except emergencies)
ANNUAL DEDUCTIBLE
OAP Traditional In-Network
$750 per individual $1,500 per family
PPO Traditional In-Network
$750 per individual 1,500 per family
COINSURANCE
OAP Traditional In-Network
20% AD
PPO Traditional In-Network
20% AD
OUT-OF-POCKET MAXIMUM
OAP Traditional In-Network
Up to $3,000 per individual, $6,000 per family
PPO Traditional In-Network
Up to $3,000 per individual, $6,000 per family
PREVENTIVE SERVICES
OAP Traditional In-Network
Covered 100%
PPO Traditional In-Network
Covered 100%
OFFICE VISITS, PRIMARY CARE, SPECIALIST
OAP Traditional In-Network

$25 copay

$40 copay

PPO Traditional In-Network

$25 copay

$40 copay

MENTAL HEALTH SERVICES, OFFICE VISIT, INPATIENT
OAP Traditional In-Network

$25 copay

20% AD

PPO Traditional In-Network

$25 copay

20% AD

EMERGENCY SERVICES, URGENT CARE, EMERGENCY ROOM, AMBULANCE
OAP Traditional In-Network

$50 copay

$250 copay AD

20% AD

PPO Traditional In-Network

$50 copay

$250 copay AD

20% AD

INPATIENT & OUTPATIENT, INPATIENT HOSPITAL, OUTPATIENT SURGERY
OAP Traditional In-Network

20% AD

20% AD

PPO Traditional In-Network

20% AD

20% AD

PRESCRIPTION MEDICATION COPAY, RETAIL (30-DAY SUPPLY)
OAP Traditional In-Network

Tier 1 / Tier 2 / Tier 3 / Tier 4

$15 / $30 / $50 / $100

PPO Traditional In-Network

Tier 1 / Tier 2 / Tier 3 / Tier 4

$15 / $30 / $50 / $100

HEALTH CARE ACCOUNT, DETAILS ON PAGE 11
OAP Traditional In-Network

Health Flexible Spending Account

(Health FSA)

PPO Traditional In-Network

Health Flexible Spending Account

(Health FSA)

HIGH-DEDUCTIBLE HEALTH PLAN
In-Network Services from out-of-network providers are not covered (except emergencies)
ANNUAL DEDUCTIBLE
OAP Traditional In-Network
$2,000 per individual $4,000 per family
PPO Traditional In-Network
$2,000 per individual $4,000 per family
COINSURANCE
OAP Traditional In-Network
20% AD
PPO Traditional In-Network
20% AD
OUT-OF-POCKET MAXIMUM
OAP Traditional In-Network
Up to $3,300 per individual, $6,600 per family
PPO Traditional In-Network
Up to $3,300 per individual, $6,600 per family
PREVENTIVE SERVICES
OAP Traditional In-Network
Covered 100%
PPO Traditional In-Network
Covered 100%
OFFICE VISITS, PRIMARY CARE, SPECIALIST
OAP Traditional In-Network

$15 copay

$25 copay

PPO Traditional In-Network

$15 copay

$25 copay

MENTAL HEALTH SERVICES, OFFICE VISIT, INPATIENT
OAP Traditional In-Network

$15 copay AD

20% AD

PPO Traditional In-Network

$15 copay AD

20% AD

EMERGENCY SERVICES, URGENT CARE, EMERGENCY ROOM, AMBULANCE
OAP Traditional In-Network

$35 copay

$75 copay AD

20% AD

PPO Traditional In-Network

$35 copay AD

$75 copay AD

20% AD

INPATIENT & OUTPATIENT, INPATIENT HOSPITAL, OUTPATIENT SURGERY
OAP Traditional In-Network

20% AD

20% AD

PPO Traditional In-Network

20% AD

20% AD

PRESCRIPTION MEDICATION COPAY, RETAIL (30-DAY SUPPLY)
OAP Traditional In-Network

Tier 1 / Tier 2 / Tier 3 / Tier 4

$7 AD / $21 AD / $42 AD / $100 AD

PPO Traditional In-Network

Tier 1 / Tier 2 / Tier 3 / Tier 4

$7 AD / $21 AD / $42 AD / $100 AD

HEALTH CARE ACCOUNT, DETAILS ON PAGE 11
OAP Traditional In-Network

Health Savings Account (HSA)

Limited Purpose Flexible Spending Account (FSA)

PPO Traditional In-Network

Health Savings Account (HSA)

Limited Purpose Flexible Spending Account (FSA)

AD* (after deductible)

Please Note: Providers may charge more than the plan allows when you receive services out-of-network. It is recommended that you ask the out-of-network provider about their billed charges before planning care.

Please see the Member Benefit Summaries for each plan to fully understand coverage and the differences between the two plans and networks. The information here is intended solely to provide you with a brief description of your benefit options. The specific provisions in our contract will govern any and all claims or coverage issues.

NETWORK INFORMATION

The Cigna OAP network provides access to non-Intermountain Health facilities and providers throughout the state. If you live in a rural area however, you will have access to Intermountain Healthcare facilities and providers.

The Cigna PPO network will be a buy-up network for employees who want access to Intermountain Health facilities and networks throughout the state. It will also include access to the same non-Intermountain Health facilities and providers as the Cigna OAP network.

CIGNA’s MDLIVE®

Cigna’s MDLIVE® is a telehealth service that offers virtual care 24/7, by phone or video, from board-certified doctors and mental health professionals. This is another option for accessing convenient, high-quality urgent care whenever and wherever you need it. You can use your smartphone, tablet, or computer to connect with a MDLIVE® clinician 24 hours a day, every day of the year.

Commonly treated conditions include stuffy and/or runny nose, allergies, sinus pain and pressure, eye infections, cough, painful urination, lower back pain, joint pain or strains, minor skin problems and for mental health support.

You can call MDLIVE® at 1-888-726-3171, login to your myCigna account and select “Talk to a doctor” or create a MDLIVE® account and connect with a provider online or by downloading the MDLIVE® app from the App Store or Google Play.

HEALTH INFORMATION LINE

You can call the Health Information Line, available 24 hours a day, seven days a week. Speak with a personal nurse advocate via chat or phone. They’re here to confidentially answer your health questions. Call 855.673.3063 or the toll-free number at 866.494.2111.

 

  • Get information to help you decide where and when you should get treatment for your immediate care needs.
  • Call if you need general health information or have a specific health concern.
  • Chat is available Monday–Friday, 9:00 a.m.–8:00 p.m. ET, excluding holidays, via myCigna.com or the myCigna app.

Intermountain Health Answers

Health Answers is a nurse line that allows you to speak to a registered nurse who will listen to your concerns, answer medical questions, and help you decide what course of action to take. You can connect with a nurse 24 hours a day, every day of the year by calling 844-501-6600.

Resources

Summary of Benefits Coverage (All Plans)

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Share (Riverton) Member Payment Summary - HDHP

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Share (Riverton) Member Payment Summary - Traditional

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Med (Kanab) Member Payment Summary - HDHP

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Med (Kanab) Member Payment Summary - Traditional

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Intermountain Home Delivery Pharmacy

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Tellica Imaging

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Out of Area Care Options

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