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.
As of May 11, 2023, the COVID-19 public health emergency (PHE) and national emergency ended. Health insurance plans are no longer required to offer coverage for treatment and testing for COVID-19. However, AXA XL will continue to cover treatment and testing for all colleagues enrolled in an AXA XL medical plan. Our COVID-19 coverage now includes:
Effective January 1, 2022, the No Surprises Act provides new protections against surprise billing, or balance billing, under medical plans, such as the one offered by AXA XL. This legislation prohibits medical providers from sending surprise bills for most emergency and some non-emergency out-of-network care. For example, if you visit an in-network facility for emergency services, you may see providers, such as specialists like an anesthesiologist, who don't participate in AXA XL's medical plan network. The No Surprises Act now protects you from charges and balance bills for these additional services.
You can find more information here and learn more about your rights under the No Surprises Act here.
From accessing your medical plan information and finding in-network providers to managing and tracking your claims, there’s so much you can do on myCigna.com or the myCigna app.
Go to myCigna.com or launch the myCigna app and select “Register Now.” When you register for the first time on the myCigna website or app, you’ll be required to provide a primary email address. Your email address can be used to recover your myCigna user ID or password.
To help protect your personal information, two-step authentication for myCigna online account access is required.
If you have any questions about your myCigna account, call the number on the back of your Cigna ID card.
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.
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. |
All three medical plans options have a tiered structure. This means you'll be able to choose from two tiers of providers that are considered part of Cigna's network: TIER 1 Cigna Care Network (CCN) for certain specialist providers and Non-Tier 1 Providers. You may be able to utilize a TIER 1 provider near you and there are currently 18 TIER 1 specialty types available. When you choose a TIER 1 provider, you’ll save on your healthcare costs by paying less for care and you may even receive better care. You can find a provider by using myCigna.com or the myCigna mobile app. If not yet a member, you may search for providers at www.cigna.com. Under “Select a Plan,” choose “Open Access Plus, OA Plus, Choice Fund OA Plus.”
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
|
$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)
|
$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:
Additional tools and resources are available to you to help you manage your prescriptions at www.caremark.com.
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.
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:
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.
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.
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:
Through CVS Caremark, you have access to the following features:
For more information, go to www.caremark.com and see how you can save time—and money—on your prescriptions.
The Livongo through Livongo helps you take control of diabetes, with easy-to-use technology and expertise from Certified Diabetes Educators. If you and your family are enrolled in an AXA XL medical/pharmacy plan and you or a family member has diabetes, you can participate in this program at no additional cost.
To get started, visit join.livongo.com/AXAXL/register or call 1-800-123-4567 use registration code “AXAXL." For more information, visit the well-being resources.
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.
Get personalized decision support based on what matters most to you with the new Cigna Easy Choice Tool available at CignaEasyChoice.com.
You'll be able to review plans and estimated costs side by side, see which doctors and hospitals are in-network, and more. Review the 2023 Benefits Decision Guide on page 8 for instructions on how to get started.
Cigna Care Designation is a tool that can help you choose a primary doctor or specialist by providing information such as experience, quality, cost and location for the providers you’re considering. To find a doctor with Cigna Care Designation, go to myCigna.com and select “Find a Doctor or Service.” Once you’re on the online directory, look for the Cigna Care Designation symbol.
The amount you pay out-of-pocket for covered services when you receive care. You and AXA XL both pay a percentage of the cost.
The fixed dollar amount you pay when you visit a doctor or other healthcare provider, or purchase certain prescription drugs in-network.
The amount you pay for covered services before the plan pays benefits.
Eligible dependents include your legal spouse, your children up to the end of the calendar year in which they turn 26, your children 26 and older who are handicapped and dependent on your for support, your domestic partner, and your domestic partner's children who qualify as described above.
Providers who have agreed to a discounted rate negotiated by Cigna, which means you can save money by using their services. In-network medical claims must be filed within 90 days of the date of service by the provider.
Providers who are not part of the Cigna network; you will typically pay higher costs for care (deductible, coinsurance, and amounts billed over the allowed amount). When you see an out-of-network provider, you are responsible for filing a claim for reimbursement. Out-of-network medical claims must be filed within 180 days of the date of service.
The most you will pay each year toward the cost of covered medical expenses (excluding amounts exceeding the Reimbursable Rate. Once you reach this maximum, the plan will pay 100% of eligible expenses for the rest of the year. The maximum depends on your medical plan option, your coverage level, and whether you use in- or out-of-network providers..
The federal Transparency in Coverage Rules require certain group health plans to publicly disclose price and cost-sharing information. This information includes in-network provider rates as well as historical out-of-network allowed amounts and billed charges for covered items and services, which is to be shared via two separate machine-readable files (MRFs). The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data. The MRFs for AXA XL's medical plans can be found here.