Choosing a medical plan option and how we fund our healthcare expenses is one of the most important decisions for you and your family. When making these decisions, it sure would be helpful if we had a crystal ball so that we could determine exactly what we need to select to protect and secure our future. However, these decisions do not need to be painstaking and difficult if you have the right tools and resources to guide you, like ALEX.

Intermountain Health offers a few medical plan options to choose from (may vary by region).

When you choose your medical plan, you will automatically receive pharmacy coverage as well as a Health Reimbursement Account (HRA) through the plan vendor you select. The Medical Plan Options are:

  1. Cigna Consumer Driven Health Plan (CDHP) - High deductible plan with lower premiums
  2. Cigna Consumer Driven Health Out-Of-Area Plan (CDHP) - High deductible plan with lower premiums
  3. Cigna Preferred Provider Organization (PPO) - Lower deductible plan with higher premiums
  4. Cigna Preferred Provider Organization (PPO) Out-of-Area - Lower deductible plan with higher premiums
  5. Kaiser Exclusive Provider Organization (EPO) - Colorado Service Area Only - Lower deductible plan with higher premiums (exclusive providers only)

Virtual Care

Cigna Plan Members — you have access to Intermountain Health Peaks region providers during normal business hours for just a $10 copay. You also have access to Doctor on Demand available 24/7 for $20 copay.

Kaiser Plan Members — you have access to Kaiser Virtual Health visits for free! Kaiser virtual visits are available 24/7. Go to kp.org to learn more.

Doctor on Demand — you will need to register as a new user to get the discounted rate. Enter your personal information, choose Cigna as your medical insurance carrier, enter your Cigna member ID and choose SCL Health as your employer. If you fail to register as an Intermountain Health (legacy SCL Health) member, you will not get the discounted rate.

blank

How Network Tiers Work

Each network tier has a different cost-sharing arrangement. You and your covered family members choose which tier to use each time you seek care:

Intermountain Health Peaks region (SCL Health Tier 1)

 

So what is a Tier 1 provider?

For our Cigna plans, Tier 1 is essentially our legacy SCL Health providers, hospitals, and medical centers. It also includes Children’s Hospital Colorado and select providers and facilities who partner with us to deliver care. For Kaiser EPO participants (Front Range only), Tier 1 is providers and facilities within the Kaiser Permanente of Colorado network.

You will save the most when you receive care or services from the Tier 1 Network. We are in the healthcare business, so we can deliver both exceptional care and a better ability to control cost. This means you receive the highest level of benefits when you use Tier 1 providers and facilities. Some of these features include lower copays for physician/specialist office visits (when applicable), lower deductibles, lower coinsurance, and lower out-of-pocket maximums.

"Find Care" at myCigna.com online or via the myCigna app. To access this updated search platform that shows the Tier 1 designation, offers improved quality and a better customer experience, login to your myCigna.com account and click on "Find Care".

Note: Kaiser members, Tier 1 applies to select SCL Health Hospitals/Facilities.

Network (Tier 2)

For Cigna members the Open Access Plus network of providers and facilities have agreed to our plan’s negotiated rates. Your deductible, coinsurance, and copays are lower than when using an out-of-network provider.

For Kaiser members, you must stay within the exclusive network of providers offered through Kaiser to receive any network benefit.

Out-of-Network (Tier 3)

For Cigna members, if you receive care from a provider who is not a part of the networks described above, your services may not be discounted, and you could be billed the difference between what the SCL Health plan pays and what the provider chooses to charge. Seeing providers outside of the Tier 1 and Cigna networks will cost you the most out-of-pocket.

For Kaiser members, there is no out-of-network coverage available, and you will be charged 100% of the billed rate that the provider charges for services sought.

More
blank

How to Search for Network Providers

Choose the appropriate medical plan vendor to access a custom provider directory created specifically for Intermountain Health Peaks Region caregivers.

myCigna.com or call 800-CIGNA24 (800-244-6224) and request the “Hospital Vertical Team”

Kaiser Provider Search or call 866-427-7701

More
blank

Cigna CDHP with HRA

SCL Health Cigna Consumer Driven Health Plan (CDHP) at a glance

Preventive Care — CDHP medical plan covers in-network preventive care at 100%. (This includes annual physical checkups, recommended screenings for your age, and immunizations.) Click here to learn all the ways your Cigna medical plan can help you stay your healthiest.

Health Reimbursement Account (HRA) — For those who elect the CDHP medical plan, a Health Reimbursement Account (HRA) is automatically opened for you to use to cover eligible medical and prescription drug out-of-pocket expenses. You cannot use HRA funds for dental or vision expenses.

