Contacts & Resources

Medical

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:
  • No deductible
  • You pay $0 for primary care, $25 for specialty
  • Other services: You pay 10% coinsurance
In-Network Benefits:
You pay 20% after deductible
Cigna-Contracted Providers Tier 2 Benefits:
  • You pay $15 for primary care, $40 for specialty
  • Other services: You pay 20% after deductible
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 &
Affiliate Providers
(varies by market)

Tier 2

Cigna-Contracted Providers
(in-network)

Tier 3

(out-of-network)

What You Pay

Deductible*

$0

$750 individual/
$1,500 family

$1,500 individual/
$3,000 family

Wellness/Preventive Care

$0
(plan covers 100%)

$0
(plan covers 100%)

40%
after deductible

Primary Care Office Visit

$0
(includes virtual visits)

$15 copay (includes virtual visits)

40% after deductible
(virtual visits not covered)

Specialty Care

$25 copay

$40 copay

40%
after deductible

  • Hospital Services
    (inpatient/outpatient)
  • Rehabilitative Services
  • Diagnostic Lab, X-ray

10%
coinsurance

20%
after deductible

40%
after deductible

Out-of-Pocket Maximum

$3,000 individual/
$6,000 family

$3,000 individual/
$6,000 family

$6,000 individual/
$12,000 family

Prescription Drug Benefits

*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*
(combined deductible for medical and prescription drugs)

$1,500 individual/
$3,000 family

$3,000 individual/
$6,000 family

VillageMD’s
HSA Contribution

$500 individual/$1,000 family
(pro-rated for new hires)

Wellness/Preventive Care

$0
(plan covers 100%)

$0
(plan covers 100%)

  • Primary Care + Virtual Visits
  • Specialty Care
  • Hospital Services
    (inpatient/outpatient)
  • Rehabilitative Services
  • Diagnostic Lab, X-Ray

20%
after deductible

40%
after deductible

Out-of-Pocket Maximum

$3,000 individual/
$6,000 family

$6,000 individual/
$12,000 family

Prescription Drug Benefits

*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.