Medical

Overview

iCapital offers three comprehensive medical plan options that offer a range of coverage levels and costs, so you can choose the one that’s best for you and your family. These plans are administered by Cigna. You can enroll as a new hire, during Open Enrollment, or if you have a qualified life event.

Our medical plans provide:

Comprehensive, affordable coverage

for a wide range of health care services.

Free in-network preventive care

with annual physicals, recommended immunizations, and routine preventive screenings all 100% covered.

Prescription drug coverage

automatically included, provided by Cigna.

Financial protection

through out-of-pocket maximums that limit your annual costs.

Plan Comparison

Use this side-by-side plan comparison to understand key differences between medical plans. You can select which plans to compare using the left button below. Click on a row to expand that section or click on the “Expand All” button to see everything at once.

TIP: Review the Glossary of Terms and check out our educational video library to better understand how the medical plans work and determine which one might be best for you.

	HDHP	EPO	PPO
Health Savings Account (HSA) or Health Care Flexible Spending Account (FSA) features
HSA-eligible	Yes (Learn about the HSA.)	No (Consider a Health Care FSA instead.)	No (Consider a Health Care FSA instead.)
Company contribution to HSA	$500 for employee-only coverage or $1,000 if you cover dependents	None	None
Annual deductible (individual/family)
In-network: Medical	$2,000/$4,000	$1,500/$3,000	None
In-network: Prescription drugs	Included in medical deductible	$150/$300*	$100/$200*
Out-of-network: Medical & prescription drugs	$4,000/$8,000	N/A	$2,000/$4,000 ($50/individual home health care deductible)
Coinsurance
In-network	You pay $0 after deductible, plan plays 100%	You pay 20%, plan plays 80%	You pay $0, plan plays 100%
Out-of-network**	You pay 30%, plan plays 70%	N/A	You pay 30%, plan plays 70%
Annual out-of-pocket maximum (individual/family)
In-network	$6,000/$12,000	$6,000/$12,000	$2,500/$5,000
Out-of-network	$10,500/$21,000	N/A	$5,000/$10,000
Health care services: Your costs
Preventive care	You pay nothing in-network, covered 100%	You pay nothing in-network, covered 100%	You pay nothing in-network, covered 100%
Primary care (in-network)	You pay $25 copay after deductible	You pay $30 copay	You pay $25 copay
Primary care (out-of-network)	You pay 30% after deductible	N/A	You pay 30%
Specialist (in-network)	You pay $50 copay after deductible	You pay $50 copay	You pay $40 copay
Specialist (out-of-network)	You pay 30% after deductible	N/A	You pay 30%
Behavioral health (in-network)	You pay $25 copay after deductible	You pay $30 copay	You pay $25 copay
Behavioral health (out-of-network)	You pay 30% after deductible	N/A	You pay 30%
Telehealth	You pay $0	You pay $0	You pay $0
Urgent care (in-network)	You pay $50 copay after deductible	You pay $50 copay	You pay $40 copay
Urgent care (out-of-network)	You pay 30% after deductible	N/A	You pay 30%
Emergency room (in- and out-of-network)	You pay $200 copay after deductible	You pay $300 copay	You pay $300 copay
Inpatient/outpatient hospital care (in-network)	You pay $250 per visit copay, and plan pays 100%	You pay 20%	You pay $500 copay inpatient, $250 copay outpatient
Inpatient/outpatient hospital care (out-of-network)	You pay 30% after deductible	N/A	You pay 30% after deductible
Inpatient Hospital Physician's Visit/Consultation (in-network)	Plan pays 100%	You pay 20%	Plan pays 100%
Inpatient Hospital Physician's Visit/Consultation (out-of-network)	You pay 30% after deductible	N/A	You pay 30%
Prescriptions – 30-day supply at retail pharmacy: Your costs
Generic	You pay $15 copay after deductible	You pay $15 copay	You pay $15 copay
Preferred	You pay $30 copay after deductible	You pay $30 copay	You pay $30 copay
Non-preferred	You pay $60 copay after deductible	You pay $60 copay	You pay $60 copay
Prescriptions – 90-day supply (mail order or retail pharmacy): Your costs
Generic	You pay $38 copay after deductible	You pay $38 copay	You pay $38 copay
Preferred	You pay $75 copay after deductible	You pay $75 copay	You pay $75 copay
Non-preferred	You pay $180 copay after deductible	You pay $180 copay	You pay $180 copay

*Prescription drug deductible does not apply to generic prescription drugs.
**Out-of-network benefits are based on reasonable and customary charges.

