Medical/Rx
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Get To Know Your Plans
Essential HSA Plan (HSA-Eligible)
Best for: Employees who want the lowest premium costs and are comfortable with a higher deductible. Perfect if you're generally healthy and want to build tax-free savings.
This plan has the lowest cost out of each paycheck but the highest annual deductible before cost-sharing begins. When you enroll, you're eligible to open a Health Savings Account (HSA) to set aside pre-tax dollars for medical expenses.
The tradeoff: You'll pay more out-of-pocket before coverage kicks in, but your HSA funds roll over year after year, even if you leave ExamWorks. You can use HSA funds for qualified medical, dental, and vision expenses now or save them for retirement.
You can also enroll in a Limited Purpose FSA to help pay for dental and vision expenses.
DID YOU KNOW?
HSA contributions reduce your taxable income, grow tax-free, and can be withdrawn tax-free for qualified medical expenses.
Enhanced HSA Plan (HSA-Eligible)
Best for: Employees who want HSA savings with employer contributions and moderate out-of-pocket costs.
This plan balances your paycheck costs with your out-of-pocket costs when you need care. When you enroll, you're eligible to contribute pre-tax dollars to your Health Savings Account (HSA).
The advantage: Lower deductible than the Essential HSA plan, free employer contributions to your HSA, and tax-free savings that are yours to keep forever. Your HSA funds roll over every year and stay with you even if you change jobs.
You can also enroll in a Limited Purpose FSA to help pay for dental and vision expenses.
Premium Point of Service (POS) Plan
Best for: Employees who prefer predictable costs and low copays for doctor visits and prescriptions.
This plan offers traditional copayments for most services, plus the lowest deductible. That means low and predictable out-of-pocket costs. You'll pay the highest cost per paycheck, but the lowest costs when you need care.
The advantage: Pay a copay at the time of service and avoid surprises. Great for families or anyone who sees doctors regularly or manages a chronic condition.
You may also enroll in a Health Care FSA to use toward your copays and out-of-pocket medical costs.
Important Things To Know
Preventive Care
Preventive care* helps you stay healthy and catch issues early. When you see in-network providers and follow federal guidelines, most routine services are covered at no cost to you. This includes an annual physical, recommended screenings, and many vaccines. Ask your provider which services count as preventive before the visit, since diagnostic testing may bill differently. If a preventive visit includes treatment for a new problem, that portion may be billed as diagnostic, and you could pay a copay or apply costs to your deductible.
*Preventive care is defined by the US Preventive Service Task Force as an A or B recommended service.
In-Network vs Out-of-Network
You can see any provider, but you usually pay less in-network. In-network providers agree to discounted rates and file claims for you. If you go out of network, you may pay more, handle pre authorizations yourself, and be billed above the plan’s allowed charge. These extra amounts do not count toward your in network deductible or your in network out of pocket maximum. Check the carrier directory to confirm network status.
IMPORTANT: Emergency care is covered anywhere. For non emergencies, choosing in network helps you avoid surprise bills.
Annual Deductible
Your annual deductible is the amount you pay before the medical plan contributes to the cost of care. In all three medical plans, deductibles are embedded which means each member in the family meets their annual deductible individually and then moves into coinsurance. Also, deductible payments count towards the out-of-pocket maximum. In both the Essential and Enhanced HSA HDHP options, your medical and prescription costs count towards your deductible. In the Premium POS Plan option, prescription copayments do not count towards the deductible. However, for all three plans, prescription copayments count towards your out-of-pocket maximum.
How Costs Work
Your premium comes from each paycheck to keep coverage active. When you get care, you may pay a copay for certain services. Other services first apply to your deductible, which is what you pay before the plan shares costs. After you meet the deductible, you and the plan share costs through coinsurance. What you pay for covered in network care counts toward your out of pocket maximum. Once you reach that maximum, the plan pays 100% of covered in network services for the rest of the plan year.
Choosing The Right Plan For You
Every employee's situation is different. Here are key factors to consider when making your decision.
How often do you visit the doctor? If you or your family have ongoing health conditions, take regular medications, or need frequent care, a plan with lower copays might save you money. If you're generally healthy and rarely need care beyond preventive visits, a high-deductible plan with lower premiums could be more cost-effective.
What's your budget? Consider what you can afford from each paycheck and what you could manage for unexpected medical expenses. HSA plans have lower premiums but higher deductibles. The Premium POS plan costs more per paycheck but offers predictable expenses when you need care.
