Children’s Mercy offers two medical plans, the Blue Plan and the Gold Plan.
The medical plans have several features in common.
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).
Click to access the Summary Plan Descriptions for the medical plans, which include plan details and eligible expenses.
Click to access Summaries of Benefits and Coverage for the medical plans, which include plan details and coverage examples.
Children’s Mercy and you share the cost of infertility treatment coverage as follows:
Your infertility treatment expenses, including medical and prescription drug expenses, do not apply to the annual out-of-pocket maximum.
The Health Account is a feature of both the Blue Plan and the Gold Plan. Here’s how it works.
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 |
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:
In either case, you will save your Health Account dollars for future eligible medical expenses you incur under your Children’s Mercy medical plan.
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:
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 Mercy Health Network (CMHN). When you use a CMHN provider, the coinsurance you normally would pay for a nonpreventive service will be waived once you meet your deductible.