Every day, we wake up to deliver the best primary care possible, centered on the physician-patient relationship. We know our physician-led, team-based model gives patients and communities a better health care experience while lowering the cost of care. That’s the value of value-based care. So it just stands to reason we’d want our own team members to enjoy this same high-quality, confidential care at an affordable cost.
You have two medical plan options:
Both plans cover the same services and give you access to affordable and quality care.
| Using These Network Providers | Will Get You These Benefits | |
| VillageMD Value-Based Plan | HSA Medical Plan | |
| VillageMD & Affiliate Providers | Tier 1 Benefits:
|
In-Network Benefits: You pay 20% after deductible |
| Cigna-Contracted Providers | Tier 2 Benefits:
|
|
| Out-of-Network Providers | Tier 3 Benefits: You pay 40% after deductible |
Out-of-Network Benefits: You pay 40% after deductible |
VillageMD Value-Based Plan
This plan has three benefit tiers, based on the provider you choose at the time of care.
- Tier 1: Care from VillageMD and Affiliate Primary Care Providers with no deductible. As VillageMD adds new employed and affiliate providers, Tier 1 network accessibility will continue to grow.
- Tier 2: Cigna-contracted providers (in-network). Deductible applies.
- Tier 3: All other providers (out-of-network). Deductible applies. Lowest benefits and highest out-of-pocket costs compared with Tiers 1 and 2.
| Plan Provision | Tier 1 VillageMD & |
Tier 2 Cigna-Contracted Providers |
Tier 3 (out-of-network) |
|---|---|---|---|
|
What You Pay |
|||
|
Deductible* |
$0 |
$750 individual/ |
$1,500 individual/ |
|
Wellness/Preventive Care |
$0 |
$0 |
40% |
|
Primary Care Office Visit |
$0 |
$15 copay (includes virtual visits) |
40% after deductible |
|
Specialty Care |
$25 copay |
$40 copay |
40% |
|
10% |
20% |
40% |
|
Out-of-Pocket Maximum |
$3,000 individual/ |
$3,000 individual/ |
$6,000 individual/ |
*With the VillageMD Value-Based Plan, each member is only responsible for their individual deductible — then coinsurance begins for that person.
HSA Medical Plan
This plan’s higher deductible makes you eligible to contribute to a Health Savings Account (HSA). An HSA will automatically be opened in your name if you enroll in this plan. VillageMD will make a contribution to your HSA, whether or not you contribute. Important: You need to complete the registration steps with Asure to activate your account in order to receive the VillageMD contribution.
- In-network: VillageMD and Affiliate and Cigna-contracted providers.
- Out-of-network: All other providers. Lower benefits and higher out-of-pocket costs than in-network.
| Plan Provision | VillageMD & Affiliate Providers Cigna-Contracted Provider Network (in-network) |
All Other Providers
(out-of-network) |
|
|---|---|---|---|
|
What You Pay |
|||
|
Deductible* |
$1,500 individual/ |
$3,000 individual/ |
|
|
VillageMD’s |
$500 individual/$1,000 family |
||
|
Wellness/Preventive Care |
$0 |
$0 |
|
|
20% |
40% |
|
|
Out-of-Pocket Maximum |
$3,000 individual/ |
$6,000 individual/ |
|
*The family deductible amount must be met before coinsurance begins for any family member.
NOTE: If you use virtual care services from MDLIVE, rather than an in-network provider, the service charges are $45 per medical visit, $65 per dermatology visit. Behavioral health service charges will vary.
GOOD TO KNOW
- Medical plans may require “prior authorization” or “pre-certification” for certain medical services. If you or your provider do not get prior authorization or pre-certification when required, benefits may be reduced or services not covered.
- Out-of-network benefits are paid based on Cigna’s Schedule of Maximum Allowances or what can be referred to as a “Usual and Customary” level. Out-of-network providers are not obligated to accept the SMA or Usual and Customary Level and may “balance bill” you for their actual charge above and beyond the SMA or Usual and Customary amount. These excess charges are not credited toward your deductible or out-of-pocket maximum.