Medical & Rx
The medical plans through Personify Health cover a wide range of services, from preventive and routine care to hospitalization and surgery. The medical plans include a prescription drug benefit through TrueScripts, which covers prescriptions at participating pharmacies and mail-order maintenance drugs.
Medical Plan
Personify | This is not a complete list of covered services. For more details, please refer to the plan documents.
If you enroll in the medical plan, you may use HSA providers at lower costs than other in-network providers. You also have access to providers in the Cigna OAP network for in-network coverage. Out-of-network care is also covered on the PPO and HDHP plans, but you will pay more for your care. There is NO out-of-network coverage on the EPO plan. Most out of network costs are subject to an annual deductible and then coinsurance is applied to the reasonable and customary charge. Providers are able to balance bill for charges, as there is no negotiated discounted in place. Members are encouraged to stay in-network.
Spousal Surcharge Program
The spousal surcharge is an additional premium that will apply if your spouse has access to health coverage through an outside employer but chooses to enroll in an AHS health plan. The additional premium amount will remain at $100 per month in 2026. The spousal surcharge does not apply if:
- You do not enroll your spouse in the health plan
- Your spouse is employed, but is not eligible for health coverage through his/her employer
- Your spouse is unemployed
- Your spouse is retired
- You and your spouse both work at an AHS
What is Prior-Authorization?
Prior authorization (PA), also called preauthorization or precertification, is a process where your insurance company must approve coverage for a specific medication, medical service, or procedure before it is provided, except in emergencies.
Your healthcare provider is responsible for submitting the prior authorization request to your insurance company. This process is commonly used for expensive medications, specialized treatments, or certain medical equipment like IV infusion pumps or portable oxygen tanks. The provider must submit clinical information, such as previous treatments tried, side effects experienced, or other relevant medical history, to justify the necessity of the service or medication. The provider may also need to complete forms or questionnaires required by Personify (medical) or Truescripts (pharmacy).
How the Process Works
- Prescription or service request: Your doctor identifies that a PA may be required.
- Submission to insurer: The provider sends the necessary documentation to the insurance company.
- Insurance review: The insurer evaluates the request based on medical necessity, cost-effectiveness, and plan guidelines.
- Decision: Approval may be granted for a defined period, after which reauthorization may be needed for future treatments.
Key Points to Remember
- Prior authorization is insurance-driven, not a requirement for cash payment.
- It ensures that treatments are medically necessary and cost-effective
- Reauthorization may be required for ongoing treatments or refills.
- Emergencies typically do not require prior authorization
- Understanding prior authorization can help you plan ahead, avoid delays, and ensure coverage for your medications or medical services.
Learn more about your
Medical Plans
Using Your Health Plan
Personify is partnering with Cigna to build the custom hospital network, so members will be able to identify a Tier 1 provider through the Personify portal. This will occur after 8/1. For now, members can review in-network Tier 2 Cigna providers through the OAP network provider tool: Cigna Health Care Provider Directory
Contact the provider of these benefits by calling this phone number or visiting this website: (833)-319-7540, login.personifyhealth.com
Prescription (Rx) Plan
TrueScripts | For more details, please refer to the plan document.
The member portal will allow you to:
- Real time drug price lookup
- Live chat
- Pharmacy locater
- Personifal plan information & claims history
- Additional member forms and resource
Please click the button bellow for instructions to register for TrueScripts Member Portal.
Contact the provider of these benefits by calling this phone number or visiting this website: (844) 257-1955, https://www.truescripts.com/members