Medical & Prescription Drugs
Infoblox provides the option to choose between two medical plans through Cigna – a traditional PPO program called the “Cigna OAP PPO” or a high deductible healthcare plan (HDHP) paired with a Health Savings Account (HSA) called the “Cigna Choice Fund OAP HSA”. If you are enrolled in medical coverage, you are automatically covered for prescription drugs. Eligible employees in California have two additional medical plan options offered through Kaiser Permanente. Kaiser is a Health Maintenance Organization (HMO) and only in-network services are covered.
How your plan works
Your Deductible
You pay out-of-pocket for most medical and pharmacy expenses until you reach the amount of the deductible.
If you're enrolled in the Cigna Choice Fund OAP HSA, you can pay for these expenses from your Health Savings Account (HSA).
Your Coverage
Once your deductible is met, your share of covered medical costs is split with the plan and paid through coinsurance.
The plan pays a percentage of each eligible expense, and you will pay the rest.
Out-of-Pocket Maximum
When you reach your out-of-pocket maximum, the plan pays 100% of covered medical and pharmacy expenses for the remainder of the plan year.
Your deductible and coinsurance apply toward the out-of-pocket maximum for eligible healthcare expenses.
Making the Most of Your Plan
It's important to understand your medical plan so you and your family can get the most out of it. Keep these helpful tips in mind when you use your plan:
- In-network providers and pharmacies: Using providers with the medical and pharmacy network means you'll pay less every time you need care or a prescription filled.
- Preventive care: In-network preventive care is covered at 100%, which means no cost to you). Preventive care includes an annual physical exam, immunizations, lab tests, screenings and other services intended to prevent illness or detect problems early enough to be treated more easily. Be sure to make an appointment for your annual physical and attend all your scheduled appointments throughout the year.
Pharmacy Coverage
Medications are divided into tiers that affect your coverage:
- Preventive drugs: Certain preventive care medications covered under these plans are available with deductible or copay when required as part of preventive care services and purchased from a Network Pharmacy. Detailed information is available at www.healthcare.gov. To access the Kaiser Preventive Services under Health Reform, visit their website at www.kp.org/prevention. A written prescription is required.
- Generic: A drug that offers equivalent uses, doses, strength, quality, and effectiveness as its brand-name counterpart.
- Brand preferred: A drug with a patent and trademark name that is considered “preferred” because it is appropriate to use for medical purposes and is usually less expensive than other brand-name options.
- Brand non-preferred: A drug with a patent and trademark name. This type of drug is “not preferred” and is usually more expensive than alternative generic and brand preferred drugs.
- Specialty: A drug that requires special handling, administration, or monitoring. Most can only be filled by a specialty pharmacy and have additional required approvals.
- Mail order pharmacy: If you take a maintenance medication on an ongoing basis for a condition like high cholesterol or high blood pressure, you can use the mail order pharmacy to save on a 90-day supply of your medication.
After the new hire enrollment period, you may only enroll or make changes to your benefits during the annual Open Enrollment period or if you experience a qualifying life event (QLE), such as a change in marital or dependent status, loss of coverage, or a big move.
Be sure to notify your Benefits Team right away if you have a qualifying life event and need to make a change to your coverage elections.
Qualifying life events include (but are not limited to):
- Marriage or divorce Birth or adoption of a baby or child
- Birth or adoption of a baby or child
- Loss or change of other healthcare coverage
- Change in residence that affects access to network providers
- Court order requiring coverage for a dependent
- Change in eligibility for Medicare or Medicaid
You have 30 days from the qualifying life event to submit changes to your coverage. Depending on the type of event, you may need to provide proof of the event, such as a marriage license or birth certificate. If you do not submit the changes within 30 days of the qualifying event, you will have to wait until the next Open Enrollment period to make the changes.
Employees who work at least 30 hours per week are eligible to enroll in benefits. Most benefits are effective on your date of hire as long as you enroll within 30 days of your date of hire.
The following dependents are also eligible to be enrolled in benefits:
- Your legal spouse.
- Your same or opposite gender domestic partner is eligible for coverage if you have completed a Domestic Partner Affidavit.
- Your children (including your domestic partner’s children):
- Under the age of 26 are eligible to enroll in medical coverage. They do not have to live with you or be enrolled in school. They can be married and/or living and working on their own.
- Over age 26 ONLY if they are incapacitated due to a disability and primarily dependent on you for support. You will need to designate in Workday and provide a physician statement.
- Named in a Qualified Medical Child Support Order (QMCSO) as defined by federal law.