Medical Plans
Overview
Children’s Mercy offers three medical plans – the Gold Plan, Blue Plan and Green Plan (new for 2021–2022). The medical plans have several features in common, and some differences. Review the chart to learn more, and then read on to find more details about each plan.
| Plan Feature | |||
|---|---|---|---|
| In-network coverage from Cigna’s national network of providers and facilities. | X | X | X |
| Out-of-network coverage. While you’ll pay less when you see an in-network provider, you have the option to see an out-of-network provider and a portion of your benefit is covered. | X | X | |
| Preventive care services are covered at 100 percent when you use an in-network provider. | X | X | X |
| Contributions from Children’s Mercy into your HRA. You cannot contribute to your HRA; only Children’s Mercy contributes. | X | X | |
| Contributions from Children’s Mercy into your HSA. You can contribute, too, up to the IRS maximum. | X | ||
| Dollars for well-being activity completion go into your HRA. Use them to pay for eligible medical expenses, or roll them over to the next year. | X | X | |
| Dollars for well-being activity completion into your HSA. Use them to pay for eligible medical expenses, or roll them over to the next year. | X | ||
| Deductible, then coinsurance are your responsibility, up to the out-of-pocket maximum. All three plans work the same. | X | X | X |
| Embedded deductibles and out-of-pocket maximums. All three plans work the same. Click the box below this table to learn more. | X | X | X |
| No lifetime maximum coverage limit. You’ll have medical benefits even in the event of a prolonged illness. | X | X | X |
What is an embedded deductible and out-of-pocket maximum?
All three medical plans have an embedded deductible and out-of-pocket maximum. If you elect to cover dependents (including spouse and/or children), each covered person has his/her own individual embedded deductible and out-of-pocket maximum. This means that once one covered person reaches his/her deductible, he/she begins paying coinsurance. Similarly, once one covered person reaches his/her out-of-pocket maximum, his/her eligible expenses are covered at 100% for the rest of the plan year. This may result in lower health care expenses, because each family member's individual expenses are capped.
Let’s look at an example.
Assume you enroll yourself, your spouse and your daughter in the Blue Plan. The in-network family deductible is $4,000. In January, your daughter falls on ice and you rush her to the emergency room. An average cost for an emergency room visit is $2,400. You pay the full cost of the visit up to the individual deductible, which is $2,000. Then you pay 10% of the remaining cost of the visit, which is $200. Your daughter has met her individual embedded deductible, so for all of her future eligible expenses, you pay 10% coinsurance until she reaches the individual embedded out-of-pocket maximum.
In April, you have an outpatient hospital procedure, which costs $2,300. You pay the full cost of the visit up to the individual deductible, which is $2,000. Then you pay 10% of the remaining cost of the visit, which is $30.
The amount you have paid for your and your daughter’s services have met your family deductible. For any future eligible expenses, you pay coinsurance.
The out-of-pocket maximum works just like the deductible.
GOLD PLAN
In the Gold Plan, you’ll pay the highest per-paycheck premiums of the three medical plans in exchange for the lowest out-of-pocket costs (deductible, coinsurance and out-of-pocket maximum) when you need care. The Gold Plan provides out-of-network coverage should you need to see a provider not in Cigna’s national network.
The Gold Plan includes an HRA. Children’s Mercy contributes to your HRA, and you can use those dollars to pay for eligible medical expenses. Any unused dollars will roll over for you to use in the next year. NOTE: If you leave Children’s Mercy, retire or discontinue coverage of the Blue Plan or Gold Plan, any remaining dollars in your HRA are forfeited.
| Employee Only | Employee + Child(ren) | Employee + Spouse | Family | |||
| In-network deductible | $1,400 | $1,700 | $2,100 | $2,600 | ||
| Out-of-network deductible | $2,800 | $3,400 | $4,200 | $5,200 | ||
| In-network coinsurance* | You pay 10%; CM pays 90% | |||||
| Out-of-network coinsurance* | You pay 40%; CM pays 60% | |||||
| In-network out-of-pocket maximum* | $3,000 | $3,750 | $4,500 | $5,250 | ||
| 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. | |||||
| Employee Wellness Center visits | Preventive care visits: Covered at 100%, including annual physicals, well-woman visits and Motion Capture visits. Non-preventive care visits: $10 copay, including those pertaining to primary care, same-day and follow-up appointments with a primary care provider, and behavioral health services. |
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BLUE PLAN
In the Blue Plan, you’ll pay lower per-paycheck premiums than the Gold Plan in exchange for higher out-of-pocket costs (deductible, coinsurance and out-of-pocket maximum) when you need care. The Blue Plan does not provide coverage for out-of-network services.
