Medical & Pharmacy
Personify Health offers both a PPO plan and a HDHP plan through Cigna’s PPO network to all benefit-eligible employees. In addition, for about two-thirds of employees, Personify Health offers lower-cost Reference Based Pricing (RBP) Plan alternatives through our partner, Fairos.
The goal of each medical plan offered by Personify Health is to provide affordable access to quality care. Review the medical and pharmacy coverage options and costs outlined below, consider your needs, and select the plan that’s right for you.
Your Medical Plan Options
All benefit-eligible employees are eligible for the two medical plans offered through Cigna’s PPO network:
- The Traditional Plan is a Preferred Provider Organization (PPO) plan.
- The High Deductible Health Plan (HDHP) offers lower per-paycheck contributions but a higher deductible and out-of-pocket maximum than the Traditional Plan. You can also participate in a Health Savings Account (HSA), which lets you set aside pre-tax dollars to pay for eligible expenses. The Company makes an annual contribution to your HSA, too, depending on the level of coverage you elect (Employee only or Family). See HSA details
In addition, most employees will have lower-cost RBP plan alternatives offered through Fairos to consider:
- The HealthChoice Plan offers lower per-paycheck contributions for generally the same deductibles, out-of-pocket maximums, copays and coinsurance as the Traditional Plan. Note that the deductible is waived for services obtained from Northwestern Medicine in the Chicagoland area when you present your virtual ID card containing the Curaechoice QR code at the time of service.
- The HealthChoice Plus Plan, another RBP plan, offers lower per-paycheck contributions for generally the same deductible, out-of-pocket maximums and coinsurance as the HDHP. Please note that employees in Illinois and Indiana are not eligible for this medical plan option in 2025 (in addition to those locations listed below). Additional information will be provided for impacted employees. Additionally, services obtained at Northwestern Medicine in Chicago are not eligible charges under this medical plan. See HSA details
The two RBP plan alternatives will be similar to the two Cigna plans in terms of design.
The HealthChoice Advantage
In addition to lower per-paycheck contributions, if you participate in either the HealthChoice Plan or HealthChoice Plus Plan, you’ll have the freedom to see any doctor you choose. That means you don’t need to worry about in- and out-of-network providers.
What is Reference Based Pricing?
In simple terms, here’s how it works:
- The plan’s prices are based on Medicare pricing, plus an incentive bonus over and above the Medicare allowable amount.
- Because we are self-funded, which means that we process and manage our medical claims instead of outsourcing to an insurance company, we review each claim to ensure that the plan is being charged the correct amount.
- The plan will then pay the Company’s portion of the claim.
- You’ll be responsible for your portion of the bill, the same as you would be from any other medical bill.
While you aren’t limited by a provider network, it is important to compare costs for services before you seek care — not all providers and facilities charge the same price for the same service. If your provider charges above the plan’s pricing, you could be charged the difference between what the provider charged and the amount the plan will pay. That’s known as “balance billing.” If that happens, contact the Personify Health Member Services at 1-800-849-0580.
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Compare Your Medical Options
The table below provides a high-level summary of the key features for each plan. Review the correct Summary of Benefits and Coverage (SBC) under each option for details.
| Traditional (PPO) SBC |
HDHP SBC |
|||
|---|---|---|---|---|
| Deductible | ||||
| Employee Only | $1,200 | $4,000 | $3,000 | $6,000 |
| Family | $2,400 | $8,000 | $6,000* | $12,000* |
| Personify Health HSA Contribution | N/A | $500 Employee only/$1,000 Family | ||
| Out-of-Pocket Maximum | ||||
| Employee Only | $3,250 | $8,000 | $7,100 | $12,000 |
| Family | $6,500 | $16,000 | $14,200 | $24,000 |
| Preventive Care | 100% covered | 40% after deductible | 100% covered | 40% after deductible |
| Office Visit | $25 copay deductible waived | 40%, after deductible | 20% after deductible | 40% after deductible |
| Specialist Visit | $35 copay deductible waived | 40% after deductible | 20% after deductible | 40% after deductible |
| Diagnostic Testing | Quest Lab No Charge – Other Lab 20% Coinsurance | 40% after deductible | 20% after deductible | 40% after deductible |
| Imaging | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible |
| Emergency Room Visit | $200/visit + 20% coinsurance | 20% after deductible | 20% after deductible | 20% after deductible |
| Urgent Care Visit | $75/visit Deductible waived | 40% after deductible | 20% after deductible | 40% after deductible |
| Outpatient Surgery | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible |
| Inpatient Hospital | 20% after deductible | 40% after deductible | 20% after deductible | 40% after deductible |
* The individual deductible is $3,300 within Family coverage.
SBC |
SBC |
|
|---|---|---|
| Deductible | ||
| Employee Only | $1,200 | $3,000 |
| Family | $2,400 | $6,000* |
| Personify Health HSA Contribution | N/A | $500 Employee only/$1,000 Family |
| Out-of-Pocket Maximum | ||
| Employee Only | $3,250 | $7,100 |
| Family | $6,500 | $14,200* |
| Preventive Care | 100% covered | 100% covered |
| Office Visit | $25 copay deductible waived | 20% after deductible |
| Specialist Visit | $35 deductible waived | 20% after deductible |
| Diagnostic Testing | Quest Lab No Charge – Other Lab 20% coinsurance | 20% after deductible |
| Imaging | 20% after deductible | 20% after deductible |
| Emergency Room Visit | $200/visit + 20% coinsurance | 20% after deductible |
| Outpatient Surgery | 20% after deductible | 20% after deductible |
| Inpatient Hospital | 20% after deductible | 20% after deductible |
*The individual deductible is $3,300 within Family coverage.
