Medical Plans
Overview
Children’s Mercy offers two medical plans, the Blue Plan and the Gold Plan.
The medical plans have several features in common.
- Extensive group of in-network providers. The Gold Plan offers coverage for in- and out-of-network providers, but you receive the greatest benefit from seeing a provider in the Cigna network. The Blue Plan does not offer out-of-network coverage.
- Preventive care services are covered at 100 percent.
- Health Account with contributions from Children’s Mercy. The money Children’s Mercy puts into your Health Account (which is a health reimbursement account, or HRA) pays for eligible medical expenses you incur during the plan year. Any unused dollars in your Health Account at the end of the plan year roll over for use in the next plan year. When you and/or your covered spouse complete wellness activities, you earn points, which convert to dollars in your Health Account on July 1 if you complete the health screening and health assessment by the communicated deadline. Learn more
Remember, unless you owe a copay for a medical service, do not pay anything at the time of your visit. If you have money in your Health Account, it can be used automatically to pay for your service when your claim is processed or you can pay out of your pocket and save your Health Account dollars for future eligible medical expenses under your Children’s Mercy plan. You should receive an Explanation of Benefits from Cigna, which will clearly state any remaining amount you owe.
- Deductible. This is the amount you pay before your medical plan starts paying benefits. The money in your Health Account offsets your total deductible amount and can be used to pay for eligible expenses automatically. Or, you can pay out of your pocket and save your Health Account dollars for future eligible medical expenses under your Children’s Mercy medical plan. If you use all the money in your Health Account, you pay the full cost of services until you meet the deductible.
- Coinsurance. Once you meet the deductible, you share responsibility for your medical expenses with Children’s Mercy through coinsurance.
- You pay 10 percent of the total cost for seeing a provider in the Cigna network, and Children’s Mercy pays the remaining 90 percent of the cost.
- When your covered dependents receive care from pediatric primary care providers who participate in the Children’s Health Network, the coinsurance you would normally pay for a nonpreventive service will be waived once you meet your deductible.
- Certain outpatient services, treatment plans and/or equipment require precertification before the plan will help cover the cost.
- You pay 10 percent of the total cost for seeing a provider in the Cigna network, and Children’s Mercy pays the remaining 90 percent of the cost.
- Out-of-pocket maximum. Once you reach the out-of-pocket maximum, the plan pays the full amount of eligible medical expenses for the remainder of the plan year.
- No lifetime maximum coverage limit. This means you’ll have medical benefits even in the event of a prolonged illness.
Review the medical plan comparison chart below to see how the plans compare and contrast, watch the Take CARE video and view the list of eligible expenses.
| Employee Only | Employee + Child(ren) | Employee + Spouse | Family | Employee Only | Employee + Child(ren) | Employee + Spouse | Family | |
| In-network deductible | $1,400 | $1,700 | $2,100 | $2,600 | $2,000 | $2,600 | $3,000 | $4,000 |
| Out-of-network deductible | $2,800 | $3,400 | $4,200 | $5,200 | ||||
| In-network coinsurance* | CM pays 90% |
CM pays 90% |
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| Out-of-network coinsurance* | You pay 40%; CM pays 60% | |||||||
| In-network out-of-pocket maximum* | $3,000 | $3,750 | $4,500 | $5,250 | $4,500 | $5,625 | $6,750 | $7,875 |
| Out-of-network out-of-pocket maximum | $6,000 | $7,500 | $9,000 | $10,500 | ||||
| Preventive care, well-child care and immunizations** | Eligible services covered at 100% in-network, subject to Cigna’s preventive care schedule. | |||||||
*Coinsurance, out-of-pocket and lifetime maximums for eligible infertility expenses are paid differently than listed above. Refer to the list of eligible expenses for details.
**In the Gold Plan, you also may be charged for out-of-network preventive care expenses over 150 percent of the Maximum Reimbursable Charge (or 150 percent of the Medicare rate).
Children’s Mercy is committed to offering comprehensive benefits that are both competitive in the health care industry and in the areas in which we serve our communities, and that are consistent year over year. We are proud to share that the deductibles and copayments in our medical, dental and vision plans have not changed for three years and counting.
Confirm your eligibility and when you can enroll for medical coverage.
If you and/or your adult dependents are enrolled in a Children’s Mercy's medical plan and at risk for type 2 diabetes, we offer a diabetes prevention program administered by Omada. This program, available at no cost to you, combines the latest technology with ongoing support to help you lose weight and reduce the risks of type 2 diabetes. If you qualify for the program, you will receive a digital scale, weekly online lessons and a professional health coach to support you on your weight-loss journey. You also will be able to participate in a small peer group. Omada provides phone and email support, a website, mobile apps and a 24/7 online help center. If you qualify, you'll receive more information directly from Omada.
