MyHealth360 provides a comprehensive suite of health and well-being benefits including: two medical plans, prescription drug, dental and vision coverage, and Flexible Spending Accounts (FSAs). If eligible, you can select one of four coverage levels: Employee Only, Employee + Child(ren), Employee + Spouse/Domestic Partner or Family.
In the Piedmont Exclusive Plan, you pay lower bi-weekly premiums than you would in the Piedmont Choice Plan because when you visit a Piedmont-network provider or facility, we have the ability to better manage your care and your cost.
The level of benefits you will receive depends on where you choose to receive care. In the Piedmont Exclusive Plan, you can receive care in two main networks or tiers.
To find a provider, MyHealth360 members can download and open the Castlight mobile app and select “Find Care.” If you are not enrolled in a MyHealth360 plan and are interested in enrolling, you may search for in-network providers and facilities. In your search results, Tier One providers will be clearly labeled with a green checkmark; all other providers are considered Tier Two.
This is the same Tier One network as the Piedmont Choice Plan.
You will receive high-quality care at the most affordable price possible when you use Piedmont Network (Tier One) providers and services. This includes: All Piedmont Clinic physicians, Piedmont Healthcare facilities, Piedmont-branded urgent care centers, Children’s Healthcare of Atlanta (CHOA) facilities, The Children’s Health Network (TCHN) pediatricians, Kids First Health pediatricians, Middle Georgia Pediatrics, Primary Pediatrics and others, as well as emergency care.
Note: Not all physician offices located on Piedmont campuses are in the Piedmont Clinic.
This is NOT the same (or as large) as the Tier Two network as the Piedmont Choice Plan.
You will have higher out-of-pocket costs when seeing providers or receiving services at the Tier Two level. The Cigna LocalPlus Network (Tier Two) consists of any providers within this network who are not listed as Tier One.
Note: Not all physician offices located on Piedmont campuses are in the Piedmont Clinic.
You will not have coverage outside of the Piedmont Preferred Network (Tier One) or Cigna LocalPlus Network (Tier Two) except for:
Urgent care centers
Emergency care (emergency room and emergency admissions)
Medically necessary (and approved) healthcare services not performed at any locations within the network
Since William’s doctor is in the Piedmont Preferred Network, the Piedmont Exclusive Plan offers lower costs across the board. William is on vacation and gets into an accident. His four-day, out-of-state hospital stay costs $900 in copays (emergencies are covered at the highest benefit level). William also needs a wheelchair for $800. He pays the $500 deductible (copays don’t count toward the deductible), and he and the plan split the remaining $300 (he pays 15% – $45).
Martha is undergoing cancer treatment at Emory. She has seen the same doctor for two years, and she doesn’t want to switch. Martha chooses the Piedmont Choice Plan because she wants to continue receiving care from her cancer doctor, who is in the Cigna Open Access Plus (OAP) Network (Tier Two).
Meet Jill
Plan: Piedmont Exclusive Plan Who’s Covered: Family Premium: $280.86 (full-time, bi-weekly) Out-of-Network Coverage: Emergency Only Deductible: $1,000 (Tier One: Piedmont Preferred Network) Out-of-Pocket Maximum: $6,850 (Tier One: Piedmont Preferred Network)
Situation:
Since the family’s doctors and pediatricians are in the Piedmont Preferred Network, the Piedmont Exclusive Plan offers lower costs across the board for Jill and her family, including most healthcare services being covered with copays.
Prescription Drugs
Prescription drug coverage through Cigna is provided automatically when you enroll in one of Piedmont’s medical plan options. The coverage for your medications is the same regardless of the medical plan you choose.
When it comes to prescriptions, there are five easy guidelines to follow:
Use generic drugs when you can. Be sure to ask your physician or pharmacist if a generic substitute is available—it could save you money!
Take advantage of preventive medication at no cost to you. To help you maintain a steady treatment regimen, certain preventive medicines are paid at 100% with no deductible when you visit an in-network pharmacy. This includes many diabetes, cholesterol, blood pressure and other select medication categories.
When you use the broad Cigna/Express Scripts network of retail pharmacies, including Piedmont pharmacies, Oconee Drugs, Walgreens, Kroger, and Walmart retail pharmacies, you can get a 90-day supply of your medication for just two times your 30-day copay amount.
Consider using Cigna’s Home Delivery Pharmacy mail-order option for your maintenance medications—for 2.5x the 30-day copay for a 90-day supply, rather than receiving refills at a retail pharmacy. Review the Home Delivery FAQs for more details.
Remember to explore drug options with your physician to avoid costly name-brand and specialty drug copays that may not be necessary. If you must use brand or specialty drugs, to help offset the cost, take advantage of manufacturer coupons.
You must meet a $150 (per member) annual deductible for brand-name prescriptions (preferred and non-preferred) before benefits begin.
This is a separate deductible from the medical plan deductible.
You will not need to meet this deductible for generic prescriptions.
Piedmont Direct Pharmacy
We offer life-changing specialty pharmacy services designed to simplify every aspect of your care. From obtaining financial assistance, to navigating through your insurance benefits, coordinating with providers, and managing refills, Piedmont Specialty Pharmacy patient liaisons are ready to help you and your family.
Our team can answer and address insurance-related questions and conduct prior authorizations for complex, rare and chronic medical conditions that require specialized medication therapy.
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Primary (team members in Atlanta, Athens, Columbus, Eastside, Fayette, Henry, Mountainside, Newnan, Newton, Rockdale, Walton, System Office and Physician Enterprise [Piedmont Clinic, PHI and PMCC])
Piedmont Augusta (formerly University Health Care System team members)
In-Region Remote (team members residing in Georgia, Alabama and South Carolina, including System Office and Physician Enterprise [Piedmont Clinic, PHI and PMCC])
Out-of-Region Remote (team members in all other U.S. states; including System Office and Physician Enterprise [Piedmont Clinic, PHI and PMCC])
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Emergencies are covered at the Piedmont Network (Tier One) level, regardless of where you receive care.
Cigna offers a network of national ancillary providers to ensure convenient access to cost-effective, quality durable medical equipment (DME) in the home setting. In addition to these national vendors, locally based participating DME providers are available. Check the Cigna provider directory to find a local provider.
What else should I know about the Piedmont Exclusive Plan?
In the Piedmont Exclusive Plan, you can:
Receive coverage with Tier One or Tier Two providers
Rest assured that emergencies are always covered, regardless of where you receive care
Plan to pay less in bi-weekly premiums for coverage
Pay fixed-dollar copays for most services
Expect to share a percentage of the cost with Piedmont for limited expenses after you meet your deductible
Budget for lower out-of-pocket maximums
It could save you money!
Brand-Name – Example
One 90-day supply
$350
Three refills (for a one-year supply
$600 (3 x $200)
Total Costs
$950
Generic – Example
One 90-day supply filled through mail order or at Walgreens
$0
Three refills (for a one-year supply
$0
Total Costs
$0
Annual Savings
$950 ($950-$0 = $950)
Legal / Disclaimer
This website is not inclusive of all situations and is provided for informational purposes only. It is not intended to be an official legal document. If there are conflicts between the website and IRS regulations, the member handbook, or the Summary Plan Description (SPD), IRS regulations, the member handbook, and the SPD will govern.
