Medical Plan Options and Pharmacy Coverage for 2022

October 27, 2021
For 2022, SmartHealth medical coverage features some changes and some benefits that will remain similar to 2021. Learn about the basic plan options in 2022.
PPO Copay Plan

In 2022, Ascension will continue to offer the PPO Copay Plan. You have higher premiums, the amount deducted from your paycheck each pay period, in exchange for lower, more predictable expenses when you seek care throughout the year. 

Benefit features include the following.

  • You pay copays (set fees) each time you seek medical care within the Ascension Network, like visiting a doctor or going to urgent care. 
  • You have no deductible or coinsurance like there is with other medical plans—as long as you stay in the Ascension Network. If you see a National Network or Out-of-Network provider, you have to pay for expenses in full until you reach the deductible, then you pay copays and coinsurance.
  • Finally, if you reach the out-of-pocket maximum (most you'll pay in a year), then your eligible medical expenses are completely covered by SmartHealth for the remainder of the year.

The PPO copay plan has one combined medical and Rx out-of-pocket maximum (OOP max) under the Ascension Network:

  • $3,000 (individual)
  • $6,000 (family)

A few reminders about the PPO:

  • HRA: The PPO Copay Plan includes a Health Reimbursement Arrangement (HRA) account that Ascension contributes to if you participate in the well-being program. HRA dollars can be used to pay for medical, prescription drug, dental or vision expenses.
  • Rx costs: As with medical expenses, you pay pharmacy copays/coinsurance if you have a prescription filled in the Ascension Rx Network. Specialty and maintenance medications must be filled by Ascension Rx in 2022 to be covered. Expenses incurred outside of Ascension Rx will also be credited to your out of pocket limits.
High deductible health plan (HDHP)

Our other plan is the SmartHealth HDHP 3000. This high deductible health plan typically offers you the lowest premiums per pay period in exchange for a higher deductible. 

Here's how the plan works.

  • You pay the full costs for services until the deductible is met.
  • After the deductible is met, all of your eligible expenses are covered at 100% for the rest of the year if you stay within the Ascension Network.

The HDHP has one combined medical and Rx out-of-pocket maximum (OOP max) under the Ascension Network:

  • $3,000 (individual)
  • $6,000 (family)

A few reminders about the HDHP:

  • Deductible: You must meet your deductible before the plan starts sharing costs. Reminder: If you are enrolled in anything other than employee-only coverage, you must meet the family deductible first before coinsurance or the out-of-pocket maximum applies. One individual could meet the entire family deductible, or it could be a combination of family members.
  • HSA: With an HDHP, you can enroll in an HSA, or Health Savings Account. HSA dollars can be used to pay for medical, prescription drug, dental or vision expenses. Ascension contributes to your HSA —plus you earn wellness rewards if you participate in our well-being program.
Socially Just Benefits
The Health Benefits Subsidy ensures that all associates and their family members have access to affordable health coverage as part of our Socially Just Benefits. The subsidy provides either a discount or waiver on coverage. New for 2022, comprehensive vision coverage will be included in the Health Benefits Subsidy. Eligible associates can apply from their myHR portal by November 12.
Ascension Rx for all SmartHealth plans
Beginning January 1, 2022, Ascension Rx will be the new covered pharmacy for SmartHealth members who have maintenance (30+ day supply) and/or outpatient specialty medication needs. To support your transition of medications to an Ascension Rx outpatient site or Ascension Rx home delivery, SmartHealth members’ first co-pay will be free. 

Cigna home delivery will not be available in 2022, but our retail pharmacy network through Cigna continues to include CVS, Walmart, Walgreens, etc., which can fill immediate and one-time use prescriptions. SmartHealth members are encouraged to use Ascension Rx pharmacies for pharmacy needs whenever possible. 

Signing up is easy. Members will need to call Ascension Rx at 833-MedsARx (833-633-7279) to get started. Access answers to frequently asked questions