Medical & Prescription Plans

Cigna
Kaiser Permanente

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

Fuze Health will offer medical coverage through

Cigna and Kaiser Permanente.

Your medical plan gives you access to doctors, hospitals, and preventive services to keep you and your family healthy. Coverage includes everything from routine checkups and vaccinations to care for illnesses, emergencies, and chronic conditions. With multiple plan options, you can choose the network and level of coverage that best fits your needs and lifestyle.

Please note that Kaiser coverage is available only to employees residing in California and Colorado.

What to consider when choosing a plan
Healthcare Terminology Glossary
Pharmacy & Know Where To Go

Fuze Health wants to make sure that you and your family members have access to excellent medical care. You can choose from two different Cigna plans, all offering great levels of coverage. Cigna OAP stands for Open Access Plus and works like a typical PPO plan.

Cigna provides a benefits education website that's useful in comparing your plan options, getting answers to questions you might have and choosing a plan that fits your needs. It's designed to make the pre-enrollment experience easier.

Highlights include:

  • Easy-to-understand details on the plans through Cigna
  • Explanations of plan components and comprehensive plan summary documents
  • Benefits education videos and information, including a video library and glossary of terms
  • Telephone support from Cigna's live representative during the enrollment period by calling the Employee Hotline: 888-806-5094.

Click HERE to start learning about Cigna programs as you get ready to enroll. For the optimal user experience, we encourage using a current browser version and clearing your cache.

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. Fuze Health 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?

Fuze Health will contribute $37.50/month to an employee’s HSA when they enroll in Employee Only coverage or $100/month when enrolling with one or more dependent. You will need to enroll in an HSA with Optum in PlanSource to receive these funds. Please notify the Total Rewards Team 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. 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 Advantage 4-Tier Prescription Drug List
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
$1,750 | $3,000
$3,500 ($3,500 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 ($3,500 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
$20/$25 copay | 30%*
10%* | 30%*
Chiropractic Care
$25 copay | 30%*
(20 visits)
10%* | 30%*
(20 visits)
Acupuncture
$25 copay | 30%*
(12 visits)
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

MONTHLY (12)
PPO 500
EMPLOYEE COST
HDHP
EMPLOYEE COST
Employee Only
$163.18
$35.82
Employee + Spouse
$515.06
$272.98
Employee + Child(ren)
$447.36
$229.85
Employee + Family
$806.10
$467.04

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. 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 CA HSA-Qualified HDHP HMO SBC & Summary
Kaiser CO HMO 20 SBC
Combined Chiropractic and Acupuncture EOC
Kaiser CA Member Resources
Kaiser CO Member Resources
KAISER PERMANENTE MEDICAL
TRADITIONAL HMO
(California Only)
HSA-QUALIFIED HDHP HMO
(California Only)
HMO 20
(Colorado Only)
Network
In-Network
In-Network
In-Network
Calendar Year Deductible
  • Individual
  • Family
$0 $0
$1,750
$3,500 ($3,500 Ind.)
$0
$0

Out-of-Pocket Maximum

  • Individual
  • Family
$1,500 $3,000
$3.500
$7,000
$1,500
$3,000

Preventive Care

No charge
No charge
No charge
Primary Office Visit
$20 copay
10%*
$20 copay
Specialty Office Visit
$20 copay
10%*
$20 copay
Telemedicine
No charge
No charge*
No charge
Chiropractic Care
$30 copay
(20 visits)
$15 copay*
(30 visits)

$30 copay

(20 visits)

Acupuncture
$30 copay
(20 visits)
$15 copay*
(30 visits)
$20 copay
(40 visits)
Lab and X-ray
No charge
10%*
No charge
Hospitalization
$250 copay
10%*
$250 copay
Outpatient Facility
$20 copay per procedure
10%*
$20 copay per procedure
Emergency Room

$100 copay

(waived if admitted)

10%*

$100 copay

(waived if admitted)

Urgent Care
$20 copay
10%*
$20 copay
PRESCRIPTION DRUGS
Retail (30-Day Supply)
Tier 1: Generic
$10 copay
$10 copay*
$15 copay
Tier 2: Preferred
$30 copay
$30 copay*
$30 copay
Tier 3: Non-Formulary
$30 copay
$30 copay*
$30 copay
Tier 4: Specialty
20% up to $150
20% up to $250*
30% up to $150

Contributions

MONTHLY (12)
TRADITIONAL HMO
EMPLOYEE COST
HSA-QUALIFIED HDHP HMO
EMPLOYEE COST
HMO 20 EMPLOYEE COST
Employee Only
$124.35
$28.62
$121.91
Employee + Spouse
$417.85
$228.45
$409.58
Employee + Child(ren)
$368.95
$193.28
$361.62
Employee + Family
$613.52
$373.10
$601.37

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Disclaimer: This presentation provides a summary of the employee benefit programs offered by Fuze Health. Should any discrepancies arise, please refer to the actual plan documents, which supersede this presentation. Once enrolled, you will receive a Combined Evidence of Coverage and Disclosure Form detailing the exclusions, limitations, and the full range of covered services of your plan.