Medical & Prescription Plans

In our continued effort to ensure the well-being of you and your family,

Alto Pharmacy will continue to provide medical plans through

Cigna and Kaiser Permanente.

Cigna members have access to Cigna’s nationwide network of physicians and hospitals. If you choose the PPO Plan or HDHP, you can choose any provider you choose; however, you will spend considerably less money by only seeing in-network providers.

Kaiser HMO members have access to medical services and doctors at any Kaiser facility in your respective service area.

Please note that Kaiser coverage is only available to CA and CO employees.

What to consider when choosing a plan
Jump to Cigna
Jump to Kaiser

Alto Pharmacy wants to make sure that you and your family members have access to excellent medical care. You can choose from three different Cigna plans, all offering great levels of coverage.

Please reference the “Cigna Provider Directory” link located to the right to find doctors and facilities that are in-network with Cigna, so you can maximize your in-network coverage. Be sure to select the Open Access Plus, Open Access Plus Tiered plan. Alto Pharmacy offers a High Deductible Health Plan (HDHP) that allows you to open a Health Savings Account (HSA). With the exception of preventive care, which is covered at no cost, all other procedures are subject to the plan’s deductible.

Why would I want a HDHP?

Alto Pharmacy will contribute $37.50/month to an employee’s HSA when they enroll in Employee Only coverage, $75/month when enrolling with Spouse or Child and $100/month when enrolling with Children or Family. You will need to enroll in an HSA with HealthEquity in PlanSource to receive these funds. Please notify HR if you are also enrolled in another medical plan (parents, spouse, Medicare, etc.) as it may limit your eligibility to receive HSA contributions.

Please note: After you have completed your enrollment, eligibility information will be sent to the carriers on the next weekly file, which is scheduled for Friday morning. Dependent eligibility will be sent to the carriers on a weekly Friday morning file following dependent verification document being received and approved. The carriers take approximately 3-4 business days to process the files at which time, you can register with myCigna.com and login to download a digital ID card and also contact Cigna Member services with any questions.

Group Number
Service Number
621855
866.494.2111

Cigna Provider Directory

Cigna PPO 500 SBC
Cigna PPO 500 Plan Summary
Cigna HDHP SBC
Cigna HDHP Plan Summary
Cigna Member Resources
CIGNA MEDICAL
PPO 500
HDHP
Network

(In-Network | Out-of-Network)

(In-Network | Out-of-Network)
Calendar Year Deductible
  • Individual
  • Family
$500 | $1,000
$1,000 | $2,000
$1,650 | $3,000
$3,300 ($3,300 Ind.) | $6,000 ($5,600 Ind.)

Out-of-Pocket Maximum

  • Individual
  • Family
$2,500 | $5,000
$5,000 | $10,000
$3,000 | $6,000 $6,000 ($3,300 Ind.) | $12,000 ($6,000 Ind.)

Preventive Care

No charge | 30%*
No charge | 30%*
Primary Office Visit
$20 copay | 30%*
10%* | 30%*
Specialty Office Visit
$25 copay | 30%*
10%* | 30%*
Telemedicine
$15/$30 copay | 30%*
10%* | 30%*
Chiropractic Care
(20 visits)
$25 copay | 30%*
(20 visits)
10%* | 30%*
Acupuncture
(12 visits)
$25 copay | 30%*
Not covered
Lab and X-ray
10%*| 30%*
10%* | 30%*
Hospitalization
10%*| 30%*
10%* | 30%*
Outpatient Facility
10%*| 30%*
10%* | 30%*
Emergency Room
$100 copay
(waived if admitted)
10%*
Urgent Care
$40 copay | 30%*
10%* | 30%*
PRESCRIPTION DRUGS
Retail (30-Day Supply)
Tier 1: Generic
$5 copay | Not covered
$5 copay* | Not covered
Tier 2: Preferred
$30 copay | Not covered
$30 copay* | Not covered
Tier 3: Non-Preferred
$50 copay | Not covered
$50 copay* | Not covered
Tier 4: Specialty
20% up to $150 | Not covered
20% up to $150* | Not covered

*after deductible has been met

Contributions

PER PAY PERIOD (26)

PPO 500

EMPLOYEE COST

HDHP

EMPLOYEE COST

Employee Only
$69.20
$15.42
Employee + Spouse
$218.42
$117.53
Employee + Children
$189.71
$98.96
Employee + Family
$341.84
$201.08

Members are required upon initial enrollment to select a Primary Care Physician (PCP) from Kaiser’s network of doctors. The PCP will be the main point of contact for all healthcare needs. The PCP will refer members to specialists within the Kaiser network when necessary. Members and dependents may each choose unique PCPs. Changes to PCP designations may be requested by calling Member Services.

PCPs and specialists within the network will work together to manage the member’s health and ensure continuity of care. All care – including lab work and prescription medical – must be provided by Kaiser.

If covered under the plan, chiropractic and acupuncture services can be accessed by members through affiliated providers.

Please note: after you have completed your enrollment, eligibility information will be sent to the carriers on the next weekly file, which is scheduled for Friday morning. Dependent eligibility will be sent to the carriers on a weekly Friday morning file following dependent verification document being received and approved. The carriers take approximately 3-4 business days to process the files at which time, you can register with kp.org & login to download a digital ID card and also contact Kaiser Member services with any questions.

Group Number
Service Number
Northern CA: 605871
Southern CA:
233866
800.464.4000
Colorado:
47065
303.338.3800

Kaiser Provider Directory

Kaiser CA Traditional HMO SBC & Summary
Kaiser CO HMO 20 SBC
Kaiser Member Resources
KAISER PERMANENTE MEDICAL
TRADITIONAL HMO
(California Only)
HMO 20
(Colorado Only)
Network
In-Network
In-Network
Calendar Year Deductible
  • Individual
  • Family
$0 $0
$0
$0

Out-of-Pocket Maximum

  • Individual
  • Family
$1,500 $3,000
$1,500
$3,000

Preventive Care

No charge
No charge
Primary Office Visit
$20 copay
$20 copay
Specialty Office Visit
$20 copay
$20 copay
Telemedicine
No charge
No charge
Chiropractic Care
(20 visits)
$30 copay

(20 visits)

$30 copay

Acupuncture
(20 visits)
$30 copay
(40 visits)
$20 copay
Lab and X-ray
No charge
No charge
Hospitalization
$250 copay
$250 copay
Outpatient Facility
$20 copay per procedure
$20 copay per procedure
Emergency Room

$100 copay

(waived if admitted)

$100 copay

(waived if admitted)

Urgent Care
$20 copay
$20 copay
PRESCRIPTION DRUGS
Retail (30-Day Supply)
Tier 1: Generic
$10 copay
$15 coopay
Tier 2: Preferred
$30 copay
$30 copay
Tier 3: Non-Formulary
$30 copay
Not covered
Tier 4: Specialty
20% up to $150
20% up to $250

Contributions

PER PAY PERIOD (26)
TRADITIONAL HMO
EMPLOYEE COST
HMO 20 EMPLOYEE COST
Employee Only
$49.12
$51.69
Employee + Spouse
$165.04
$173.67
Employee + Children
$145.73
$153.34
Employee + Family
$242.33
$255.00

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Disclaimer: This presentation is to provide a summary of Alto Pharmacy employee benefit programs. Should any discrepancy arise, please refer to actual plan documents which supersede this presentation. Once enrolled, you will receive a Combined Evidence of Coverage and Disclosure Form that explains the exclusions and limitations, as well as the full range of covered services of your plan, in detail.