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| Plan | Description |
|---|---|
| Consumer Plan | A plan that puts you in charge of your spending through lower premiums, higher deductibles, and a tax-free Health Savings Account (HSA) (with contributions from Mosaic) that you own for life. |
| Traditional Plan | A plan that reduces your unexpected financial responsibility when you need care through copays and no deductible for physician services; however, you pay higher premiums from your paycheck. |
| Compare the plans | |
Key features
Both of Mosaic’s medical plans offer:
Comprehensive, affordable coverage
for a wide range of health care services.
A network of preferred providers through Cigna
with the option to receive care from providers outside the network.
Free in-network preventive care
with services such as annual physicals, recommended immunizations, and routine cancer screenings covered at 100%. See a list of covered preventive services.
Prescription drug coverage
included with each medical plan. Prescription benefits are provided by Express Scripts.
Financial protection
through annual out-of-pocket maximums that limit the amount you’ll pay each year.
The table below provides a side-by-side comparison of key in-network coverage features for the two medical plans. Complete details, including out-of-network costs, can be found in the Summary of Benefits Coverage (SBC) and summary plan descriptions for each plan.
| In-Network Features | Consumer Plan | Traditional Plan |
|---|---|---|
| HSA-eligible | Yes | No |
| Mosaic contribution to HSA* | $750 for single coverage; $1,500 for family coverage** | None |
| Deductible (per person/per family**) | $2,800/$5,600 Note: The embedded family deductible is $3,200. Learn more about what an embedded deductible is! |
$1,000/$2,000 |
| Coinsurance | You pay 20%, plan pays 80% | You pay 25%, plan pays 75% |
| Out-of-pocket maximum (per person/per family**) | $4,000/$8,000 | $5,000/$10,000 |
| In-network medical care: Your costs | ||
| Preventive care | Covered at 100% in-network, so you pay nothing | |
| Office visit (primary care) | You pay 20% after deductible | You pay $40 copay |
| Office visit (specialist) | You pay 20% after deductible | You pay $60 copay |
| Telemedicine visit | You pay 20% after deductible | You pay $10 copay |
| Emergency room visit | You pay 20% after deductible | You pay $200 copay (waived if admitted) |
| Inpatient and outpatient hospital care | You pay 20% after deductible | You pay 25% after deductible |
| Mental health and substance abuse – inpatient | You pay 20% after deductible | You pay 25% after deductible |
| Mental health and substance abuse – outpatient | You pay 20% after deductible | You pay $60 copay |
| Prescriptions: Your costs | ||
| Retail – up to 30-day supply | ||
| Preventive*** | Covered 100%, you pay nothing | Covered 100%, you pay nothing |
| Generic | You pay 20% after deductible | $10 copay |
| Brand name – preferred | You pay 20% after deductible | You pay 25% coinsurance ($20 min/$50 max) |
| Brand name – nonpreferred | You pay 20% after deductible | You pay 40% coinsurance ($40 min/$100 max) |
| Mail-order – up to 90-day supply | ||
| Preventive*** | Covered 100%, you pay nothing | Covered 100%, you pay nothing |
| Generic | You pay 20% after deductible | $25 copay |
| Brand name – preferred | You pay 20% after deductible | You pay 25% coinsurance ($50 min/$125 max) |
| Brand name – nonpreferred | You pay 20% after deductible | You pay 40% coinsurance ($100 min/$250 max) |
*HSA contribution is prorated based on benefits eligibility date.
**Family coverage benefits shown above also apply to Employee + Spouse and Employee + Children coverage levels.
***The list of what is covered as a preventive prescription is different based on the plan you elect.
We understand how confusing and overwhelming it can be to review your health plan options, and we want to help by providing the resources you need to make a decision with confidence. That’s why Cigna One Guide® service is available to you now.
How does an embedded deductible work?
Let’s take a look at an illustrative example!