Your Medical Plan Contributions
Personify Health pays the majority of the cost of coverage for all our medical plans. You help share in the cost through pre-tax deductions from your paycheck each pay period, based on which plan and level of coverage you choose.
Note that if you elect to cover your spouse and he/she has access to coverage elsewhere (e.g., through an employer), you will be charged the Working Spouse Surcharge of $1,500/year. This surcharge is not included in the monthly rates below and will be divided equally among your 26 paychecks in 2025. Based on your participation in the PersonifyYou platform, you can earn up to 20% off your health insurance premiums as outlined in the table below.
- For legacy Virgin Pulse employees: The rates you will see for the medical plans reflect no discount. However, each quarter you are eligible for a 5% discount for a possible maximum of 20% for your 2025 medical premiums. To receive your 5% premium discount for Quarter 4, you must reach Level 2 or 6,000 points by November 30, 2024.
- For legacy HealthComp employees: The rates you will see during Open Enrollment for the medical plans reflect no discount. Your 2025 actual medical contributions in 2025 will be based on your participation in the Wellness program in Q4 2024. Please see below for a full list of the 2025 premiums at the various discount levels.
The Benefits Team will be calculating actual discount levels at the end of 2024. Once these amounts are finalized, your premium amounts will adjust as needed to reflect your actual level of attainment.
0% Discount (Monthly Rates)
| Employee Only | $85.00 | $125.00 | $170.00 | $240.00 |
| Employee and Spouse** | $270.00 | $395.00 | $520.00 | $745.00 |
| Employee and Child(ren) | $240.00 | $350.00 | $480.00 | $675.00 |
| Family** | $480.00 | $705.00 | $945.00 | $1,340.00 |
5% Discount (Monthly Rates)
| Employee Only | $80.75 | $118.75 | $161.50 | $228.00 |
| Employee and Spouse** | $256.50 | $375.25 | $494.00 | $707.75 |
| Employee and Child(ren) | $228.00 | $332.50 | $456.00 | $641.25 |
| Family** | $456.00 | $669.75 | $897.75 | $1,273.00 |
10% Discount (Monthly Rates)
| Employee Only | $76.50 | $112.50 | $153.00 | $216.00 |
| Employee and Spouse** | $243.00 | $355.50 | $468.00 | $670.50 |
| Employee and Child(ren) | $216.00 | $315.00 | $432.00 | $607.50 |
| Family** | $432.00 | $634.50 | $850.50 | $1,206.00 |
15% Discount (Monthly Rates)
| Employee Only | $72.25 | $106.25 | $144.50 | $204.00 |
| Employee and Spouse** | $229.50 | $335.75 | $442.00 | $633.25 |
| Employee and Child(ren) | $204.00 | $297.50 | $408.00 | $573.75 |
| Family** | $408.00 | $599.25 | $803.25 | $1,139.00 |
20% Discount (Monthly Rates)
| Employee Only | $68.00 | $100.00 | $136.00 | $192.00 |
| Employee and Spouse** | $216.00 | $316.00 | $416.00 | $596.00 |
| Employee and Child(ren) | $192.00 | $280.00 | $384.00 | $540.00 |
| Family** | $384.00 | $564.00 | $756.00 | $1,072.00 |
**Working spouse surcharge of $1,500/year applies only if your spouse has coverage through their employer.
Following enrollment, you will receive a new medical ID card to use in 2025. If you enroll in the HDHP or HealthChoice Plus and participate in an HSA, you will also receive a debit card to use to pay for eligible healthcare expenses.
Compare Your Pharmacy Benefits
Express Scripts, via RxBenefits, is the pharmacy benefits manager (PBM) for all four medical/Rx plans. If you participate in the HealthChoice Plus Plan or the HDHP Plan, your pharmacy coverage is embedded, which means you do not pay a separate deductible for prescription medications. You will pay a copay/coinsurance when you fill a prescription after you meet the combined deductible. If you participate in the HealthChoice Plan or Traditional PPO Plan, you will pay a $150 annual deductible for non-generic/brand prescriptions. Note that for all plans, prescription medications are not covered out-of-network. Additionally, pre-authorization or enrollment in certain programs may be required before coverage is provided for some prescriptions.
| Deductible | ||
| Employee Only | $150 | Combined with medical plan deductible |
| Family | $150 | Combined with medical plan deductible |
| Retail | ||
| Generic | $10 copay | 20% after deductible |
| Brand Formulary | $30 copay | 20% after deductible |
| Brand Non-Formulary | $50 copay | 20% after deductible |
| Specialty | 30% up to $150 maximum | 20% after deductible |
| Mail Order | ||
| Generic | $25 copay | 20% after deductible |
| Brand Formulary | $75 copay | 20% after deductible |
| Brand Non-Formulary | $125 copay | 20% after deductible |
| Specialty | 30% up to $150 maximum | 20% after deductible |
***Preventive drugs are medications that are effective in preventing the development of a disease or health condition.
Save More with a Flexible Spending Account
You can save more by participating in a Flexible Spending Account (FSA) to help cover eligible healthcare expenses. See FSA details
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What’s New for 2025
We’ve conducted an extensive analysis of our two legacy benefits programs and carefully selected the best-in-class offerings to harmonize the Personify Health benefits package for U.S.-based employees, effective January 1, 2025.