Highlights

Plan benefits are offered through a network of participating health care providers (for example, doctors, hospitals, labs, and outpatient facilities).
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.
For in-network care:
There is no annual deductible
You are not required to select or assign a Primary Care Physician.
You do not need referrals to see a specialist.
You pay only the copayment — a fixed out-of-pocket amount — associated with each covered service.
Important: 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 are covered after a $15 copayment.
Primary care providers include family practitioners, internists, pediatricians, OB/GYNs, nurse practitioners and Convenience Care Clinics. Internists must be contracted with Aetna or Cigna as a Primary Care Physician (PCP).
Mental health care providers include psychologists, therapists and social workers.
Go to Aetna's or Cigna's websites through My Health > My Medical Plan Website to search for PCPs/primary care physicians and mental health care providers.
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 eligible 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.
Out-of-network information:
You must meet an annual deductible before the copays apply for covered services.
Benefits for out-of-network care have a higher copays.
There is a separate, higher out-of-pocket maximum for eligible 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.
More information can be found on the Tip Sheet, What You Need to Know and Do for Out-of-Network Care, available on My Health > Benefits Enrollment > 2021 Benefits Resources.
Prescription drug coverage copays are based on the drug category and where you fill your prescription. Preventive generic drugs are covered at 100%, with no copay.
Simplified Option 1 and Simplified Option 2 can be used in conjunction with a Medical Reimbursement Account (MRA) you can use to help pay for covered out-of-pocket medical and prescription drug copays. The MRA is funded by JPMorgan Chase when you take action and complete designated Wellness Activities. Employees cannot contribute funds to an MRA.