Consumer Plan Deductible/Single Coverage - $2,800
Consumer Plan Deductible/Family Coverage - $5,600 (*no more than $3,200 per individual within a family)
*Consumer Plan embedded deductible (only applies if you are covering dependents) – No one family member can contribute more than $3,200 toward the deductible. Once the member pays $3,200 toward the deductible, they will start paying copays and/or coinsurance for their in-network services. (If two or more members of the family needed treatment, the $5,600 family deductible would apply.)
Embedded deductible example #1: Susan and John have family coverage for them and their three children. Susan pays $3,200 towards the deductible after giving birth to their youngest child in February. For the remainder of the year, she will pay copays and/or coinsurance for her medical care. Teenage son Tommy breaks his leg while playing football and also needs extensive care. He pays $2,400 towards the deductible, which means the family deductible of $5,600 has now been met. Later in the year, when John needs carpal tunnel surgery, he pays the applicable coinsurance because the family deductible was already met.
Embedded deductible example #2: Daniel and Grace have employee plus spouse coverage. Daniel pays $4,000 towards his care ($3,200 towards the deductible and $800 in coinsurance) after having knee replacement surgery in June. For the remainder of the year, he will not pay coinsurance for his medical care as he has hit his embedded out-of-pocket maximum. Grace has emergency surgery to remove her appendix in September. She pays $2,400 towards the deductible, which means their family deductible of $5,600 has now been met. She will now pay coinsurance for her medical care through the end of the year or when she hits the family out-of-pocket maximum ($8,000).
The Consumer Plan pairs low-premium, high-deductible coverage with a tax-free Health Savings Account (HSA) that helps you save for future medical expenses. As an added bonus, Mosaic will contribute to your HSA — $750 for single coverage or $1,500 if you cover dependents. Any money left in your HSA can be carried forward from year to year and is always yours to keep. With this plan, you can see any provider you wish, but you will pay less when you stay in network.
How the Consumer Plan works
You pay the plan premium from your paycheck to have coverage.
HSA
You can set aside tax-free money from your paycheck and receive company contributions to help cover your costs — now, or in the future.
Deductible
You pay 100% of your medical and prescription costs until you meet the annual deductible.
Coinsurance
After meeting the deductible, you and the plan share the cost of covered medical care and prescriptions, with the plan paying the majority.
Out-of-Pocket
Maximum
You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
Money-Saving Tip
Use the annual contribution Mosaic makes to your HSA, as well as your own pre-tax HSA contributions, to help you pay for your out-of-pocket costs.
The Traditional Plan offers a lower deductible in exchange for higher premiums. With this plan, your costs are more predictable, since you pay a copay for visits to the doctor’s office, urgent care, and emergency room, as well as for generic prescriptions. You can see any provider you wish, but you will pay less when you stay in network.
How the Traditional Plan works
You pay the plan premium from your paycheck to have coverage.
Copay
You pay a small fee at the time of service for doctor visits and generic prescriptions.
Deductible
For care that doesn’t charge a copay, such as hospital stays, you pay 100% of the costs until you meet the annual deductible.
Coinsurance
After meeting the deductible, you and the plan share the cost of certain services, with the plan paying the majority.
Out-of-Pocket
Maximum
You’re protected by an annual limit on costs — the plan pays 100% of any further covered expenses for the rest of the year.
When you enroll in a Mosaic medical plan, you will automatically receive prescription drug coverage through Express Scripts. The Express Scripts website offers several tools to help you understand how to make the most of your prescription drug coverage while keeping your costs down. You can:
- Understand your prescription drug costs.
- Search for in-network pharmacies.
- Learn more about specific medications.
- Refer to the list of preventive drugs that are covered at 100% under the Consumer Plan.
If you enroll in the Traditional PPO plan, you'll also have access to the SaveOnSP program, which can save you out of pocket costs if you use one of the covered specialty drugs.
Drug tiers
Certain medications may require prior authorizations, in order for them to be covered by the plan. Your provider will need to work with Express Scripts to provide documentation for this authorization process. The cost of your prescription drugs under each medical plan depends on the tier of the medication:
Generic
Generic drugs contain the same active ingredients as their brand-name equivalents and meet the same federal standards for safety, but typically cost significantly less.
