Medical

Each network tier has a different cost-sharing arrangement. You and your covered family members choose which tier to use each time you seek care:

Intermountain Health Peaks region (SCL Health Tier 1)

So what is a Tier 1 provider?
For our Cigna plans, Tier 1 is essentially our legacy SCL Health providers, hospitals and medical centers. It also includes Children’s Hospital Colorado and select providers and facilities who partner with us to deliver care. For Kaiser EPO participants (Front Range only), Tier 1 is providers and facilities within the Kaiser Permanente of Colorado network.

You will save the most when you receive care or services from the Tier 1 Network. We are in the healthcare business, so we can deliver both exceptional care and a better ability to control cost. This means you receive the highest level of benefits when you use Tier 1 providers and facilities. Some of these features include: lower copays for physician/specialist office visits (when applicable), lower deductibles, lower coinsurance and lower out-of-pocket maximums.

"Find Care" at myCigna.com online or via the myCigna app. To access this updated search platform that shows the Tier 1 designation, offers improved quality and a better customer experience, login to your myCigna.com account and click on "Find Care".

Note: Kaiser members, Tier 1 applies to select SCL Health Hospitals/Facilities.

Network (Tier 2)

For Cigna members the Open Access Plus network of providers and facilities have agreed to our plan’s negotiated rates. Your deductible, coinsurance, and copays are lower than when using an out-of-network provider.

For Kaiser members, you must stay within the exclusive network of providers offered through Kaiser to receive any network benefit.

Out-of-Network (Tier 3)

For Cigna members, if you receive care from a provider who is not a part of the networks described above, your services may not be discounted and you could be billed the difference between what the SCL Health plan pays and what the provider chooses to charge. Seeing providers outside of the Tier 1 and Cigna networks will cost you the most out-of-pocket.

For Kaiser members, there is no out-of-network coverage available and you will be charged 100% of the billed rate that the provider charges for services sought.

Choose the appropriate medical plan vendor to access a custom provider directory created specifically for Intermountain Health Peaks region caregivers.

myCigna.com or call 800-CIGNA24 (800-244-6224) and request the “Hospital Vertical Team”

Kaiser Provider Search or call 866-427-7701

SCL Health's Cigna Consumer Driven Health Plan (CDHP) at a glance

Preventive Care — CDHP medical plan covers in-network preventive care at 100% (this includes annual physical checkups, recommended screenings for your age, and immunizations). Click here to learn all the ways your Cigna medical plan can help you stay your healthiest. 

Health Reimbursement Account (HRA) — For those who elect the CDHP medical plan, a Health Reimbursement Account (HRA) is automatically opened for you to use to cover eligible medical and prescription drug out-of-pocket expenses. You cannot use HRA funds for dental or vision expenses. 

SCL Health will contribute the following to your account upon enrollment in the plan or as of January 1, each subsequent year, if enrolled in the plan:

• $250 to those with Associate Only coverage
• $500 to those who also cover one or more dependents

You and your spouse/Legal Domicile Adult (LDA) each, if applicable, may fund this account by participating in any of the following programs:

• Virgin Pulse wellness incentive program (up to $200)
• Cigna Personal Health Team (up to $400)
• Cigna Healthy Pregancies, Healthy Babies (up to $200)

Questions about your HRA? Visit mycigna.com or contact Customer Support at 800-244-6224.

Deductible — The CDHP option has a deductible that you must meet before the plan begins to pay coinsurance. The deductible does apply to your out-of-pocket maximum.

Out-of-Pocket Maximum — The out-of-pocket maximum is the most you will pay out-of-pocket during the plan year. Once you reach the out-of-pocket maximum, the plan pays 100% of your eligible medical and pharmacy expenses for the rest of the plan year.

Reminder – If you elected to contribute to a Health Care Flexible Spending Account (FSA), you can use your FSA to pay for eligible out-of-pocket expenses, such as annual deductible and coinsurance responsibility.

