Medical - Benefits

Your medical plan, administered by Cigna, covers a wide range of services — including preventive care, office visits, hospital stays, surgery, mental health care and prescription drugs. Preventive care is covered in full when you use in-network providers — so there's no reason to skip your annual checkup or vaccines.

This coverage is bundled with your dental, vision and hearing coverage into a single health plan package. See the Plan Rates page for your per-paycheck cost and you can earn a premium discount by taking the Cigna Health Assessment each year.

What You Pay

The charts below provide an overview of your medical benefits.
Some services require a flat copay at the time of visit. Others require you to meet an annual deductible first, then pay a percentage of the cost (coinsurance).
Copays do not count toward the deductible, but all amounts you pay — copays, deductible and coinsurance — count toward your annual out-of-pocket maximum. Once you hit that maximum, the plan pays 100% for the rest of the calendar year.

Employee & Family Health Care Centers

Your medical plan allows you and your family members to use all the services offered at the MNPS Employee & Family Health Care Centers at no cost to you. You also enjoy:

Five convenient locations
Vanderbilt quality
Whole-person patient-centered care
Virtual visit and weekend care options

Deductible and Benefit Limits

Medical Benefits	In-Network	Out-of-Network
Annual deductible	$500 per person or $1,500 per family	$800 per person or $2,050 per family
Annual medical out-of-pocket maximum	$3,600 per person or $7,200 per family	$7,200 per person
Lifetime maximum medical benefits	Unlimited	Unlimited

Office and Routine Care

Medical Services	In-Network	Out-of-Network
Preventive care and immunizations	You pay $0	You pay 40% after deductible
MNPS Health Care Centers visits	You pay $0	N/A
Primary care and convenient care visits	You pay $35	You pay 40% after deductible
Mental health office visits	You pay $0	You pay 40% after deductible
Substance use disorder office visits	You pay $0	You pay 40% after deductible
Specialist visits	You pay $50	You pay 40% after deductible
Lab and x-ray in physician's office	You pay $0	You pay 40% after deductible
Urgent care facility	You pay $35	You pay $35
Chiropractic (up to 24 visits/year)	You pay $50	Not covered
Physical, occupational, speech therapy	You pay 15% after deductible	You pay 40% after deductible
Durable medical equipment	You pay 15% after deductible	You pay 40% after deductible

Maternity Care

The chart shows your medical plan benefits for maternity care.
Learn about the Vanderbilt MyMaternity Health bundle, which covers everything an expectant mother needs, from enrollment through 90 days after birth — at $0 cost to you.

Medical Services	In-Network	Out-of-Network
Prenatal care	You pay $35 copay for initial visit, then $0	You pay 40% after deductible
Delivery	You pay 15% after deductible	You pay 40% after deductible

Hospital and Outpatient Facility Care

Medical Services	In-Network	Out-of-Network
Hospitalization inpatient	You pay 15% after deductible	You pay 40% after deductible
Outpatient surgery	You pay 15% after deductible	You pay 40% after deductible
Outpatient or diagnostic facility	You pay 15% after deductible	You pay 40% after deductible
Emergency room (waived if admitted)	You pay $150 plus deductible and 15%	You pay $150 plus deductible and 15%
Ambulance	You pay 15% after deductible	You pay 15% after deductible
Skilled nursing facility	You pay 15% after deductible	You pay 40% after deductible
Home health care	You pay 15% after deductible	You pay 40% after deductible

Mental Health and Substance Use Disorder Care

The chart shows your medical plan benefits for mental health and substance use care.
Learn about all your mental health benefits in the Mental Health Resource Guide.

Medical Services	In-Network	Out-of-Network
Mental health inpatient care	You pay $0	You pay 40% after deductible
Substance use disorder inpatient care	You pay $0	You pay 40% after deductible
Mental health outpatient therapy (individual and group)	You pay $0	You pay 40% after deductible
Substance use disorder outpatient therapy (individual and group)	You pay $0	You pay 40% after deductible

Prescription Drugs

You pay a flat dollar amount called a copay per prescription. Copays count toward your medical out-of-pocket maximum. Certain preventive drugs are covered at $0 with no deductible — visit myCigna for the full list.

Retail Pharmacy

The chart shows your in-network copays.
Out-of-network: The same 30-day copays apply. 90-day supply not covered.

Drug Tier	30-Day Supply	90-Day Supply
Certain preventive drugs — generic and brand	You pay $0	You pay $0
Generic	You pay $5 copay	You pay $10 copay
Preferred brand	You pay $35 copay	You pay $70 copay
Non-preferred brand	You pay $100 copay	You pay $200 copay

Home Delivery (90-day supply)

Drug Tier	Cigna Home Delivery	Other Mail Order Pharmacies
Generic	You pay $10 copay	Not covered
Preferred brand	You pay $70 copay	Not covered
Non-preferred brand	You pay $200 copay	Not covered

Brand vs. Generic

If you choose a brand name drug when a generic equivalent is available, you pay the brand copay plus the cost difference between the two. The exception: If your doctor certifies the brand is medically necessary and gets authorization from Cigna, you pay only the brand copay.

Cigna Home Delivery

Save money on medications you take ongoing by ordering a 90-day supply through Cigna Home Delivery. Standard shipping is free. Call 1-800-285-4812 to get started.

In-Network vs. Out-of-Network

The plan uses Cigna's Open Access Plus (OAP) network. You don't need to choose a primary care physician, and you don't need a referral to see a specialist.

You can see any provider you choose, but your costs are lowest when you use OAP network providers.
If you go out-of-network, your benefits will be lower and you'll likely pay more out of pocket.
Additionally, out-of-network providers may charge more than Cigna's maximum allowable charge (called the MAC). If they do, you're responsible for that difference on top of your regular cost-share.

Finding Network Providers

Already enrolled? Log onto the myCigna member portal to search providers, view claims and estimate costs.
Not yet enrolled? Visit the Cigna website and search under Open Access Plus.
By phone: Call 1-800-244-6224.

Extra Programs Included at No Cost

All enrollees have access to these Cigna programs:

24-Hour Nurse Line

Talk to a registered nurse any time for symptom advice and guidance on when to seek care. Call 1-800-244-6224.

Televisits with MDLIVE

Connect with a board-certified doctor by phone or video for common conditions like colds, flu, allergies, rashes and UTIs — no appointment needed. Register at the MDLIVE website or call 1-888-726-3171.

myCigna Member Portal

View your plan details on the myCigna Member Portal. You also can track claims, compare provider quality ratings and estimate procedure costs. Download the myCigna app to manage your benefits on the go.

Questions?

Call Cigna at 1-800-244-6224 or log on to myCigna anytime. TTY/TDD users: call 1-800-987-8816.

Summary of Benefits and Coverage

In accordance with the Affordable Care Act (ACA), MNPS and Cigna have prepared a Summary of Benefits and Coverage (SBC) with additional details about your medical plan. You can find the SBC online at Oracle Cloud, or request a free printed copy by emailing or calling Employee Benefit Services at 615-259-8607.

This page summarizes your medical plan benefits but does not describe every limitation or exclusion. The plan document is the governing legal publication that defines eligibility, enrollment, benefits and administrative rules. A copy of the plan document is available on Oracle Cloud.