Like the Gold Plan, the Blue Plan also includes an HRA. Children’s Mercy contributes to your HRA, and you can use those dollars to pay for eligible medical expenses. Any unused dollars will roll over for you to use in the next year. NOTE: If you leave Children’s Mercy, retire or discontinue coverage of the Blue Plan or Gold Plan, any remaining dollars in your HRA are forfeited.
| Employee Only | Employee + Child(ren) | Employee + Spouse | Family | |||
| In-network deductible | $2,000 | $2,600 | $3,000 | $4,000 | ||
| Out-of-network deductible | ||||||
| In-network coinsurance* | ||||||
| Out-of-network coinsurance* | No coverage | |||||
| In-network out-of-pocket maximum* | $4,500 | $5,625 | $6,750 | $7,875 | ||
| Out-of-network out-of-pocket maximum | No coverage | |||||
| Preventive care, well-child care and immunizations** | Eligible services covered at 100% in-network, subject to Cigna’s preventive care schedule. | |||||
| Employee Wellness Center visits | Preventive care visits: Covered at 100%, including annual physicals, well-woman visits and Motion Capture visits. Non-preventive care visits: $10 copay, including those pertaining to primary care, same-day and follow-up appointments with a primary care provider, and behavioral health services. |
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GREEN PLAN (NEW FOR 2021–2022)
In the Green Plan, a high deductible health plan (HDHP), you’ll pay the lowest per-paycheck premiums of the three medical plans in exchange for the highest out-of-pocket costs (deductible, coinsurance and out-of-pocket maximum) when you need care. The Green Plan provides out-of-network coverage should you need to see a provider not in Cigna’s national network.
The Green Plan comes with a Health Savings Account (HSA). Children’s Mercy contributes to your HSA, and you can contribute before-tax dollars, too, up to the annual IRS maximum. You can use the dollars to pay for eligible medical expenses. Any unused dollars will roll over for you to use in the future.
| Employee Only | Employee + Child(ren) | Employee + Spouse | Family | |||
| In-network deductible | $2,800 | $3,400 | $4,200 | $5,600 | ||
| Out-of-network deductible | $5,600 | $6,800 | $8,400 | $11,200 | ||
| In-network coinsurance* | ||||||
| Out-of-network coinsurance* | You pay 40%; CM pays 60% | |||||
| In-network out-of-pocket maximum* | $4,500 | $5,625 | $6,750 | $9,000 | ||
| Out-of-network out-of-pocket maximum | $9,000 | $11,250 | $13,500 | $18,000 | ||
| Preventive care, well-child care and immunizations** | Eligible services covered at 100% in-network, subject to Cigna’s preventive care schedule. | |||||
| Employee Wellness Center visits | Preventive care visits: Covered at 100%, including annual physicals, well-woman visits and Motion Capture visits. Non-preventive care visits: You will be charged a discounted fair market value rate, including those pertaining to primary care, same-day and follow-up appointments with a primary care provider, and behavioral health services. |
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Use your HSA to save money and plan ahead!
Contributing to your HSA is a great way to budget for your deductible and other out-of-pocket expenses while also saving money — your HSA contributions are tax-free!*
Keep in mind:
- When you elect the Green Plan, you pay the least in premiums for medical coverage, so you may have extra money available to put in your HSA.
- You and Children’s Mercy can contribute to your HSA, up to the annual IRS maximum. For 2021, that is $3,600 if you cover yourself only and $7,200 if you cover dependents.
- You can only spend HSA money that’s actually been deposited into your account. If you don’t have enough money in your account when you need it, you can pay another way and reimburse yourself later so you take full advantage of the tax savings.
- You will never forfeit any money left in your HSA; it rolls over year after year. If you know about future expenses or want to save for your health care costs in retirement, set aside a little extra each paycheck so your balance can grow over time.
- You can change your HSA contribution amount throughout the year as needed to keep up with any changes in your situation.
- You can pair your HSA with a tax-free Limited Purpose Flexible Spending Account to save even more.
*Contributions are not subject to federal tax. However, HSA contributions are currently subject to state tax in AL, CA, and NJ. Consult with your tax adviser to understand the potential tax consequences of enrolling in an HSA. Money in an HSA can be withdrawn tax-free as long as it is used to pay for qualified health-related expenses. If money is used for ineligible expenses, you will pay ordinary income tax on the amount withdrawn, plus a 20% penalty tax if you withdraw the money before age 65.
