Choosing Your Health Plan

Eligibility

Visit the Eligibility page.

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Plan tier comparison chart

As an active employee, once you are eligible, the following benefits are available to support the overall health of you and your family:

No matter which health tier you choose, you get protection from health care expenses.

Both tiers:

• Use the same nationwide Cigna network – which also includes pharmacy coverage with OptumRx
• Cover the same medical services, although the amount you pay out of your pocket may be different, as shown in the table below
• Include vision coverage and prescription drug coverage
• Cost you $300 per quarter (unless you choose to buy up or buy down to another tier)
• Give you the option to purchase dependent medical coverage. NOTE: You pay the full cost of dependent coverage out of your pocket.
• Give you the option to purchase dependent dental coverage. NOTE: You pay the full cost of dental coverage out of your pocket.
• Cost less when you use a provider who is in-network

For individuals who live in the Maryland-Virginia-Washington, DC metropolitan areas, or in California, an HMO medical plan option is also available.

The other differences between the tiers have to do with how you and the Fund share the cost when you receive health care services and fill prescriptions. View a brief summary below. View the complete Summaries of Benefits.

As an active employee, once you are eligible, the following benefits are available to support the overall health of you and your family:

Medical and Hospital Care—Cigna

Prescription Drugs (In-Network)²—OptumRx

In Maryland, Virgina, Washington, D.C., and metropolitan areas of California, HMOs with no deductibles are also available, which you may want to consider.

¹ Where flat copays are shown for medical benefits, they are in lieu of the deductible and coinsurance.

² A separate $100 / $200 annual deductible applies to all drugs other than generics, and there is a separate coinsurance maximum of $4,000 per individual and $8,000 per family. Generics are generally the lowest-cost drugs, but occasionally the brand-name version can be lower in cost than the generic, in which case your out-of-pocket cost may be similar to that for a generic. Preferred drugs generally have the same outcomes as non-preferred but are less expensive. Non-preferred drugs are higher-cost name brands.

Access to Spring Health mental health and substance use benefits

Mental health and substance use services offered through Spring Health are available to all covered participants and their eligible covered dependents who have Cigna coverage. This benefit will apply in the same manner for both Cigna Plans—Tiers 1 and 2.

Participants who have enrolled in any of the Fund’s HMO plans or who have enrolled in Medicare as their primary coverage are not eligible for the Spring Health benefit.

Kaiser Permanente’s mental health and substance use resources

If you have coverage through Kaiser Permanente, you can visit Kaiser’s website for information on available options and how to make an appointment with a Kaiser mental health care professional—and you don’t need a referral. This includes dedicated help for those struggling with alcohol or drugs. Kaiser also offers many tools including self-care apps (Calm and Headspace) that can help with stress, anxiety, and sleep—available at no cost. You can also try wellness coaching, join a health class, or take an online self-assessment. Visit Kaiser’s website to learn more about the resources available.

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Things to consider

There are many things to consider when choosing your health plan. Use the content below to help you evaluate your CIGNA options. Learn about the HMOs.

You Have the Following Choices

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Unused weeks: Understanding Accumulation Periods

If you choose not to enroll in a health plan as soon as you are eligible, or if you choose to enroll in a plan that does not use all your weeks, it’s important to remember that any unused weeks must be used within an applicable Accumulation Period.

Each Accumulation Period looks at the number of weeks you worked in 12 consecutive months (January to December, April to March, July to June, etc.). Once a week is earned, it must be used to enroll in coverage within 12 months; otherwise, it will fall outside all applicable Accumulation Periods. And remember that there is a two-month waiting period between the end of the applicable Accumulation Period and the beginning of your Benefit Period.

Take a look at some examples.

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