Medical/Prescription drug

We want you to make the most of your medical plan options and choose the coverage that is right for you and your family.

AXA XL offers three medical plans for you to choose from: OAP, OAP HSA 1, and OAP HSA 2, so you can have choice and control over your healthcare spending. All three options are available through Cigna.

You may be wondering what the differences are among the plans. Click on the medical coverage of your choice in the navigation to the left for more information on what each plan offers. Compare plans using the Plan Comparison section.

If you’re new to AXA XL, review the new colleague presentation for help determining which medical plan is right for you.

For more information, visit the Cigna website to learn more about eligibility, find a provider, review claims, and gain insight into your medical coverage.

You will be able to choose from three options: OAP, OAP HSA 1 and the OAP HSA 2. All of these plans cover the same services and are a part of the Open Access Plus (OAP) network through Cigna. Keep in mind that the difference in cost of the plans will depend on your utilization, the premium, deductible, and out-of-pocket maximum.

How the plans differ

The OAP and the OAP HSA plans share features, but differ in some ways, as well. Review the chart below to see how the OAP and OAP HSA plans compare. 

What’s the same	What’s different
Covered services and provider choices. All of the medical plan options cover the same services from preventive care to specialist visits and more. And, with each plan, you have access to the Open Access Plus (OAP) provider network.	Lower contributions. The OAP HSA plans have a higher deductible than the OAP. You pay less per paycheck when you enroll in one of the HSA plans.
100% covered preventive care. When you use an in-network provider, you pay nothing for eligible preventive care services — no deductible, and no copay.	Higher deductible. The OAP HSA plans have a higher deductible you must reach before the plan begins to pay for covered services, including prescription drugs and physician office visits. Preventive care is not subject to the deductible.
Responsibility for the deductible. You must meet the applicable annual deductible before the plan begins to pay for certain healthcare expenses.	“True” family deductible under the HSA plans. If you elect to cover dependents, you must meet the entire family deductible before the plan starts to pay benefits for any individual family member. This is different from the OAP plan in which each covered family member needs to satisfy only the individual deductible.
Cost protection. Once you meet your deductible, the plan pays a percentage of the cost of covered services, and you pay the remaining percentage (the coinsurance) or copays until you reach the annual out-of-pocket maximum. Then, the plan pays 100% of covered expenses for the rest of the calendar year.	Health Savings Account (HSA). If you are enrolled in one of the HSA plans, you can pay for qualified healthcare expenses using pre-tax dollars with your HSA. The Company will contribute annually to the account and you may also contribute to this account, up to IRS limits, less what the company contributes. Money in your HSA can be carried over from year to year and is always yours to keep.

Plan comparison

See how each plan pays for benefits below.

	OAP	OAP HSA 1	OAP HSA 2
HSA-eligible	No	Yes	Yes
AXA XL contribution to HSA (Individual/family)1	N/A	$500/ $1,000	$500/ $1,000
Deductible2 (Single/family)	In-Network: $750/$1,500 Out-of-Network: $2,500/$5,000	In-Network: $1,500/$3,000 Out-of-Network: $3,000/$6,000	In-Network: $2,500/$5,000 Out-of-Network: $4,000/$8,000
Out-of-pocket maximum3 (Single/family)	In-Network: $3,000/$6,000 Out-of-Network: $6,000/$12,000	In-Network: $4,000/$8,000 Out-of-Network: $6,000/$12,000	In-Network: $5,000/$10,000 Out-of-Network: $8,000/$16,000
PCP office visits	TIER 1 Cigna Care Network: $10 Non-Tier 1 Providers: $25 Out-of-Network: 40% after deductible	TIER 1 Cigna Care Network: 10% after deductible Non-Tier 1 Providers: 20% after deductible Out-of-Network: 40% after deductible	TIER 1 Cigna Care Network: 10% after deductible Non-Tier 1 Providers: 20% after deductible Out-of-Network: 40% after deductible
Specialist office visits	TIER 1 Cigna Care Network: $25 Non-Tier 1 Providers: $50 Out-of-Network: 40% after deductible	TIER 1 Cigna Care Network: 10% after deductible Non-Tier 1 Providers: 20% after deductible Out-of-Network: 40% after deductible	TIER 1 Cigna Care Network: 10% after deductible Non-Tier 1 Providers: 20% after deductible Out-of-Network: 40% after deductible
Emergency room visits	$150 copay	20% after deductible	20% after deductible
Preventive care4	In-network: Covered at 100% Out-of-Network: 40% after deductible	In-network: Covered at 100% Out-of-Network: 40% after deductible	In-network: Covered at 100% Out-of-Network: 40% after deductible
Prescription drugs5
Prescription drug deductible (Single/family)	$125/$250	Medical deductible applies	Medical deductible applies
Prescription drug out-of-pocket maximum (Single/family)	$1,250/$2,500	Medical out-of-pocket maximum applies	Medical out-of-pocket maximum applies
Short-term prescription drugs (CVS Caremark retail pharmacy network, up to a 30-day supply)6 Generic Preferred Non-Preferred	$10 for one 30-day supply 30% for one 30-day supply 40% for one 30-day supply	20% after deductible for one or three 30-day supplies 30% after deductible for one or three 30-day supplies 40% after deductible for one or three 30-day supplies	20% after deductible for one or three 30-day supplies 30% after deductible for one or three 30-day supplies 40% after deductible for one or three 30-day supplies
Long-term prescription drugs (CVS Caremark mail service pharmacy or CVS pharmacy locations; up to a 90-day supply) Generic Preferred Non-Preferred	$20 copay 30% 40%	20% after deductible 30% after deductible 40% after deductible	20% after deductible 30% after deductible 40% after deductible

