Page 9 - Enrollment guide 2025-26_Final

Medical Overview Plan Highlights

SchoolCare has partnered with Cigna for many years to deliver comprehensive health care Consumer Driven Suite Traditional Suite
service and claims administration. We use Cigna’s National Open Access Plus network of
providers. This gives you access to care in every state of the country. Primary care provider The Consumer Driven Plan Suite offers SchoolCare’s Traditional Plan Suite includes long-
(PCP) referrals are not required to seek care from a specialist. comprehensive health plans with deductibles established copay plans as well as a plan with a
that can be offered with an HRA or HSA, modest deductible for medical services.
depending on the plan. This gives you more
What Does National Network Mean? What Does Open Access Mean? control of personal health care expenses.

The expanded provider network consists of any Cigna Open Access means there is no requirement to
contracted provider or facility in the country. designate a PCP for any plans. Therefore, no PCP Yellow Plan Orange Plan Green Plan Red Plan
Participants have in-network coverage not only referrals are required. Participants can make
regionally, but nationally as long as services are appointments and receive services for in-network Moderate Deductible High Deductible Low out-of-pocket Low deductible
provided by a Cigna contracted provider (you always covered benefits with any Cigna participating provider Pair with HSA
have access to emergency care anywhere, worldwide). without obtaining a referral from your PCP. Pair with HRA HMO-like Coinsurance
Combined Medical Combined Medical Office Visits & Rx Copays
& Rx OOP
& Rx OOP Rx Copays
Key Terms

Deductible All plans provide:

You must meet the entire deductible
before the plan starts to pay medical • Self-referral to any Cigna contracted provider in the country
and prescription drug benefits (excluding • The same coverage for all services (your cost may vary)
in-network preventive care and certain • Preventive care at no cost
preventive medications). NOTE: If you For more details on specific plans, please review Schoolcare health plan webinars.
enroll one or more family members, you
must meet the full family deductible
before the plan starts to pay expenses for Review the Summary of Benefits and Coverage (SBC) to compare costs and coverage
any one individual. between health plans based on price, benefits, and features important to you.

Coinsurance
Once you’ve met the plan’s annual
deductible, you are responsible for a Don't Forget to Activate Your
portion of your medical expenses, which is Choice Fund
called coinsurance.
Subscribers enrolled in the Yellow Plan with
Out-of-pocket maximum Choice Fund must complete a confidential
Once your deductible and coinsurance Cigna Health Assessment annually to
activate their Choice Fund.
add up to the plan’s annual out-of-pocket $1,000
maximum, the plan will pay 100% of all • Biometric health data is not Single
eligible covered services for the rest of the required
plan year. NOTE: If you enroll one or more • Current Subscribers must
family members, you must meet the full complete between July 1 $2,000
st
family out-of-pocket maximum before the and August 31 Two-Person/
st
plan starts to pay covered services at 100% Find your group’s plan offerings • New Subscribers must Family
for any one individual. complete within 60 days of
at www.schoolcare.org
effective date.
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