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MyHealth360

MyHealth360 provides a medical plan with access to prescription drug coverage. If eligible, you can select one of four coverage levels: Team Member Only, Team Member + Child(ren), Team Member + Spouse/Domestic Partner or Family.

What to know

  • Piedmont PRN Plan: Ready to enroll or have any questions? Please view the FAQ.
  • The Piedmont PRN Plan provides medical and prescription drug coverage
  • Provider networks based on in- or out-of-network structure
  • Participate in well-being activities to earn points to apply towards sweepstakes

Piedmont PRN Plan

The Piedmont PRN Plan is designed to meet your physical and financial needs. 

Frequently Asked Questions (FAQs)

Monthly Premiums for Coverage

MyHealth360 Medical Plan Coverage Summary

Benefit Summary

Summary of Benefits and Coverage (SBC)

How does coordination of benefits work?

Example: Coordination of Benefits

Questions about the Piedmont PRN Plan? Please contact PRNMedicalBenefits@piedmont.org.

Provider Networks and Directories

The level of benefits you will receive depends on where you choose to receive care. In the Piedmont PRN Plan, you can receive care from in-network providers, but you will not be covered if you choose to see out-of-network providers. You pay for the full cost of health care services, including prescription drugs, until you reach the in-network deductible/out-of-pocket maximum.

To locate a provider, use one of the following options:

Note: Not all physician offices located on Piedmont campuses are in the Piedmont Clinic.

When you select an out-of-network provider, you will incur the highest out-of-pocket expenses. Providers and facilities are those not included in the Cigna Open Access Plus Network.

Where can I get high-quality, low-cost care?

Is support available for diabetes and nutrition issues?

Cigna-approved Durable Medical Equipment (DME)Provider Listing

How the Piedmont PRN Plan Works

This example shows coverage using in-network providers.

Key Plan Details
  • You pay the full cost of care until you meet the in-network deductible/out-of-pocket maximum; then, the plan pays the full cost of care for the rest of the year.
  • The deductibles are “embedded” (i.e., the plan begins to pay if one covered family member meets the in-network, team member only deductible).
  • In emergencies, coverage is provided at the in-network level, regardless of where you receive the care.

Still not sure how the plan works? Scroll through these examples:

Meet William

Plan: Piedmont PRN Plan
Who’s Covered: Employee Only
Premium: $101.00 (monthly)
Out-of-Network Coverage: Emergency only
Deductible/Out-of-Pocket Maximum: $8,550 (in-network only: Cigna LocalPlus Network)

Situation:

William is on vacation and gets into an accident. His one-day, out-of-state hospital stay costs $5,000 (emergencies are covered at the highest benefit level). Remember, William pays the full, upfront cost for any health care services until he reaches the deductible/out-of-pocket maximum. If he needs additional care, William will need to pay $3,550 more before the plan pays for in-network care in full for the rest of 2024.

Meet Martha

Plan: Piedmont PRN Plan
Who’s Covered: Employee + Spouse
Premium: $903.99 (monthly)
Out-of-Network Coverage: Emergency only
Deductible/Out-of-Pocket Maximum: Unlimited (out-of-network care)

Situation:

Martha wants to continue receiving care from her cancer doctor, who is not in the Cigna LocalPlus Network. She will pay the full, upfront cost of care for all out-of-network services.

Meet Jill

Plan: Piedmont PRN Plan
Who’s Covered: Family
Premium: $1,438.94 (monthly)
Out-of-Network Coverage: Emergency only
Deductible/Out-of-Pocket Maximum: $17,100 (in-network only: Cigna LocalPlus Network)

Situation:

Jill and her family have a very unhealthy year. Her husband receives multiple surgeries (triggering the individual family deductible embedded in the plan – $8,550). His in-network follow-up care is covered at 100%. The rest of the family exceeds the $17,100 deductible/out-of-pocket maximum, so their in-network care is covered in full for the rest of 2024.

Prescription Drugs

Prescription drug coverage through Cigna is provided automatically when you enroll in the Piedmont PRN Plan. If your medication is not on the no-cost generic preventive medications listing, you will you pay the full cost until you reach your deductible/out-of-pocket maximum. Any prescription drug costs you pay for on your own will contribute towards your annual deductible/out-of-pocket maximum.

When it comes to prescriptions, there are five easy guidelines to follow:

  1. 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!
  2. 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.
  3. 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.
  4. 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.

Prescription Drug Formulary

List of No-Cost Generic Medications

How the prescription drug deductible works:

  • 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.

For more information, visit Piedmont Direct Pharmacy, call 833-551-2024 (Monday through Friday, 8am – 4:30pm) or email piedmontdirect@piedmont.org.

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