SCL Health Cigna PPO medical plan at a glance

Preventive Care — PPO medical plan covers in-network preventive care at 100% (this includes annual physical checkups, recommended screenings for your age, and immunizations). Click here to learn all the ways your Cigna medical plan can help you stay your healthiest. 

Health Reimbursement Account (HRA) — For those who elect the PPO medical plan, a Health Reimbursement Account (HRA) is automatically opened for you to use to cover eligible medical and prescription drug out-of-pocket expenses. You cannot use HRA funds for dental or vision expenses. 

You and your spouse/Legal Domicile Adult (LDA) each, if applicable, may fund this account by participating in any of the following programs:

• Virgin Pulse wellness incentive program (up to $200)
• Cigna Personal Health Team (up to $400)
• Cigna Healthy Pregancies, Healthy Babies (up to $200)

Questions about your HRA? Visit mycigna.com or contact Customer Support at 800-244-6224.

Convenient PPO Copay -- The PPO plan is built on a predicable copay schedule that allows you to know ahead of time what you will pay for services. 

Deductible — Cigna PPO option has a deductible that you must meet before the plan begins to pay coinsurance. The deductible does apply to your out-of-pocket maximum

Out-of-Pocket Maximum — The out-of-pocket maximum is the most you will pay out-of-pocket during the plan year. Once you reach the out-of-pocket maximum, the plan pays 100% of your eligible medical and pharmacy expenses for the rest of the plan year.

Reminder – If you elected to contribute to a Health Care Flexible Spending Account (FSA), you can use your FSA to pay for eligible out-of-pocket expenses, such as annual deductible and coinsurance responsibility.

Kaiser Permanente Exclusive Provider Organization (EPO) medical plan at a glance:

Preventive Care — The Kaiser EPO medical plan covers in-network preventive care at 100% (this includes annual physical checkups, recommended screenings for your age, and immunizations). 

Click here to find Colorado Service Area locations including medical offices, primary care with extended hours, urgent care, emergency care and behavioral health.

 If you require care when outside the Colorado Service Area, you may contact the Away From Home Travel Line.

Health Reimbursement Account (HRA) — For those who elect the EPO medical plan, a Health Reimbursement Account (HRA) is automatically opened for you to use to cover eligible medical and prescription drug out-of-pocket expenses.

You and your spouse/Legal Domicile Adult (LDA) each, if applicable, may fund this account by participating in any of the following programs:

• Virgin Pulse wellness incentive program (up to $200)

Questions about your HRA? Visit kp.org or contact Customer Support at 877-761-3399.

Deductible — The Kaiser EPO medical plan option has a deductible that you must meet before the plan begins to pay coinsurance. The deductible does apply to your out-of-pocket maximum.

Out-of-Pocket Maximum — The out-of-pocket maximum is the most you will pay out-of-pocket during the plan year. Once you reach the out-of-pocket maximum, the plan pays 100% of your eligible medical and pharmacy expenses for the rest of the plan year.

For Benefit Coverage details for the Kaiser EPO medical plan, see below information under Summary of Benefits and Coverage drop down.

Reminder – If you elected to contribute to a Health Care Flexible Spending Account (FSA), you can use your FSA to pay for eligible out-of-pocket expenses, such as annual deductible and coinsurance responsibility.

The Summary of Benefits and Coverage, or SBC, assists you in understanding your healthcare coverage with a summary of services covered and not covered (excluded) by the plan.

2023: 

• Cigna CDHP
• Cigna PPO
• Kaiser EPO
• Cigna CDHP - Out of Area
• Cigna PPO - Out of Area
• Kaiser - DHMO (Mount Saint Vincent Only)
• Kaiser - HMO (Mount Saint Vincent Only)

The Summary Plan Description, or SPD, communicates plan rights and obligations to participants and beneficiaries. This is a summary of the material provisions of the plan document. See the Medical SPDs.