Precertification for certain outpatient services is required, which means services, treatment plans and/or equipment will be reviewed for medical necessity, helping ensure you’re using your health care dollars in the best way possible.
24/7 access to medical professionals by phone or video conference is available through Cigna’s Telehealth Connection to help you get the right care any time of day. Learn more now.
Need a health advocate? Cigna provides an on-site RN Case Manager if you need help managing a health issue.
Eligible Expenses
SUMMARY PLAN DESCRIPTIONS
Click to access the Summary Plan Descriptions for the medical plans, which include plan details and eligible expenses.
SUMMARIES OF BENEFITS AND COVERAGE
Click to access Summaries of Benefits and Coverage for the medical plans, which include plan details and coverage examples.
INFERTILITY TREATMENT COVERAGE
Children’s Mercy and you share the cost of infertility treatment coverage as follows:
- Under the medical plan, once you meet the deductible, the plan pays 50-percent coinsurance for in-network infertility services, up to a lifetime maximum of $10,000.
- Under the prescription drug plan, the plan pays 50-percent coinsurance for in-network infertility services, up to a lifetime maximum of $5,000 for prescription drug services. The prescription drug plan, offered through MedImpact, does not have a deductible that you must meet.
Your infertility treatment expenses, including medical and prescription drug expenses, do not apply to the annual out-of-pocket maximum.
Health Account
The Health Account is a feature of both the Blue Plan and the Gold Plan. Here’s how it works.
- Children’s Mercy puts money in your Health Account (which is a health reimbursement account, or HRA) – $500 to $1,000, depending on your coverage level. You can use the money to automatically pay for eligible medical expenses before you pay anything out of your pocket, or you can choose to pay for the eligible expenses out of your pocket and save your Health Account dollars for future eligible medical expenses under your Children’s Mercy medical plan. Read more about using your Health Account dollars below.
- Any unused dollars in your Health Account at the end of the plan year will roll over for use in the next plan year. Log in to check your Health Account balance throughout the year.
- When you and/or your covered spouse complete wellness activities, you earn points, which convert to dollars in your Health Account on July 1 if you complete the health screening and health assessment by the communicated deadline.
- You must enroll in a Children’s Mercy medical plan for the 2020–2021 plan year to have a Health Account.
Review the chart to understand the Health Account contributions.
| Employee Only | Employee + Child(ren) | Employee + Spouse | Family | |
|---|---|---|---|---|
| Automatic contribution from CM | $500 | $750 | $750 | $1,000 |
| Additional contributions by completing wellness activities by deadlines | $400 | $400 | $400 employee + $400 spouse = $800 | $400 employee + $400 spouse = $800 |
| Total eligible contributions | $900 | $1,150 | $1,550 | $1,800 |
USING YOUR HEALTH ACCOUNT DOLLARS TO PAY FOR ELIGIBLE EXPENSES
We offer choice for how and when you use your Health Account dollars to pay for eligible medical expenses through Cigna’s MyClaimPay tool. This easy-to-use, online bill pay tool works seamlessly with the AutoPay feature, which is the default when your Health Account is established. You can turn off AutoPay, which then allows you to choose when to use your Health Account dollars to pay for eligible medical expenses. If you turn off AutoPay, Health Account dollars will not be used automatically to pay for eligible expenses. Instead, you can:
- Pay out of your Health Care Flexible Spending Account (FSA) and/or your spouse’s Health Savings Account, if applicable, or
- Pay out of your pocket.
In either case, you will save your Health Account dollars for future eligible medical expenses you incur under your Children’s Mercy medical plan.
Discounts
As an employee of Children’s Mercy, you receive discounts on the cost of inpatient and outpatient services your child receives at Children’s Mercy. Discounts are applied to your account differently depending on whether your child is enrolled in one of the Children’s Mercy medical plans.
If your child is enrolled in a Children’s Mercy medical plan, your discount is applied twice:
- If your health care provider is a member of Cigna’s network, Cigna will apply the network discount plus an additional 20 percent. The additional 20 percent is included in the amount of your discount on the Explanation of Benefits you receive from Cigna after your claim has been processed.
- If you have an out-of-pocket balance after Cigna processes your claim, Children’s Mercy will apply an additional 20-percent discount.
To be sure you receive your discount(s), provide your employee ID number when you check in your child for care. If your discount isn’t applied, contact Patient Financial Services at (816) 701-5100.
If your child is enrolled in another medical plan:
After your medical plan processes your claim, Children’s Mercy will discount any amount remaining by 20 percent of the original amount billed or your balance after your medical plan processes the claim.
For more information, search for “Discounted Children’s Mercy Services” on the Scope.
More affordable coverage also is available to you if your covered dependents receive care from pediatric primary care providers who participate in the Children’s Health Network (CHN). When you use a CHN provider, the coinsurance you normally would pay for a nonpreventive service will be waived once you meet your deductible.