Combining low-premium, high-deductible coverage with a tax-free Health Savings Account (HSA) helps you save money and plan ahead for future medical expenses. This type of medical plan is often known as a consumer-directed health plan — by taking more responsibility for your actual medical and prescription costs, you’re rewarded for making healthy, cost-conscious choices. In addition, iCapital will contribute to your HSA to help cover your out-of-pocket costs — $500 for employee-only coverage or $1,000 if you cover dependents.

Prescription Drugs

When you enroll in an iCapital medical plan, you automatically receive prescription drug benefits through Cigna. Use the Cigna website or mobile app to manage your prescriptions, order refills, sign up for home delivery, and more.

Drug tiers

The cost of your prescription drugs under each medical plan depends on the tier of the medication — generic, preferred, or non-preferred. All prescription carriers have a formulary, or list of drugs based on effectiveness and cost. This list will determine how your prescriptions are covered. Keep in mind that the formulary may change as a result of regular reviews and updates. You can find the current formulary for your plan on the Cigna website.

Learn about the drug tiers

Generic drugs

Preferred drugs

Non-preferred drugs

You pay: $

Generic drugs have the same active ingredients as brand-name equivalents and meet the same standards for quality and effectiveness, but usually cost much less.

You pay: $$

Preferred drugs are brand-name medications included on the plan’s formulary and favored by Cigna.

You pay: $$$

Non-preferred drugs are brand-name medications not preferred by Cigna. They may still be covered, but may require prior authorization and cost more.

Prescription programs

Your prescription drug benefits include several programs aimed at ensuring the most clinically appropriate and cost-effective medication use.

Specialty medication – All prescriptions for specialty medication used to treat certain conditions (such as rheumatoid arthritis, multiple sclerosis, or psoriasis) must be filled through the Cigna Specialty Pharmacy.
Dispense as written (DAW) – If your doctor writes DAW on a brand-name prescription when a generic alternative is available, you will pay the brand cost. Without DAW, you would also pay the price difference between the brand and generic drug.
Prior authorization – Some medications may require prior authorization from your doctor before receiving approval for coverage. This is done to ensure the medication is the best option for you.
Step therapy – Step therapy requires that you try the most cost-effective medications appropriate for your condition before more expensive medications can be approved for coverage.

Ask your doctor about generic medications. They’re generally just as effective as brand-name medications, but typically cost 80-85% less.
Use the home delivery feature. Save time and money on maintenance medication for chronic conditions — such as an allergy, high blood pressure, or diabetes — with the convenient, cost-saving home delivery prescription program through Cigna.

Virtual Care

Save time and money while enjoying the convenience of receiving health care at home!

You have access to telehealth services through First Stop Health at no cost to you, whether you enroll in medical insurance or not. Consider using telehealth for non-emergency medical or behavioral health care — it’s available from the comfort of your home or wherever you are.

First Stop Health provides virtual urgent care services anytime, anywhere. You have 24/7 access to video consults with board-certified doctors using the First Stop Health mobile app or website. Doctors can diagnose, treat, and prescribe medication when needed for many common conditions.

You don’t feel up to going to the doctor’s office.
You can’t get to your doctor because you’re traveling.
You need care after hours (nights, weekends, holidays).

Get started by registering in advance on the First Stop Health website. You can also learn about other specialty care that may be available through the First Stop Health program.

Health Management Programs

iCapital is committed to helping you and your family through a variety of health challenges with programs that provide specialized support and resources.