Medical


BJC 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. Other similarities and differences:

  • Both medical options include Prescription Drug coverage
  • In general, you will pay more out of your biweekly paycheck for Choice Plus, but pay considerably less in out-of-pocket costs for deductibles, copayments and coinsurance for medical services.
  • Conversely, you will pay less per pay period for Choice, but pay considerably more in out-of-pocket costs when you receive medical services.
  • There are three coverage levels within each medical option:
    • BJC Facility Network: You will save the most when you receive services from BJC facilities. Deductibles, coinsurance and copayments are the lowest when you use the BJC Facility Network.The BJC Facility Network does not include physicians. See next coverage level — Cigna OAP Network. See the listing on myCigna.com.
    • Cigna Open Access Plus (OAP) Network: The Cigna OAP Network features health care facilities and physicians (including BJC Medical Group and Washington University physicians) who have agreed to provide services at a reduced cost. Deductibles, coinsurance and copayments for facility services are much lower than those from Non-Network providers, but higher than BJC Network providers. See the listing on myCigna.com.
    • Non-Network: Services from health care providers not within the BJC Facility Network or Cigna OAP Network may not be discounted.

See also Preventive Care. Many preventive services are covered at 100 percent (you owe nothing) if received from a BJC Facility Network or Cigna OAP Network provider.

Annual Wellness Incentive

The Annual Wellness Incentive is just one of the many benefits BJC provides to support achieving and sustaining healthy outcomes for ourselves and our families.

Employees and spouse who are actively enrolled in the BJC Medical Plan on January 1, 2019, can each earn an annual wellness incentive of $175. Learn more about the Annual Wellness Incentive.

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 essentially different about the two options is the amount you pay for services via copayments, deductibles and coinsurance, as well as the per-pay-period deductions for coverage. To gain a better understanding, spend some time with this Choice-Choice Plus infographic.

Medical Coverage Chart

This chart provides a few examples of your payment responsibility under each medical option. Consult the Summary Plan Descriptions (SPD) for coverage details.

 

Choice Plus

Choice

 

BJC Facility Network

Cigna
OAP Network

Non-Network

BJC Facility Network

Cigna
OAP Network

Non-Network

Annual Deductible – Per Individual (3x Family)

$200

$600

$3,000

$600

$2,500

$5,000

Annual Out-of-Pocket Maximum

  • Per Individual

$1,200

$4,600

Unlimited

$4,000

$4.600

Unlimited

  • Per Family
$3,600 $9,200 $9,200 $9,200

Urgent Care

$50

$60

Emergency Room

$150

$200

Wellness and Preventive Care

$0

$0

50%

$0

$0

75%

Cigna Telehealth

N/A*

$25

Not Covered

N/A*

$25

Not Covered

Diagnostic/Non-Preventive Office Visit

  • Primary Care Physician (PCP)

N/A*

$25

50%*

N/A*

$40

75%

  • Specialists

N/A*

$50

50%

N/A*

$60

75%

Outpatient Short-Term Therapy

$20

$35

50%

$30

$50

75%

Outpatient Surgery

0%

40%

$1,500
& 50%

15%

60%

$3,000
& 75%

Hospital Services

  • Inpatient Technical Charges**

0%

40%

$2,500
& 50%

15%

60%

$5,000
& 75%

  • Outpatient Technical Charges**

0%

40%

50%

15%

60%

75%

  • Inpatient Professional Charges***

N/A*

20%

50%

N/A*

40%

75%

  • Outpatient Professional Charges***

N/A *

20%

50%

N/A*

40%

75%


* The BJC Facility Network does not include physicians; BJC 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 uses 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.

Employee Costs for Medical Coverage

The costs listed below (which have increased for 2019) are pre-tax, per-pay-period deductions, based on 26 pay periods a year.

 

Full-Time

Part-Time

    CHOICE PLUS

Employee Only

$77.92

$116.88

Employee + Children

$131.06

$196.59

Employee + Spouse

$183.46

$275.19

Employee + Family

$235.40

$353.10

    CHOICE

Employee Only

$40.94

$61.41

Employee + Children

$74.73

$112.10

Employee + Spouse

$107.04

$160.56

Employee + Family

$140.80

211.20


Note: Additional coverage costs may apply due to the Working-Spouse Surcharge and/or the Tobacco-User Surcharge. 

For more information, call Cigna 800.244.6224 or go to www.myCigna.com