Simplified Medical Plan Coverage Highlights
My Health is your central internal online resource for our health care plans. From My Health, you can easily connect to the Medical Plan claims administrators' websites to find in-network provider directories, access treatment cost estimators, check claims status, view Explanations of Benefits (EOBs), track your Medical Reimbursement Account balance, access your electronic ID card and much more. My Health also has benefits materials, tip sheets and other information on health and wellness.
Option 1 and Option 2 of the Simplified Medical Plan, each offered through Aetna and Cigna, are copayment-based plans that do not have a deductible for in-network services. Both options cover the same medically necessary services and supplies, including prescription drugs and pre-existing conditions.
However, Option 1 has higher payroll contributions but generally lower copays and out-of-pocket maximums, while Option 2 has lower payroll contributions but generally higher copays and annual out-of-pocket maximums.
Option 1 and Option 2 benefits are offered through a network of participating health care providers (for example, doctors, hospitals, labs, and outpatient facilities that belong to Aetna and Cigna's networks).
You can visit any provider each time you need care, even if it's not in the network. But even though there is an out-of-network benefit available, JPMorgan Chase strongly urges you to stay in-network. Selecting out-of-network providers and services cost more for all employees and JPMorgan Chase. Selecting in-network providers and services will reduce your out-of-pocket costs. Additionally, to help make it easier for you to find in-network care, Aetna and Cigna continue to increase the size of their network by adding doctors and hospitals and other ancillary providers (e.g., laboratories).
- There is no annual deductible and no coinsurance.
- You pay only the copayment — a fixed out-of-pocket amount — associated with each covered service.
- You are not required to select or assign a Primary Care Physician.
- You do not need referrals to see a specialist.
- Important: Eligible in-network preventive care, including physical exams and recommended preventive screenings, is covered at 100% with no copays; and in-network primary care and mental health care office visits (psychologists, therapists, etc.) are covered after a $15 copayment. Primary care physicians include doctors who practice family medicine, internal medicine (and are contracted with Aetna or Cigna as Primary Care Physicians), obstetricians/gynecologists, and pediatricians. Visits to convenience care clinics, such as CVS Minute Clinic®, are also considered primary care visits.
The plan's out-of-pocket maximum — your financial "safety net" — limits the total amount you are required to pay out-of-pocket each year. The out-of-pocket maximum includes both medical and prescription drug amounts (i.e., a combined maximum). Note that there are separate out-of-pocket maximums for in-network and out-of-network charges.
- You generally must meet an annual deductible before the copays apply for covered services.
- Benefits for out-of-network care have a higher copay than for in-network care.
- There is a separate, higher out-of-pocket maximum for out-of-network charges.
- Benefits for out-of-network care are limited to reasonable and customary (R&C) charges after you meet the out-of-network deductible. These R&C charges are based on average claims data in your area and are determined by your health care company to be appropriate fees for medical services. You are responsible for any amount above the R&C charges.
- It's important to understand that if you are using out-of-network providers (doctors, facilities or other service providers), it is your responsibility to check with your health care company to see if there is a prior authorization or medical necessity requirement that you need to meet before receiving any out-of-network treatment, service or procedure. Otherwise, the treatment, service or procedure may not be covered by the Plan and you will be responsible for the full cost.
When you enroll in Simplified Option 1 or Simplified Option 2, you are eligible to receive funding in a tax-free account, the Medical Reimbursement Account (MRA), that you can use to pay for eligible medical and prescription drug out-of-pocket expenses not covered by your plan. Your MRA is funded by JPMorgan Chase when you and your covered spouse/domestic partner complete certain wellness activities. You cannot contribute your own dollars.
Contribution rates vary by the types of dependent whom you choose to cover — for example, a spouse/domestic partner vs. a child. You will be charged for up to a maximum of four children, regardless of how many additional children you choose to cover. (You can cover all of your children, as long as they meet eligibility requirements.) Contributions will also vary based on your Total Annual Cash Compensation, geographical location, the Simplified Medical Plan option you select, your and your covered spouse's/domestic partner's tobacco user status, and your and your covered spouse's/domestic partner's Initial Wellness completion status. The amount you pay does not differ depending on whether you choose Aetna or Cigna as your health care company.