Medical & Prescription
We offer you a comprehensive benefits program to help you and your family protect your health and financial security. Your benefits are a valuable part of your compensation; we encourage you to learn how your plans work so you can get the most from them. Uptima offers 2 HDHP and 2 PPO medical plan options through Auxiant utilizing the Cigna network.
Watch this video to learn more about your Medical Plans
Medical Highlights
Base HDHP
Network
Cigna
Type of Deductible
Embedded
Plan Year Deductible (Individual / Family)1,2
$3,500 / $7,000
Your Coinsurance (Individual / Family)
20%
Out-of-Pocket Maximum (Individual / Family)
$5,000 / $10,000
Physician Visit / Specialist Visit
Deductible, then coinsurance
Preventive Care Services3
Covered 100%
Emergency Room Visit
Deductible, then coinsurance
Urgent Care Visit
Deductible, then coinsurance
Out-of-Network
Plan Year Deductible (Individual / Family)1,2
$7,000 / $14,000
Your Coinsurance (Individual / Family)
40%
Out-of-Pocket Maximum (Individual / Family)
$10,000 / $20,000
Buy-Up HDHP
Network
Cigna
Type of Deductible
Non-Embedded
Plan Year Deductible (Individual / Family)1,2
$1,650 / $3,300
Your Coinsurance (Individual / Family)
10%
Out-of-Pocket Maximum (Individual / Family)
$4,000 / $8,000
Physician Visit / Specialist Visit
Deductible, then coinsurance
Preventive Care Services3
Covered 100%
Emergency Room Visit
Deductible, then coinsurance
Urgent Care Visit
Deductible, then coinsurance
Out-of-Network
Plan Year Deductible (Individual / Family)1,2
$3,000 / $6,000
Your Coinsurance (Individual / Family)
30%
Out-of-Pocket Maximum (Individual / Family)
$5,000 / $10,000
Base PPO
Network
Cigna
Type of Deductible
Embedded
Plan Year Deductible (Individual / Family)1,2
$2,500 / $7,500
Your Coinsurance (Individual / Family)
20%
Out-of-Pocket Maximum (Individual / Family)
$6,000 / $12,000
Physician Visit / Specialist Visit
$40 / $70 copay
Preventive Care Services3
Covered 100%
Emergency Room Visit
$250 copay
Urgent Care Visit
$75 copay
Out-of-Network
Plan Year Deductible (Individual / Family)1,2
$5,000 / $15,000
Your Coinsurance (Individual / Family)
40%
Out-of-Pocket Maximum (Individual / Family)
$8,700 / $17,400
Buy-Up PPO
Network
Cigna
Type of Deductible
Embedded
Plan Year Deductible (Individual / Family)1,2
$1,000 / $2,000
Your Coinsurance (Individual / Family)
10%
Out-of-Pocket Maximum (Individual / Family)
$5,000 / $10,000
Physician Visit / Specialist Visit
$35 / $60 copay
Preventive Care Services3
Covered 100%
Emergency Room Visit
$150 copay
Urgent Care Visit
$75 copay
Out-of-Network
Plan Year Deductible (Individual / Family)1,2
$2,000 / $4,000
Your Coinsurance (Individual / Family)
30%
Out-of-Pocket Maximum (Individual / Family)
$6,000 / $12,000
- All covered services are subject to the deductible except Preventive Care services.
- Plan year deductible runs on calendar year.
- Preventive Care services include but are not limited to routine wellness exams, pelvic exams, pap testing, PSA tests, immunizations, annual diabetic eye exam, and routine vision and hearing exams rendered in a physician's office and outpatient service centers.
The plan deductible for the Buy Up High Deductible Health Plan is non-embedded. A non-embedded deductible means that everyone works toward one shared deductible. When the deductible is met collectively, coinsurance begins.
The deductible for all other plans is embedded. An embedded deductible means that each person covered on the plan (employee, spouse, child) has a personal deductible. When each personal deductible is met, coverage begins for that individual only.
WHAT IS A...
Deductible: Amount you have to pay for a covered medical expense before your coinsurance kicks in.
Coinsurance: A percentage of the claim amount you pay (after your deductible is met), while your insurance plan pays for the rest. For example: You pay 20% and the plan pays 80%.
Copay: Fixed fee you may need to pay for healthcare services (i.e., office visits, prescriptions).
Out-of-Pocket Maximum: You will not have to pay more than this amount during your plan year – once you reach it, your insurance plan will cover all additional expenses.
