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. 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
  • 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:​  
  1. 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
  2. Cigna OAP Network: Facilities and physicians, including BJC Medical Group and Washington University School of Medicine physicians, who have agreed to provide services to BJC Medical Plan members at a reduced cost; deductibles, coinsurance and copayments for facility services are much lower than those from Non-Network providers, but higher than BJC Facility Network providers
  3. Non-Network: Services from health care providers not within the BJC Facility Network or Cigna OAP network may not be discounted
  • Many preventive services are covered at 100 percent (you owe nothing) if received from a BJC facility or Cigna Network OAP provider
  • For just a $25 copay, BJC Medical Plan members can access doctors 24/7/365 via secure video chat or phone, without leaving their home or office; Cigna Telehealth includes national telehealth providers AMWell and MDLIVE who will treat you and your dependents for minor, non-life-threatening illnesses. To use the service, plan members must register with one or both: AmWellforCigna.com, 855.667.9722; MDLIVEforCigna.com, 888.726.3171. Learn more here.

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, 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.

For more information, see the Summary Plan Descriptions.

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. To gain a better understanding, spend some time reviewing this Choice-Choice Plus infographic.

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 contributions listed below )which have increased for 2018) 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.

Annual Wellness Incentive

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

Employees and spouses who are actively covered in the BJC Medical Plan on January 1, 2019, can each earn an annual wellness incentive of $175 for 2019 by completing the following two steps:

  1. Complete the Cigna Health Risk Assessment (HRA) via myCigna.com, which includes entering your health screening results between January 1, 2019 and June 30, 2019.
  2. In addition to completing the Cigna HRA, complete one of the following wellness options between July 1, 2018 and June 30, 2019:
  • A preventive care exam: colonoscopy, mammogram, prostate, gynecological or pap
  • A preventive annual physical (blood draw not required)
  • A preventive vision exam through the BJC Medical Plan or VSP Vision Plan
  • Two preventive dental oral exams through the BJC Dental Plan
  • The Quit For Life® tobacco-cessation program. Requires five (5) weekly calls with your Quit Coach for completion. To get started, call 866.784.8454 or go to quitnow.net/bjc. Enroll by May 1, 2019
  • The Omada health-management program for qualified individuals. Go to omadahealth.com/bjc to apply. Requires 16 weekly lessons for completion. Enroll by February 1, 2019

Employees can earn an additional $25 incentive by completing by June 30, 2018, an at-work health screening at a BJC Community Health Department health fair; see schedule, or the Boone Hospital WELLAWARE health fair. Spouses are not eligible. The additional Incentive cannot be earned unless the first two steps of the Annual Wellness Incentive are completed as outlined above. Completing a health screening is not a substitute for completing the Cigna HRA. Completion of the at-work health screening needs to include height, weight, waist circumference, blood pressure and a finger-stick blood draw for cholesterol and blood glucose.

No documentation is required to prove that you completed any of the above wellness options or the health screening at a BJC health fair. BJC will obtain completion reports from all benefit administrators (Cigna, Delta Dental, VSP) on your behalf, and will load your health screening results from the BJC health fair directly into your Cigna HRA. Documentation will not be accepted from non-BJC administrators.

HRA Instructions