Do you want tax advantages? Both HSA-eligible plans let you save pre-tax dollars, which reduces your taxable income. If you're interested in building long-term healthcare savings or reducing your tax burden, an HSA plan is worth considering.
IMPORTANT: All three plans cover preventive care at 100% with no cost to you, including annual physicals, well-child visits, immunizations, and screenings.
We understand how confusing and overwhelming it can be to review your health plan options. We want to help by providing the resources you need to make a decision confidently. Cigna provides an Easy Choice tool (please refer to your Benefits Guide for your access code, which can be found on Paycom Self-Service), which will help you:
- Easily understand the basics of health coverage.
- Identify the types of health plans available to you.
- Check if your doctors are in-network to help you avoid unnecessary costs.
- Get answers to any other questions you may have about the plans or provider networks available to you.
Medical Plan Comparison
You have three medical plan choices with the Cigna Open Access Plus network. Preventive care is covered at no cost when you use in-network providers.
Use the comparison tables below to see deductibles, out-of-pocket maximums, and common services.
Cigna In-Network Benefits
Retail is a per 30 day supply. Home Delivery is a per 90 day supply. You can also fill 90 day prescriptions at select retail locations such as CVS, Walmart, and Kroger.
*Specialty is incorporated in Tier 3 for the Premium POS Plan option.
Please Note: If you are Medicare eligible (age 65 or older), or will be Medicare eligible in 2026, the Essential Plan is not considered creditable coverage under Medicare Part D. Please contact 1-800-MEDICARE with questions or reach out to Mike Groh from Risk Strategies:
mgroh@risk-strategies.com
513-247-2709
DID YOU KNOW?
Deductibles and out-of-pocket maximums (OOPM) are embedded, which means: each member in the family meets his/her annual deductible and then moves into coinsurance. Each member in the family meets their OOPM individually.
- Prior authorizations and pre-approvals for certain benefits are required and typically completed by the providers.
- Pre-existing conditions are covered at 100% (subject to plan design).
- Specialty Rx such as those for multiple sclerosis, rheumatoid arthritis, and hepatitis C, are limited to a 30 day supply.
Cigna Out-of-Network Benefits
Need help choosing a plan?
- Use the Cigna Easy Choice Tool to compare plan designs and rates. Please refer to your Benefits Guide for your access code, which can be found on Paycom Self-Service) to log in.
- Get answers through myCigna.com or the myCigna app. You can chat or call Cigna for personalized support.
- Text your benefits questions to 90887 for real-time AI answers, 24/7, 365 days per year.
- Email the ExamWorks Benefits Team: benefits@examworks.com
Technical support
Contact your local HR Business Partner or email benefits@examworks.com.
Medicare Planning
If you are enrolled in Medicare or will become eligible in the next year, navigating your options can feel confusing. Schedule a no-cost personal consultation with Risk Strategies to make an informed decision that fits your needs.
Services offered:
- Finding the right Medicare supplemental plan and enrolling
- Learning how Medicare works with Health Savings Accounts (HSAs)
- Learning how employer-sponsored plans compare to individual Medicare plans
- Support avoiding penalties and duplicate coverage
Family members of ExamWorks employees can also use this service at no cost. Contact Mike Groh at 513-247-2709 or mgroh@risk-strategies.com. Important Notice: Medicare Part D Creditable Coverage. If you are Medicare eligible, or will be Medicare eligible in 2026, please note that the Essential Plan is not considered creditable coverage under Medicare Part D. Please contact a Medicare specialist to educate yourself on coverage levels.
Network Flexibility
All three plans give you access to Cigna's broad network of doctors, specialists, and hospitals.
In-network care costs less because Cigna has negotiated discounted rates with these providers. Always confirm your provider is in-network before scheduling appointments by visiting mycigna.com or calling member services.
Out-of-network care costs more. The Premium POS plan offers the most flexibility for out-of-network care, though your costs will still be higher than staying in-network.
To find a provider, log into mycigna.com and use the "Find a Doctor" tool. You can search by name, specialty, or location.
Find In-Network Care
Cigna uses the Open Access Plus, OAP network.
- Go to mycigna.com and log in or register.
- Select Find Care.
- Search for doctors, specialists, hospitals, or urgent care near you. Using in-network providers saves you money and gives you the highest level of benefits.