¹ The company’s HSA contribution is prorated for the number of full months you’re enrolled in the plan.
² Under the OAP HSA 1 and OAP HSA 2, if you enroll in employee + child(ren), employee + spouse, or family coverage, you and your dependents must meet the full family deductible before the plan shares in the cost of non-preventive care for any one family member. Medical expenses from any covered person or combination of family members can meet the deductible.
³ Under the OAP HSA 1 and OAP HSA 2, you have embedded individual out-of-pocket maximums. This means that after each eligible family member meets his or her individual out-of-pocket maximum, the plan will play 100% of their covered expenses. Or, after the family out-of-pocket maximum has been met, the plan will pay 100% of each eligible family member’s covered expenses.
⁴ Preventive care services include, but are not limited to well baby, well child, adult preventive care, well woman exams, mammograms, PSA, and pap smears.
⁵ When a generic is available, but the pharmacy dispenses the brand-name medication for any reason, you will pay the difference between the brand-name medication and the generic plus the brand copay. The difference does not apply to the deductible or out-of-pocket maximum.
⁶ Specialty drugs follow plan coinsurance.

With the OAP plan, you’ll pay more in premiums, but have a lower deductible and smaller copays when you visit the doctor or require medical care. You will also have a deductible and coinsurance for other services.

With the OAP HSA 1 plan, for most services, you’ll pay out-of-pocket until you reach your deductible. Then you will pay coinsurance for eligible services and expenses until you reach your out-of-pocket maximum. Remember: You can use your tax-advantaged HSA, including HSA contributions from the Company, to pay for eligible out-of-pocket expenses. Learn more about the HSA in the Savings and Spending Account section.

With the OAP HSA 2 plan, for most services, you’ll pay out-of-pocket until you reach your deductible. Then you will pay coinsurance for eligible services and expenses, until you reach your out-of-pocket maximum. Remember: You can use your tax-advantaged HSA, including HSA contributions from the Company to pay for eligible out-of-pocket expenses. Learn more about the HSA in the Savings and Spending Account section.

You automatically receive prescription drug coverage when you enroll in the OAP, OAP HSA 1, or the OAP HSA 2 medical plans.

With the prescription drug benefit through CVS Caremark, you can either get your prescriptions at a participating retail pharmacy or use their mail order service.

To get started, sign in or register at caremark.com/startnow and follow the instructions to:

• Request a new 90-day prescription
• Refill an existing prescription, if available to you

Additional tools and resources are available to you to help you manage your prescriptions at www.caremark.com.

Access the CVS Caremark prescription drug lists

Becoming familiar with the CVS Caremark prescription drug lists can save you time and even money. Visit www.caremark.com for the most up-to-date lists, including the formulary, medications that require preauthorization, and preventive generic drug lists. Be sure to check back often as these lists are occasionally updated.

Keep in mind that you pay nothing for prescription drugs found on the preventive generic drug list.

Mandatory All Access Maintenance Choice Program

If you take long-term medications, you’ll need to fill a 90-day supply through mail order or retail pickup at CVS through the Mandatory All Access Maintenance Choice Program in order for your prescription drug to be covered by the plan.

With this program, you can avoid paying more for your long-term prescriptions. All you need to do is have 90-day supplies filled through the CVS Mail Service or at a CVS pharmacy.

Whether you choose delivery or pick-up, you can:

• Save money: You’ll pay less for 90-day refills.
• Get shipping at no extra cost: 90-day refills are delivered in discreet packaging and can be tracked on line at www.caremark.com.
• Have peace of mind: You’ll have the medications you need, when you need them.

Note: If you do not switch to the All Access Maintenance Choice Program after one initial retail fill and one refill, your maintenance medication will no longer be covered under the prescription drug plan.

To get started, call the Customer Care number on your prescription ID card or visit www.caremark.com.

Specialty drugs

AXA XL partners with ArchimedesRx, the industry leader in specialty drug management solutions. Specialty medications are generally prescribed for people with complex or ongoing medical conditions such as multiple sclerosis, hemophilia, and rheumatoid arthritis. Eligible colleagues will be contacted directly by ArchimedesRx.

Need another CVS Caremark ID card?

If you're enrolled in an AXA XL medical plan, you'll receive two CVS Caremark pharmacy ID cards in the mail. The ID cards have your name on them, but will apply to all covered family members.

You may obtain additional ID cards by:

• Visiting www.caremark.com access and print them
• Accessing your ID card using the CVS Caremark mobile app
• Calling CVS Caremark at 844-462-0196

As you consider which plan option is right for you, review your family’s medical history and take some time to think about how much coverage you need. You’ll also want to evaluate whether you’d like to pay more for your medical coverage and care through payroll deductions throughout the year or out of pocket when you use the plan.

Before you enroll in medical coverage through AXA XL, access the Cigna One Guide, which provides the highest level of customer support for your medical plan needs. Whether you want to learn more about how your coverage works, find a Cigna Care Network provider, or identify cost savings opportunities for care, your Cigna One Guide representative can help. Contact a One Guide team member by calling 1-800-CIGNA-24 or “click to chat” on myCigna.com or on the myCigna mobile app.