Overview
In order to support you and your family’s health and well-being, we have developed the following guide to health care. This guide is packed with essential information and practical tips that aim to simplify the complexities of health care and to help you understand how Quantum Health and the AXA XL benefits can support your holistic well-being.
By exploring this page, you will gain valuable insights into the health care journey, empowering you to make informed decisions and maximize the benefits available to you.
Quantum Health fulfills two key functions: it serves as your dedicated well-being advisor and acts as the primary gateway to your medical plan. All AXA XL colleagues, regardless of their chosen medical plan, have free access to Quantum Health for support with AXA XL benefits.
Functioning as a comprehensive healthcare resource, Quantum Health consolidates all of AXA XL's benefits in one convenient location. It also offers a team of expert Care Navigators who are well-versed in AXA XL benefits that can provide valuable guidance to help you optimize your benefit choices and answer any benefit related questions you may have.
The Quantum Health app provides easy access to your AXA XL benefits. With single sign-on features to your AXA XL medical, dental, and vision coverage accounts, you’ll be able to access your benefit details seamlessly from one app. Plus, with a dedicated dashboard for your savings and spending accounts, and a secure messaging platform with Care Navigators, you can monitor your claims and account details and get healthcare support in one single place.
The Quantum Health Care Navigators can help to do the following and more:
Get started with Quantum Health today by downloading the Quantum Health app on Google Play or the Apple App Store, visiting axaxl-quantum.com, or calling 844-460-2821.
Understanding the Quantum Health, Cigna, and Allegiance relationship
Quantum Health serves as our healthcare navigation and advocacy partner. They work closely with Allegiance, our medical plan administrator, to support you in getting the care you need. Allegiance is a Cigna brand and makes use of Cigna’s Open Access Plus network—meaning you can take advantage of all Cigna Tier 1 and Non-Tier 1 network providers.
Preventive care
Under all AXA XL medical plans, eligible in-network preventive care is free— so you have coverage that protects both your wallet and your long-term health. Preventive care helps you stay healthy by monitoring your health, preventing illness, and catching potential problems early before they get worse. See below for a snapshot at what’s included in preventive care.
A primary-care provider (PCP) is your go-to resource for coordinating your preventive care. They’ll ensure you get the right screenings and vaccinations at the right time. It’s also important to build a trusting relationship with your PCP so you have someone to turn to when you have questions about your health. In addition to providing medical care, your PCP can direct you to resources and specialists to meet your needs, address your health goals and fit your lifestyle and preferences.
*Coverage for specific cancer screenings will depend on your age and other risk factors. Your PCP will let you know which preventive screenings you should get.
Where to go for care
Your primary care provider (PCP) forms the foundation of your medical care and is the best place to start when you have a health concern. They’re your go-to resource when you’re feeling unwell or just have a question. Of course, if you’re experiencing an emergency, dial 911 or go to the nearest emergency room.
How to Find a PCP
There are two ways to find a PCP if you are enrolled in an AXA XL medical plan:
- Visit axaxl-quantum.com to access the in-network provider search.
- Call Quantum Health at 844-460-2821. A Care Coordinator can speak with you about your provider preferences, provide you with a list of options, and even help you schedule your appointment.
If you can’t see a PCP and your medical issue isn’t an emergency, consider one of the following care options:
Telehealth | Urgent care clinic | Emergency room |
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Use it for | ||
When you want the convenience of at-home or on-the-go care and have a non-emergency medical issue that can be diagnosed by phone or online video visit | When you have an injury or illness that needs immediate care but is not life- or limb-threatening | A life-threatening or potentially crippling condition that needs immediate attention |
Examples | ||
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Cost | ||
Low You pay: $ | Moderate You pay: $$ | High You pay: $$$ |
Availability | ||
Open 24/7 365 days a year with no appointment or long wait. | Open during extended hours, including evenings and weekends for walk-in service. | Open 24/7, 365 days a year |
Find it | ||
To schedule an appointment through MDLIVE, go to https://app.mdlive.com/landing/allegiance. To find a Evernorth Behavioral Health network provider, visit Cigna.com, go to “Find Care & Costs” and enter “Virtual counselor” under Doctor by Type. | Reach out to a Quantum Health Care Navigator at 844-460-2821 or visit axaxl-quantum.com to access the provider search. | Call 911 or search online for the nearest hospital. |
Terms to know
You’ll likely come across the following commonly used terms as part of your health care experience. Understanding what they mean will help you get the most from your benefits and make smart health care choices.
Support for navigating your care
Based on your feedback in our employee focus groups, we heard that it was sometimes difficult to understand bills from doctors and insurance, and that you wanted support in this area. Get an understanding of common terms you may encounter here, and if you have more questions about your treatment plan, consider reaching out to Quantum Health or Teladoc Expert Medical Services for more assistance.
Before-tax contributions – HSA and FSA
Before-tax contributions to your heath savings and spending accounts are deducted from your pay before federal taxes (and in many cases, state and local income taxes) are withheld.
Coinsurance
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.
Copay
The fixed dollar amount you pay when you visit a doctor or other healthcare provider, or purchase certain prescription drugs in-network.
Deductible
The amount you pay for covered services before the plan pays benefits.
Eligible dependent(s)
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.
Diagnostic care
Health care provided when a condition or illness arises. Diagnostic care typically results in out-of-pocket expenses in accordance with the way your medical plan option covers benefits.
Evidence of Insurability (EOI)
Evidence of Insurability, or proof of good health, is a statement of medical history and related information which is used to determine whether you (or a dependent) will be approved for certain types of coverage, such as life insurance.
High Deductible Health Plan
A High-Deductible Health Plan (HDHP) covers 100% of preventive care and requires you to pay 100% of all non-preventive care and prescription costs up to the deductible. After reaching the deductible, you pay a coinsurance percentage of the cost of care for things like specialist visits, and the plan pays as well until you reach your out-of-pocket maximum. Once you hit your out-of-pocket maximum, the plan pays for all additional covered care at 100% through the end of the plan year.
In-network
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.
No Surprises Act
The No Surprises Act provides 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.
Out-of-network
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.
Out-of-pocket maximum
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.
PPO
A Preferred Provider Organization (PPO) Plan covers 100% of preventive care and requires you to pay copays for certain medical treatments, such as office visits, urgent care, and prescriptions. For other types of care, you pay 100% until you reach the deductible. Once you reach your out-of-pocket maximum, the plan pays for 100% of eligible care for the rest of the plan year.
Primary Care Provider (PCP)
A health care practitioner who serves as your first point of contact when you need health care and can help coordinate your preventive, diagnostic and medical care.
Transparency in Coverage Rules
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 access and analyze data more easily. The MRFs for AXA XL's medical plans can be found here.