Brand name – preferred
Brand name – preferred drugs are on a prescription drug plan's formulary, or list of preferred drugs.
Brand name – nonpreferred
Brand name – nonpreferred drugs are not on a prescription plan’s formulary, or list of preferred drugs. The plan may still cover the medication but will often cost you more.
Mail-order
If you regularly take long-term or maintenance medication to treat a chronic condition — such as an allergy, heart disease, high blood pressure, or diabetes — using the Express Scripts mail-order program is convenient and saves you money. After two pharmacy fills of the same medication, you are required to fill any additional prescriptions through mail-order, otherwise additional costs may apply.
Why use mail-order?
- Prescriptions are shipped to you for free — no waiting in line at the pharmacy.
- You can set up automatic refills. Click here to learn more.
- You save money by avoiding the additional charge for filling more than two prescriptions for the same medication at a retail pharmacy.
Get started with mail-order
Using mail-order is easy! You can ask your doctor to submit your prescription directly to Express Scripts, or fill out a form to transfer existing prescriptions. Click here to learn more.
Generic medication
Generic medications are generally just as effective as brand-name medications, but they typically cost between 80% and 85% less. The Mosaic prescription drug program requires the use of generic medications when available. If you elect to receive a brand-name drug when a generic equivalent is available — even if your doctor writes your prescription as Dispense as Written (DAW) — your cost will be the copayment for the drug plus the difference in cost between the brand-name drug and the generic drug.
Specialty medications
If you take any oral or injectable specialty medications that are self-administered, you may be required to purchase these medications through the specialty pharmacy. Specialty medications include those used to treat multiple sclerosis, hepatitis C, rheumatoid arthritis, hemophilia and self-administered oral cancer medications. They may require additional authorization.
If you enroll in the Traditional Health Plan Option, you have access to participate in the SaveOnSP (Save On Specialty) program that can save you out of pocket costs on covered specialty drugs. The medications and associated copays included in this program are subject to plan clinical rules and are subject to change.
For additional information on the SaveOnSP program, call 1-800-683-1074.
Cigna One Guide – Your Cigna One Guide team is ready and waiting to help. It’s the highest level of personal support available. Simply call, click-to-chat on myCigna.com, or use the myCigna App. You’ll automatically be connected to a One Guide representative who will help guide you where you need to go.
MDLIVE – You have access to medical advice from board-certified physicians 24/7, 365 days a year through your medical plan’s telemedicine service. MDLIVE offers you fast, convenient diagnosis and treatment for many common conditions through video consult on your smartphone or computer. You also have access to virtual behavioral health visits through Cigna. It’s convenient, confidential and costs the same as an in-office visit. Visit the MDLIVE website to enroll or learn more. You can also read this flyer.
NurseLine – Cigna nurses are available to answer your health questions and help you get the most out of your medical plan — confidentially and at no cost to you. Your nurse can guide you to the right care for a health problem; coordinate services before, during, and after a hospital stay; or support you while you work toward a health goal. Call 1-800-564-9286 to reach a nurse on Cigna's health information line.
Medical plan website – Find a doctor, compare costs, manage claims, and more. Visit the Cigna website.
Prescription drug plan website – Order or refill prescriptions, sign up for mail-order, and more. Visit the Express Scripts website.
HSA/FSA Website – Manage your Health Savings Account or Health Care Flexible Spending Account online. Track your contributions and spending, request reimbursement, and more. Visit the Cigna website.
Need a flu shot?
Visit a physician or pharmacy to get a flu shot. Flu shots are covered at 100% if completed at an in-network provider. If you are an employee working onsite with a clinic at your location, you can get a flu shot from the nurse by scheduling an appointment.
Need a Covid-19 vaccine?
The vaccinations are covered at no cost to you. For locations where you can get vaccinated, visit myCigna.com.
Using in-network providers saves you money. Here’s how to find doctors in your medical plan’s Cigna network.
If you’re already a Cigna member:
- Visit the Cigna website and log in. You can also download the myCigna® App and search for providers on the go.