SCL Health will contribute the following to your account upon enrollment in the plan or as of January 1, each subsequent year, if enrolled in the plan:

  • $250 to those with Caregiver Only coverage
  • $500 to those who also cover one or more dependents

You and your spouse/Legal Domicile Adult (LDA) each, if applicable, may fund this account by participating in any of the following programs:

  • Virgin Pulse wellness incentive program (up to $200)
  • Cigna Personal Health Team (up to $400)
  • Cigna Healthy Pregnancies, Healthy Babies (up to $200)
Questions about your HRA? Visit mycigna.com or contact Customer Support at 800-244-6224.

Deductible — The CDHP option has a deductible that you must meet before the plan begins to pay coinsurance. The deductible does apply to your out-of-pocket maximum.

Out-of-Pocket Maximum — The out-of-pocket maximum is the most you will pay out-of-pocket during the plan year. Once you reach the out-of-pocket maximum, the plan pays 100% of your eligible medical and pharmacy expenses for the rest of the plan year.

Reminder – If you elected to contribute to a Health Care Flexible Spending Account (FSA), you can use your FSA to pay for eligible out-of-pocket expenses, such as annual deductible and coinsurance responsibility.

More
blank

Cigna PPO Plan with HRA

SCL Health Cigna PPO medical plan at a glance

Preventive Care — PPO medical plan covers in-network preventive care at 100% (this includes annual physical checkups, recommended screenings for your age, and immunizations). Click here to learn all the ways your Cigna medical plan can help you stay your healthiest.

Health Reimbursement Account (HRA) — For those who elect the PPO medical plan, a Health Reimbursement Account (HRA) is automatically opened for you to use to cover eligible medical and prescription drug out-of-pocket expenses. You cannot use HRA funds for dental or vision expenses.

You and your spouse/Legal Domicile Adult (LDA) each, if applicable, may fund this account by participating in any of the following programs:

  • Virgin Pulse wellness incentive program (up to $200)
  • Cigna Personal Health Team (up to $400)
  • Cigna Healthy Pregnancies, Healthy Babies (up to $200)

Questions about your HRA? Visit mycigna.com or contact Customer Support at 800-244-6224.

Convenient PPO Copay — The PPO plan is built on a predicable copay schedule that allows you to know ahead of time what you will pay for services.

Deductible — Cigna PPO option has a deductible that you must meet before the plan begins to pay coinsurance. The deductible does apply to your out-of-pocket maximum.

Out-of-Pocket Maximum — The out-of-pocket maximum is the most you will pay out-of-pocket during the plan year. Once you reach the out-of-pocket maximum, the plan pays 100% of your eligible medical and pharmacy expenses for the rest of the plan year.  

Reminder – If you elected to contribute to a Health Care Flexible Spending Account (FSA), you can use your FSA to pay for eligible out-of-pocket expenses, such as annual deductible and coinsurance responsibility.

 

More
blank

Kaiser EPO Plan with HRA (Colorado Service Area only)

Kaiser Permanente Exclusive Provider Organization (EPO) medical plan at a glance:

Preventive Care — The Kaiser EPO medical plan covers in-network preventive care at 100% (this includes annual physical checkups, recommended screenings for your age, and immunizations).

Click here to find Colorado Service Area locations including medical offices, primary care with extended hours, urgent care, emergency care, and behavioral health.

If you require care when outside the Colorado Service Area, you may contact the Away From Home Travel Line. 

Health Reimbursement Account (HRA) — For those who elect the EPO medical plan, a Health Reimbursement Account (HRA) is automatically opened for you to use to cover eligible medical and prescription drug out-of-pocket expenses.

You and your spouse/Legal Domicile Adult (LDA) each, if applicable, may fund this account by participating in any of the following programs:

Questions about your HRA? Visit kp.org or contact Customer Support at 877-761-3399.

Deductible — The Kaiser EPO medical plan option has a deductible that you must meet before the plan begins to pay coinsurance. The deductible does apply to your out-of-pocket maximum.

Out-of-Pocket Maximum — The out-of-pocket maximum is the most you will pay out-of-pocket during the plan year. Once you reach the out-of-pocket maximum, the plan pays 100% of your eligible medical and pharmacy expenses for the rest of the plan year.

For Benefit Coverage details for the Kaiser EPO medical plan, see below information under Summary of Benefits and Coverage drop-down.

Reminder – If you elected to contribute to a Health Care Flexible Spending Account (FSA), you can use your FSA to pay for eligible out-of-pocket expenses, such as annual deductible and coinsurance responsibility.

More
blank

Summary of Benefits and Coverage

The Summary of Benefits and Coverage, or SBC, assists you in understanding your healthcare coverage with a summary of services covered and not covered (excluded) by the plan. 2023:
More
blank

Summary Plan Description

The Summary Plan Description, or SPD, communicates plan rights and obligations to participants and beneficiaries. This is a summary of the material provisions of the plan document. See the Medical SPDs.
More