Medical & Pharmacy

Personify Health offers both a PPO plan and a HDHP plan through Cigna’s PPO network. Personify Health also offers lower-cost Reference Based Pricing (RBP) plan alternatives through Fairos.

Personify Health
5
Health
5
Medical & Pharmacy

Eligibility

All regular full-time employees are eligible to enroll in Personify Health benefits. You must enroll in plans within 31 days of your eligibility date (new hire or status change). You may also enroll your eligible dependents, including:

Your legal spouse or domestic partner
Your children under age 26 — biological, step or adopted child(ren)

If you cover a spouse or domestic partner, you will receive instructions following enrollment to confirm their eligibility. Please provide all necessary documentation by the requested deadline.

Once you enroll, you can access your medical ID cards through PersonifyYou.

Making Changes During the Year

Once you enroll, you may only make changes to your benefit elections during the year if you experience a recognized Qualifying Life Event (QLE), which include marriage, divorce, the birth or adoption of a child, death, or change in coverage status elsewhere (e.g., if your spouse gains coverage through his/her employer). All documentation must be submitted within 31 days of the event date.

Your Plan Options

Choose from four medical plan options: two options through the Cigna Healthcare PPO network and two Reference Based Pricing (RBP) plans through Fairos. Personify Health is the administrator for all four medical plan options.

Cigna: The two Cigna plans (the Traditional PPO Plan and the HDHP Plan) are offered through the Cigna PPO network. As a result, the plans have both in-network and out-of-network benefits. In-network benefits have lower cost-sharing requirements but require you to see a Cigna PPO provider.
Fairos: The RBP plans (the HealthChoice Plan and HealthChoice Plus Plan) are lower-cost alternatives offering largely the same coverage as the in-network portion of the Cigna plans. The RBP plans allow you to see any doctor you choose without worrying about in- and out-of-network providers. This means that all providers are considered “in-network.” For 2026, we have expanded RBP plan access to all benefit-eligible employees (please note the HealthChoice Plus Plan is not available in the Chicagoland area). Please see below for details and use the provider search tool.

Reach out to Personify Health Member Services at 1-800-849-0580 if you have questions or if you would like help navigating your medical benefits.

What is Reference Based Pricing?

Participants can access hospitals and doctors of their choice. There is no network for the RBP plans, unlike traditional insurance plans.
The plan’s prices are based on Medicare pricing, plus an incentive bonus over and above the Medicare allowable amount.
We review each claim to ensure the correct pricing has been applied.
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.

Note that 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.

Compare Your Medical Options

The table below provides a high-level summary of the key features for each plan. As you review your options, please keep in mind that out-of-network benefits only apply to the Cigna plans (Traditional PPO Plan and HDHP Plans). The HealthChoice Plan and HealthChoice Plus Plan consider every provider to be in-network.

	Traditional (PPO) & HealthChoice*		HDHP & HealthChoice Plus*
	Cigna In-Network & Fairos RBP	Cigna Out-of-Network	Cigna In-Network & Fairos RBP	Cigna Out-of-Network
Deductible
Employee Only	$1,200	$4,000	$3,000	$6,000
Family	$2,400	$8,000	$6,000**	$12,000**
Spending Accounts	FSA eligible		HSA eligible (Personify Health contributes $500 Individual/$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%	100% covered	40%
Office Visit	$25 copay	40%	20%	40%
Specialist Visit	$35 copay	40%	20%	40%
Diagnostic Testing	Quest Lab no charge – other lab 20% coinsurance	40%	20%	40%
Imaging	20%	40%	20%	40%
Emergency Room Visit	$200/visit + 20% coinsurance	20%	20%	20%
Urgent Care Visit	$75/visit	40%	20%	40%
Outpatient Surgery	20%	40%	20%	40%
Inpatient Hospital	20%	40%	20%	40%

Coinsurance generally applies after the deductible. The deductible is waived in the in-network Traditional PPO Plan and HealthChoice Plan for Office, Specialist and Urgent Care visits. Please see each plan’s Summary Benefits Coverage for details.

Important Note: For the HealthChoice Plus Plan, services obtained at Northwestern Medicine in Chicago are not eligible charges.

* Out-of-network benefits only apply to the Cigna plans (Traditional PPO Plan and HDHP Plan). The HealthChoice Plan and HealthChoice Plus Plan consider every provider to be in-network.

** The individual deductible is $3,400 within Family coverage.

Compare Your Pharmacy Benefits

Express Scripts, via RxBenefits, is the pharmacy benefits manager (PBM) for all four medical/Rx plans. 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.

	Traditional (PPO) & HealthChoice	HDHP & HealthChoice Plus*
Deductible
Employee Only	$150	Combined with medical plan deductible
Family	$150	Combined with medical plan deductible
30-Day Supply
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
90-Day Supply
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

*ACA preventive drug coverage bypasses deductible in certain scenarios.

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. You can earn up to 20% off your premiums for 2026 when you participate in certain activities through the PersonifyYou platform.