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7Understanding Terms in Your Health PlansHow do I determine if a medicalservice will be covered by the Ardenamedical plan?It is YOUR responsibility to confirm if a service will becovered by the medical plan. A provider%u2019s office mayor may not know the specifics of the Ardena medicalplan. Whenever possible, contact Cigna memberservices via phone at (866) 494-2111, online atwww.mycigna.com, or on the myCigna mobile App ifyou have questions about coverage before receivingmedical services.What is a Copay?A copay is a flat fee you pay when you receive amedical service if you are on a traditional PPO plan. Theremaining balance is paid for by the medical plan. Forexample, if you%u2019re on a traditional plan and you visityour in-network primary care provider, you will pay aflat $30 copay for that office visit.What is Coinsurance?What is a Deductible?What is an Out-of-Pocket Maximum?Coinsurance is a percentage of the total allowedcharge that you must pay. For example, if the innetwork allowed charge is $100 and your coinsurance is20%, you will pay $20, which is 20% of $100. The medicalplan will pay the remaining $80 balance.A deductible is the amount you must pay out-of-pocketfor services once per calendar year before the planbegins paying for healthcare services, known ascoinsurance.An out-of-pocket maximum (OOP) is the maximumamount of money you are required to pay in copays,deductibles, and coinsurance for covered medicalservices during each calendar year. Once you reachthis amount during any calendar year, the Ardenamedical plan will pay 100% of the allowed amounts forcovered services for the remainder of that plan year.What is a PPO?A Preferred Provider Organization (PPO) is a health planwith a network of contracted healthcare providers. Witha PPO, you have the flexibility to choose your providers.However, you%u2019ll save the most money when you select aprovider or hospital within the health plan%u2019s network.You can choose a provider not in the network, but itmay cost more.What is an HDHP?A high-deductible health plan (HDHP) is a medical planthat typically has a lower monthly premium and ahigher deductible than a traditional plan. With an HDHP,you pay out-of-pocket for all your healthcare servicesuntil you reach the deductible. Once you meet thedeductible, the plan pays for healthcare services.What are the covered medication tiers?Tier 1: Generic Formulary. These medications havethe same active ingredients as brand-namemedications, but they cost less.Tier 2: Brand Name. These medications are onlymade by one manufacturer. They%u2019re proven to bethe most effective medications in their class.Tier 3: Non-Formulary. Medications that aren%u2019t onyour health plan's list of preferred medications,which is called their %u201cformulary.%u201d Usually, thishappens when there is a safe and effectivealternative that is less expensive%u2014often a generic. Ifyour doctor prescribes a non-formulary prescription,it%u2019s a good idea to speak with them or yourpharmacist about generic alternatives.Tier 4: Specialty. These medications treat chronic orcomplex conditions. They might require specialstorage or careful monitoring.Covered medications are divided into tiers or costshare levels. Typically, the higher the tier, the higher theprice you%u2019ll pay to fill the prescription.Ardena offers two medical plan options that include both in-network and out-of-network benefits. There are coveragefeatures in the plan such as calendar-year deductibles, copays, out-of-pocket maximums, and coinsurance. Theseterms are defined within the guide and highlighted below. Please refer to the Summary Plan Description (SPD) and eachplan%u2019s Summary of Benefits and Coverage (SBC) for coverage details.Medical Plans & Prescription Benefits