Prescription Drug Coverage
All three plans include prescription drug coverage through Cigna. Your costs vary by plan and which tier your medication falls into.
Cigna uses a tiered formulary. Generic drugs are the least expensive. Preferred brand-name drugs cost more than generics. Specialty medications are in the highest tier.
The Premium POS plan offers copays for prescriptions. HSA plans require you to pay the full negotiated cost until you meet your deductible. You can use HSA or FSA funds to pay for prescriptions.
Ways to save: Use mail-order pharmacy for maintenance medications to get a 90-day supply at a lower cost. Ask your doctor if a generic version is available. Use Cigna's prescription cost comparison tool on myCigna.com to find the best pharmacy prices.
Go to the Medical Plan Comparison section above to learn more about Prescription Drug Coverage.
Virtual Care And Enhanced Services
MDLIVE, 24/7 Virtual Care From Home
See a doctor by phone or video for minor issues, primary care, dermatology, and behavioral health.
How to access: Log in to mycigna.com or the myCigna app, select Talk to a Doctor. For help, call 888-726-3171.
Virtual Wellness Screenings With MDLIVE
Complete your wellness screening from home at no additional cost as part of preventive care.
- Take your Health Assessment on mycigna.com.
- Schedule a lab at an in-network site.
- Book your MDLIVE wellness visit at least 3 days after your lab.
- Attend your lab for bloodwork and biometrics.
- Meet virtually to review results and next steps.
Foodsmart, Personal Nutrition Coaching
Virtual visits with registered dietitians, custom meal plans and recipes, grocery savings tools.
Who can use it: Employees and dependents enrolled in a Cigna medical plan through ExamWorks.
Get started: foodsmart.com/members/cigna-healthcare
Airrosti Remote Recovery, Muscle and Joint Pain
Virtual orthopedic evaluation, custom rehab plan, recovery kit, and coaching. In network with Cigna.
Get started: airrosti.com/remoterecovery
Heartbeat Health, Virtual Cardiovascular Care
Virtual visits with cardiology providers, evidence-based treatment, and local coordination.
Get started: heartbeat.health/cigna
Visana Health, Virtual Women’s Health
Preventive care, gynecologic care, hormone support, and menopause care from licensed providers.
Get started: visanahealth.com/cigna
Oshi Health, Virtual GI and Digestive Care
Next-day virtual visits for IBS, GERD, IBD, and other GI issues with dietitians and gut-brain specialists.
Get started: oshihealth.com/cigna
Learn The Lingo
Preventive Care: Routine services that help you stay healthy. When in network and meeting guidelines, these are typically covered at no cost to you.
Deductible: What you pay for covered services before the plan starts sharing costs.
Premium: The amount you pay for your health insurance coverage, deducted from your paycheck each pay period. This is what you pay to have coverage, regardless of whether you use medical services. Your premium is separate from deductibles, copays, and coinsurance.
Coinsurance: The percentage you pay for covered services after you meet your deductible.
Copayment (Copay): A fixed amount you pay for a covered service at the time of service. For example, a $30 copay for a doctor's visit or $10 for a generic prescription. Common in the Premium POS plan.
Health Savings Account (HSA): A tax-advantaged savings account for employees enrolled in a high-deductible health plan. You contribute pre-tax dollars, the money grows tax-free, and withdrawals for qualified medical expenses are tax-free. Funds roll over year after year and the account stays with you even if you change employers.
Flexible Spending Account (FSA): A tax-advantaged account that lets you set aside pre-tax dollars for eligible healthcare expenses. FSA funds generally must be used within the plan year. Health Care FSA covers medical, dental, and vision expenses. Limited Purpose FSA only covers dental and vision if you're enrolled in an HSA-eligible plan.
In-Network Care: In-network providers offer services at negotiated rates, resulting in cost savings for you.
Out-of-Network Care: When you receive care outside the plan’s network, you may experience higher costs and balance billing. While you still have the option to seek care outside the network, it’s important to be aware of the financial implications.
Out-of-Pocket Maximum (OOPM): The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.
Digital Document Resources
Continue Your Benefits Journey
Your Rights
This website highlights some of your benefit plans. Your actual rights and benefits are governed by the official plan documents. If any discrepancy exists between this communication and the official plan documents, the plan documents will prevail. The company reserves the right to change any benefit plan without notice. Benefits are not a guarantee of employment.
Benefits Department
For information about any of the benefits you see, reach out to benefits@examworks.com