Third Party Administrator (TPA): A TPA is the entity (such as Auxiant) contracted to set up and provide administration to the health plan. A TPA is not an insurance company. Auxiant’s primary role is to process and pay claims as instructed by Uptima via the Plan Document which outlines all medical benefits.
Health Network: A Health Network contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. Our network will be CIGNA for 2024. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals and providers outside of the network for an additional cost.
Pharmacy Benefit Manager (PBM): Similarly, there is a pharmacy benefit manager (PBM) selected by your employer to offer prescription drugs through contracted discount rates. Using an In-Network pharmacy will also keep your out of pocket costs lower. Our PBM will be TrueRx for 2024.
Auxiant Resources
Contact the provider of these benefits by calling this phone number or visiting this website: Auxiant Customer Service - (800) 245-0533, www.auxiant.com
What do I need to know about my ID cards?
- New ID cards will be provided and will identify all information needed on the network providers, pharmacy benefits information, claim flow and contact information.
- Present your ID card to all of your providers. All providers include the pharmacy, physicians/clinics and hospitals.
- Use of the new Auxiant ID card will ensure prompt claims payment when going to a medical or pharmacy provider.
How do I find healthcare providers in the Network?
- Your plan has partnered with Cigna. This partnership will give you access to a network of doctors and facilities with great savings.
- You can get the most of out of your benefits by using providers that belong to the Cigna network. Providers that belong to the Cigna network have agreed to provide a discounted fee, making your benefits go further.
- It is very easy to find a Cigna network provider by using the online provider directory at www.mycigna.com. The online directory includes the most detailed provider information available.
- Important note: It is very important that you verify that your professional providers are in-network prior to any scheduled visit.
RX Highlights (In-Network)
HDHP (Base & Buy-Up)
Retail Pharmacy (30 day supply)
Generic1
Deductible, then $10
Brand Name Formulary1
Deductible, then $35
Brand Name Non-Formulary1
Deductible, then $60
Specialty Medication1
Deductible, then $120
Mail-Order Pharmacy (90 day supply)
Generic1
Deductible, then $25
Brand Name Formulary1
Deductible, then $88
Brand Name Non-Formulary1
Deductible, then $150
PPO (Base & Buy-Up)
Retail Pharmacy (30 day supply)
Generic1
$10 copay
Brand Name Formulary1
$35 copay
Brand Name Non-Formulary1
$60 copay
Specialty Medication1
$120 copay
Mail-Order Pharmacy (90 day supply)
Generic1
$25 copay
Brand Name Formulary1
$88 copay
Brand Name Non-Formulary1
$150 copay
1. You will be responsible for the copay amount until your total expenses have reached the out-of-pocket maximum. 2. Specialty medications are limited to a 30-day supply, regardless of whether they are retail or mail order.
Pharmacy Benefits Manager
True Rx's team works with employers, employees and prescribers to ensure optimum value at the lowest possible cost. True Rx pharmacists will monitor your prescriptions and suggest generic substitutes that will reduce costs for you and your employer. When your True Rx pharmacist identifies a medication that would be an appropriate substitute, they'll send you a letter letting you know you can save money on your copay by switching your medication to get the generic form of the same drug. Just reply to their letter or call the toll-free number (866) 921-4047 and True Rx will do the rest.
If you have a medication that requires prior authorization, please have your physician fill out the Prior Authorization Request form linked below and submit to the fax number listed at the top of the form.
For more information regarding mail order prescriptions, please reach out to TrueRx or contact the mail order pharmacy directly using the contact information linked in the button below.
Questions about your prescription benefits? TrueRx Customer Service: (866) 921-4047, www.truerx.com TrueRx Pharmacist Help Desk: (833) 202-8783
HDHP MEDICAL & Rx COSTS
(Based on 24 pays per year)
Employee Only
Base HDHP: $0.00
Buy-Up HDHP: $15.43
Employee + Spouse
Base HDHP: $96.29
Buy-Up HDHP: $161.98
Employee + Child(ren)
Base HDHP: $87.17
Buy-Up HDHP $146.63
Employee + Family
Base HDHP: $142.19
Buy-Up HDHP: $239.19
PPO MEDICAL & Rx COSTS
(Based on 24 pays per year)
Employee Only
Base PPO: $0.00
Buy-Up PPO: $43.48
Employee + Spouse
Base PPO: $113.30
Buy-Up PPO: $227.89
Employee + Child(ren)
Base PPO: $102.56
Buy-Up PPO $206.29
