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 servi ces. 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:

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 contributions 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 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

Unlimted

$4,000

$4.600

Unlimted

  • Per Individual
       

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 Physcian (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%

41,500
& 50%

12%

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%

$5,000
& 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, Memorial 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

$74.75

$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. See Additional Costs for Medical Coverage.

For more information, call Cigna 800.244.6224 or log in to your myCigna account. 

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