Health
Health Insurance claims are processed and administered by MCA Administrators.
Incentives are included in the plan to encourage employees and covered family members to utilize Hutcheson facilities whenever possible. Deductibles are eliminated and coinsuranceis 90% for services performed at Hutcheson. The benefits save you money when using Hutcheson and make your insurance benefits more affordable. The plan utilizex CIGNA’s network of physicians and facilities. Remember that your out-of-pocket cost will be less if you use CIGNA network providers.
If you do not utilize Hutcheson for medical services, the coverage will remain at 80% with other Cigna network providers. There will not be an additional fee for inpatient or outpatient services.
The plan charges higher premiums for tobacco use. Substantial premium discounts are given for employees (and covered family members) who have not used tobacco products in the last 12 months. When enrolling, employees will be required to answer a tobacco use question.
If your spouse is eligible for health insurance coverage with his/her employer, the spouse is not eligible to be covered under Hutcheson's plan.
The Hutcheson Health insurance plan utilizes the Cigna "Open Access Plus network. Please consult the full summary of benefits for a review of the benefits.
To locate a CIGNA network provider go to http://www.cigna.com and choose from the open access: plus network.
Medical Benefit Summary
For detailed plan information, please refer to the 2016 Schedule of Medical Benefits
Physician Office Visits
-
In-Network:
- Primary Care - $20.00 co-pay
- Specialist - $40.00 co-pay
-
Out-of-Network:
- 50% after Deductible
Pharmacy Plan
In-Network prescription drug co-pays are as follows:
- Generic $10.00 Co-pay
- Formulary $25.00 Co-pay
- Non-Formulary $45.00 Co-pay
- Specialty $100.00 Co-pay
- OTC (prescription required) $0.00 Co-pay
Out-of-Network prescriptions are only covered at participating pharmacies
Mail / Retail-Order Option (90-day supply)
Available In-Network only
- Generic $25.00 Co-pay
- Formulary $65.00 Co-pay
- Non-Formulary $110.00 Co-pay
- Specialty not covered
- OTC (prescription required) $0.00 Co-pay
Note: This plan has mandatory generic. If a generic drug is available, and the member decides to get a brand drug, the member must pay the difference between the brand drug price and generic drug price, plus the co-pay.
|
Medical (Full-time) |
Medical (Part-time) |
Medical (Full-Time) Non-Tobacco |
Medical (Part-Time) Non-Tobacco |
|
| Employee Only | $63.36 | $109.21 | $47.52 | $ 81.91 |
| Employee + Spouse | $129.43 | $217.06 | $97.08 | $162.92 |
| Employee + Children | $90.32 | $152.35 | $67.74 | $114.26 |
| Employee + Spouse & Children | $152.35 | $254.81 | $114.26 | $191.12 |
In compliance with the Affordable Healthcare Act, the current Summary of Benefit Changes (SBC) is available to all employees on-line at http://www.houze.org/hmc or by contacting the Human Resources Department.
Claims Manager & Customer Service
Dave DiDasilio 800-922-4966 x220
Claims Address
GWH-Cigna
1000 Great West Drive
Kennett, MO 63857
Electronic Payor ID: 62308
Members:
Claim questions, benefits, or verifying eligibility, call MCA at 800-922-4966
Providers:
Pre-certification authorization, claim questions, benefits, etc. call MCA at 800-922-4966