- Click on “Find a doctor, hospital, special facility or dentist” and follow the prompts. You will need to click on “Find Care & Costs” at the top of the home page.
- The “Find Care & Costs” section allows you to search by condition or specialty and find doctors within a certain geographic area.
If you’re not currently enrolled in a Cigna medical plan:
- Visit the Cigna Easy Choice Tool (Access Code: QRU60ZZU).
- To get started, enter the access code, and then press "Continue" at the bottom of the home page.
- Enter your zip code, and answer a few questions about what you want in a plan.
- Based on your answers, you will be shown your "Best Fit" plans.
- Compare the plans side-by-side to view costs, learn about plan details, and access the provider search to help inform your decision for which plan is right for you.
Don’t have a personal doctor? You should. Here’s why.
- Better health. Getting the right health screenings each year can reduce your risk for many serious conditions. Preventive care is free, so there’s no excuse to skip it.
- A healthier wallet. Having a doctor you can call helps you avoid costly trips to the emergency room and decide when you really need to see a specialist.
- Peace of mind. Advice from someone you trust ... it means a lot when you’re healthy, but it’s even more important when you’re sick. Your personal doctor gets to know you and your health history and can help coordinate any care you need.
Get the most value from your medical plan and help reduce your health care spending by following these consumer-smart tips:
Use in-network providers.
They’ve agreed to charge only up to negotiated rates and bill your insurance company directly, which saves you money and time. Also, check with your insurance company to ensure that a service is covered before you receive care.
Keep up with preventive care.
It’s covered in full by all of the medical plans and can help detect and prevent potentially costly health issues early. You pay nothing for annual physicals, recommended immunizations, routine cancer screenings, and more when you see in-network providers.
Use tax-free money to pay for eligible health expenses.
Contributing to a Health Savings Account (HSA) and/or a Flexible Spending Account (FSA) is easy and saves you money. You can set aside pre-tax dollars from your paycheck to use for your out-of-pocket costs. Keep in mind that with an HSA, you can only spend contributions that have actually been deposited into your account. And with an FSA, the money in your FSA does not carry over to the next plan year; you must “use it or lose it.”
Shop smart for prescriptions.
Using generic alternatives will almost always save you money — and they’re just as effective as brand name prescriptions. Also, try calling a few local pharmacies to compare prices before deciding where to fill a prescription. For your ongoing prescriptions, use the mail-order service to save money and time.
Take advantage of the Mosaic wellness program offering.
It offers valuable resources to help you improve your health. In addition, the Virgin Pulse wellness incentive program allows you to earn money for completing different wellness related activities!
Use your plan’s website.
Log in to the Cigna website to see how much of your deductible you’ve met, review claims, find in-network providers, use helpful cost-estimating tools, and more.
Choose the right place to get care.
Facilities charge different amounts for the same services, so think about your options when you or a family member needs medical attention. Use the guide below to help you save money and choose the most appropriate care for your situation.
| Telemedicine | Doctor’s office | Urgent care clinic | Emergency room |
|---|---|---|---|
| Use it for | |||
| A common, nonemergency medical issue that can be diagnosed by phone or online | A condition that doesn’t need immediate attention and can wait until the next day | A condition that needs immediate care but is not life- or limb-threatening | A life-threatening or potentially crippling condition that needs immediate attention |
| Examples | |||
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| Cost* | |||
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Average price: $ $55* *If more complex services are received via telemedicine including urgent care or dermatology, the cost may be as high as $300. |
Average price: $ $0 (preventive) $176 (nonpreventive) |
Average price: $$ $229 |
Average price: $$$ $821 (minor) $1,644 (moderate) $3,069 (severe) |
| Find it | |||
| Visit the MDLIVE website. | Call your regular doctor or search for an in-network provider on the Cigna website. | Search for urgent care clinics near you at Cigna. | Call 911 or search online for the nearest hospital. |
*Average costs are from healthcarebluebook.com. Contact your health insurance carrier for your specific costs.