MEDICAL PLAN COMPARISON
Review the chart below to see how the plans compare and contrast. And, click to find information about your prescription drug coverage.
| In-network deductible (Details about the embedded deductible and out-of-pocket maximum are described above) |
Employee only: $1,400 Employee + Children: $1,700 Employee + Spouse: $2,100 Family: $2,600 |
Employee only: $2,000 Employee + Children: $2,600 Employee + Spouse: $3,000 Family: $4,000 |
Employee only: $2,800 Employee + Children: $3,400 Employee + Spouse: $4,200 Family: $5,600 |
| Out-of-network deductible | Employee only: $2,800 Employee + Children: $3,400 Employee + Spouse: $4,200 Family: $5,200 |
No coverage | Employee only: $5,600 Employee + Children: $6,800 Employee + Spouse: $8,400 Family: $11,200 |
| In-network coinsurance* | You pay 10%; CM pays 90% |
You pay 10%; CM pays 90% |
You pay 20%; CM pays 80% |
| Out-of-network coinsurance* | You pay 40%; CM pays 60% |
No coverage | You pay 40%; CM pays 60% |
| In-network out-of-pocket maximum* (Details about the embedded deductible and out-of-pocket maximum are described above) |
Employee only: $3,000 Employee + Children: $3,750 Employee + Spouse: $4,500 Family: $5,250 |
Employee only: $4,500 Employee + Children: $5,625 Employee + Spouse: $6,750 Family: $7,875 |
Employee only: $4,500 Employee + Children: $5,625 Employee + Spouse: $6,750 Family: $9,000 |
| Out-of-network out-of-pocket maximum | Employee only: $6,000 Employee + Children: $7,500 Employee + Spouse: $9,000 Family: $10,500 |
No coverage | Employee only: $9,000 Employee + Children: $11,250 Employee + Spouse: $13,500 Family: $18,000 |
| Preventive care, well-child care and immunizations** | Eligible services covered at 100% in-network, subject to Cigna’s preventive care schedule. | ||
Employee Wellness Center visits
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*Coinsurance, out-of-pocket and lifetime maximums for eligible infertility expenses are paid differently than listed above. Refer to the list of eligible expenses below 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).
Use HealthEquity’s plan comparison tool to compare your medical plan options. You’ll simply estimate your annual medical expenses, then view the plans side-by-side. The tool also shows the benefits of an HSA, which is available with the Green Plan only.
Be in the know about all that your Children’s Mercy medical plan offers.
- Children’s Mercy is committed to your health and well-being. That’s why we offer comprehensive benefits that are both competitive and consistent year over year in the health care industry and in the areas in which we serve our communities.
- It’s important that you confirm your eligibility and when you can enroll for medical coverage. Go to the Eligibility page to learn more.
- We offer diabetes prevention support at no cost to you. If you and/or your adult dependents are enrolled in a Children's Mercy medical plan and are at risk for type 2 diabetes, you can benefit from the latest technology and ongoing support to help you lose weight and reduce type 2 diabetes risks. If you qualify, you will receive more information directly from Omada, including a digital scale, weekly online lessons, a professional health coach and more.
- Need a health advocate? Cigna provides an on-site RN Case Manager if you need help managing a health issue.
- Precertification for certain outpatient services is required. This 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.
- Get 24/7 access to medical professionals by phone or video conference. Available through Cigna’s Telehealth Connection, this service ensures you get the right care any time of day. Learn more.
Eligible Expenses
Find the Summaries of Benefits and Coverage and Summary Plan Descriptions for the medical plans, on the Documents page.
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.
Your infertility treatment expenses, including medical and prescription drug expenses, do not apply to the annual out-of-pocket maximum.
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:
If your health care provider is a member of Cigna’s network, Cigna will apply the network discount plus an additional employee discount.
Your statement from Children’s Mercy Patient Financial Services will reflect the amount you owe. This updated process, which will comply with health plan regulations, may mean you will receive bills for services for which you previously have not been billed.
If you have an out-of-pocket balance after Cigna processes your claim, Children’s Mercy will send you a bill or statement. This amount is your patient responsibility.
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 and your balance after your medical plan processes the claim.
*Medical plans that already have a negotiated discount with CM as a provider may not be eligible for additional discount (i.e., TRICARE). Please check with CM Patient Financial Services if you have questions.
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.