To help you cover any increases in premiums, deductibles, and out-of-pocket maximum limits effective January 1, 2027, you’ll have access to a new program that will enable you to be reimbursed for some of these costs.
The following plan changes take effect January 1, 2027.
Quarterly premium for coverage through covered employment will increase
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Why this change is necessary
Health care costs throughout the United States have skyrocketed at rates that continue to outpace most other expenses. For 2027, the Fund’s medical costs are expected to increase by 8%. Prescription drug costs are expected to increase by 11%; specialty drugs will account for much of this spike, driven by pharmacy manufacturers’ demands.
We’ve been able to absorb these increases for more than six years without raising premiums, but we can no longer continue to shoulder this burden alone.
The premium you pay now, $300 every three months, represents a fraction of the total cost of your coverage (about $4,300 per quarter for Tier 1 coverage or $4,046 per quarter for Tier 2 coverage). Even with the premium increase, you’ll continue to pay less than 10% of the cost of your coverage.
The Tier 1 buy-up will not increase
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Tier 1 updates: Deductibles and out-of-pocket maximums
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New—in-network deductible: Tier 1 plan participants will need to satisfy an in-network annual deductible before the plan begins to pay its share of select medical services: $1,000 for member-only coverage or $2,000 if you cover yourself and one or more dependents. The deductible will not apply to most other Tier 1 services; participants will pay only the usual copays. For details, review the 2027 benefit summary.
In-network, out-of-pocket maximum increase: The annual limit on out-of-pocket expenses will increase from $4,550 to $5,550 for member-only coverage, and from $9,100 to $11,100 if you cover yourself and one or more dependents.
Out-of-network deductible increase: The annual out-of-network deductible will increase from $500 to $1,500 for member-only coverage, and from $1,000 to $3,000 if you cover yourself and one or more dependents.
Tier 2 updates: Deductible and out-of-pocket maximums
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In-network deductible increase: The annual in-network annual deductible will increase from $1,000 to $2,000 for member-only coverage, and from $2,500 to $4,500 if you cover yourself and one or more dependents. The deductible will not apply to most Tier 2 services; participants will pay only the usual copays. For details, review the 2027 benefit summary.
In-network, out-of-pocket maximum increase: The annual limit on out-of-pocket expenses will increase from $4,550 to $5,550 for member-only coverage, and from $9,100 to $11,100 if you cover yourself and one or more dependents.
A new way to save on out-of-pocket costs
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Beginning January 1, Cigna plan participants will have a new healthcare benefit that helps them find high-quality doctors and reimburses qualifying out-of-pocket medical costs. This benefit will work in conjunction with Cigna’s in-network benefits. It will be administered by Garner Health.
Garner’s preferred providers are the top providers in the Cigna network, based on patient outcomes, adherence to medical guidelines, and history of avoiding unnecessary procedures. When you see a Garner Health preferred provider, Garner will reimburse you for eligible out-of-pocket medical expenses (including your deductible and copays for medical, hospital and prescription drug benefit) through deposits to a Health Reimbursement Account (HRA) that Garner establishes for you. You can receive annual reimbursements of up to $2,000 if you have coverage only for yourself, or up to $4,000 if you cover yourself and one or more dependents.
The reimbursement through Garner is for Cigna Tier 1 and Tier 2 plan participants only; HMO participants and Medicare recipients are not eligible for the Garner reimbursements. Progyny infertility benefits are also excluded from the Garner reimbursement.
After January 1, if you choose a new, in-network Cigna doctor who is not a Garner preferred provider, you’ll cover your copays and coinsurance as you do now; they will not be reimbursed by Garner.
You can receive reimbursement for your out-of-pocket expenses if either of the following scenarios applies to you:
- You select a doctor in the Garner Health network and register them in your Garner account (on the Garner website or app) before you see that provider.
- You notify Garner before seeing your current primary care physician (PCP), pediatrician, ob-gyn, and/or in-network mental health provider (including Spring Health) who are not in the Garner network. These are the only non-Garner providers you can see and also receive the reimbursement. We have grandfathered them into this benefit to avoid any disruptions in your care.
Stay tuned for more information about how you can begin using Garner doctors beginning January 1.