MyHealth360 provides a comprehensive suite of health and well-being benefits including: two medical plans, prescription drug, dental and vision coverage, and Flexible Spending Accounts (FSAs). If eligible, you can select one of four coverage levels: Employee Only, Employee + Child(ren), Employee + Spouse/Domestic Partner or Family.
In the Piedmont Exclusive Plan, you pay lower bi-weekly premiums than you would in the Piedmont Choice Plan because when you visit a Piedmont-network provider or facility, we have the ability to better manage your care and your cost.
Medicare navigation support will be available through SmartConnect at no cost to you. All Medicare-eligible team members, spouses/domestic partners and dependents who are interested in enrolling in Medicare, Medicare Supplements or Medicare Advantage plans can receive assistance with plan comparisons, selection and enrollment. Additional resources include ongoing support for plan and claims questions, as well as access to educational materials, webinars and licensed agents. Learn more.
The level of benefits you will receive depends on where you choose to receive care. In the Piedmont Exclusive Plan, you can receive care in two main networks or tiers.
To find a provider, MyHealth360 members can download and open the Castlight mobile app and select “Find Care.” If you are not enrolled in a MyHealth360 plan and are interested in enrolling, you may search for in-network providers and facilities. In your search results, Tier One providers will be clearly labeled with a green checkmark; all other providers are considered Tier Two.
This is the same Tier One network as the Piedmont Choice Plan.
You will receive high-quality care at the most affordable price possible when you use Piedmont Preferred Network (Tier One) providers and services. This includes: All Piedmont Clinic physicians, Piedmont Healthcare facilities, Piedmont-branded urgent care centers, Children’s Healthcare of Atlanta (CHOA) facilities, The Children’s Health Network (TCHN) pediatricians, Kids First Health pediatricians, Middle Georgia Pediatrics, Primary Pediatrics, Wellstar Augusta University pediatric facilities and pediatric network and others, as well as emergency care.
Note: Not all physician offices located on Piedmont campuses are in the Piedmont Clinic.
This is NOT the same (or as large) as the Tier Two network as the Piedmont Choice Plan.
You will have higher out-of-pocket costs when seeing providers or receiving services at the Tier Two level. The Cigna LocalPlus Network (Tier Two) consists of any providers within this network who are not listed as Tier One.
Note: Not all physician offices located on Piedmont campuses are in the Piedmont Clinic.
You will not have coverage outside of the Piedmont Preferred Network (Tier One) or Cigna LocalPlus Network (Tier Two) except for:
This example shows coverage using Piedmont Preferred Network (Tier One) providers:
If you have questions about your two medical plan options, contact Cigna at 877-601-3835 or visit mycigna.com.
Fertility, pregnancy and postpartum benefits will be available through Progyny beginning Jan. 1, 2025. MyHealth360 plan members can receive up to two SmartCycles with coverage for IVF, IUI and fertility preservation through Progyny providers. This includes medical services and medication on each treatment journey. You also receive unlimited guidance and support from a dedicated patient care advocate who can help you navigate a large network of fertility experts. Progyny also offers menopause and midlife care to help address your unique needs during all stages of menopause. You can receive a personalized care plan to manage your symptoms and work with your patient care advocate for care coordination, emotional support and more.
For more information, see the benefits overview and Progyny Member Guide. You can also call 833-233-0722 or visit progyny.com/benefits.
Partnering with Progyny closely aligns with our systemwide goal of improving and advancing maternal fetal health in Georgia and beyond.
Plan: Piedmont Exclusive Plan
Who’s Covered: Employee Only
Premium: $56.67 (full-time, bi-weekly)
Out-of-Network Coverage: Emergency Only
Deductible: $500 (Tier One: Piedmont Preferred Network)
Out-of-Pocket Maximum: $4,000 (Tier One: Piedmont Preferred Network)
Situation:
Since William’s doctor is in the Piedmont Preferred Network, the Piedmont Exclusive Plan offers lower costs across the board. William is on vacation and gets into an accident. His four-day, out-of-state hospital stay costs $900 in copays (emergencies are covered at the highest benefit level). William also needs a wheelchair for $800. He pays the $500 deductible (copays don’t count toward the deductible), and he and the plan split the remaining $300 (he pays 15% – $45).
Plan: Piedmont Choice Plan
Who’s Covered: Employee + Spouse
Premium: $301.09 (full-time, bi-weekly)
Out-of-Network Coverage: Yes
Deductible: $8,550 (Tier Two: Cigna OAP Network)
Out-of-Pocket Maximum: $17,100 (Tier Two: Cigna OAP Network)
Situation:
Martha is undergoing cancer treatment at Emory. She has seen the same doctor for two years, and she doesn’t want to switch. Martha chooses the Piedmont Choice Plan because she wants to continue receiving care from her cancer doctor, who is in the Cigna Open Access Plus (OAP) Network (Tier Two).
Plan: Piedmont Exclusive Plan
Who’s Covered: Family
Premium: $303.78 (full-time, bi-weekly)
Out-of-Network Coverage: Emergency Only
Deductible: $1,000 (Tier One: Piedmont Preferred Network)
Out-of-Pocket Maximum: $6,850 (Tier One: Piedmont Preferred Network)
Situation:
Since the family’s doctors and pediatricians are in the Piedmont Preferred Network, the Piedmont Exclusive Plan offers lower costs across the board for Jill and her family, including most healthcare services being covered with copays.
Prescription drug coverage administered directly by Express Scripts is provided automatically when you enroll in one of Piedmont’s medical plan options. The coverage for your medications is the same regardless of the medical plan you choose. Please note: Weight loss drugs are not covered under any MyHealth360 medical plan, and all fertility medications are managed through Progyny rather than Express Scripts.
When it comes to prescriptions, there are six easy guidelines to follow:
Prescription Drug Coverage Summary
Preferred Prescription Drug Formulary and Exclusions List
List of No-Cost Generic Medications
How the prescription drug deductible works:
We offer life-changing specialty pharmacy services designed to simplify every aspect of your care. From obtaining financial assistance, to navigating through your insurance benefits, coordinating with providers, and managing refills, Piedmont Specialty Pharmacy patient liaisons are ready to help you and your family.
Our team can answer and address insurance-related questions and conduct prior authorizations for complex, rare and chronic medical conditions that require specialized medication therapy.
For more information, visit Piedmont Direct Pharmacy, call 833-551-2024 (Monday through Friday, 8am – 4:30pm) or email piedmontdirect@piedmont.org.
Emergencies are covered at the Piedmont Network (Tier One) level, regardless of where you receive care.
In the Piedmont Exclusive Plan, you can:
|
Brand-Name – Example |
|
|---|---|
|
One 90-day supply |
$350 |
|
Three refills (for a one-year supply |
$600 (3 x $200) |
|
Total Costs |
$950 |
|
Generic – Example |
|
|---|---|
|
One 90-day supply filled through mail order or at Walgreens |
$0 |
|
Three refills (for a one-year supply |
$0 |
|
Total Costs |
$0 |
|
Annual Savings |
$950 ($950-$0 = $950) |
This website is not inclusive of all situations and is provided for informational purposes only. It is not intended to be an official legal document. If there are conflicts between the website and IRS regulations, the member handbook, or the Summary Plan Description (SPD), IRS regulations, the member handbook, and the SPD will govern.