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MyHealth360

MyHealth360 provides a medical plan with access to prescription drug coverage. If eligible, you can select one of four coverage levels: Employee Only, Employee + Child(ren), Employee + Spouse/Domestic Partner or Family.

What to know

Piedmont PRN Plan

The Piedmont PRN Plan is designed to meet your physical and financial needs. 

Frequently Asked Questions (FAQs)

Monthly Premiums for Coverage

MyHealth360 Medical Plan Coverage Summary

Benefit Summary

Summary of Benefits and Coverage (SBC)

How does coordination of benefits work?

Example: Coordination of Benefits

Are you eligible for Medicare?

Medicare navigation support will be available through SmartConnect at no cost to you. All Medicare-eligible team members, spouses/domestic partners and dependents who are interested in enrolling in Medicare, Medicare Supplements or Medicare Advantage plans can receive assistance with plan comparisons, selection and enrollment. Additional resources include ongoing support for plan and claims questions, as well as access to educational materials, webinars and licensed agents. Learn more.

Provider Networks and Directories

The level of benefits you will receive depends on where you choose to receive care. In the Piedmont PRN Plan, you can receive care from in-network providers, but you will not be covered if you choose to see out-of-network providers. You pay for the full cost of health care services, including prescription drugs, until you reach the in-network deductible/out-of-pocket maximum.

To locate a provider, use one of the following options:

Note: Not all physician offices located on Piedmont campuses are in the Piedmont Clinic.

When you select an out-of-network provider, you will incur the highest out-of-pocket expenses. Providers and facilities are those not included in the Cigna Open Access Plus Network.

Where can I get high-quality, low-cost care?

How the Piedmont PRN Plan Works

This example shows coverage using in-network providers.

Key Plan Details
  • You pay the full cost of care until you meet the in-network deductible/out-of-pocket maximum; then, the plan pays the full cost of care for the rest of the year.
  • The deductibles are “embedded” (i.e., the plan begins to pay if one covered family member meets the in-network, team member only deductible).
  • In emergencies, coverage is provided at the in-network level, regardless of where you receive the care.

Support for Reproductive Health

Fertility, pregnancy and postpartum benefits will be available through Progyny beginning Jan. 1, 2025. MyHealth360 plan members can receive up to two SmartCycles with coverage for IVF, IUI and fertility preservation through Progyny providers. This includes medical services and medication on each treatment journey. You also receive unlimited guidance and support from a dedicated patient care advocate who can help you navigate a large network of fertility experts. Progyny also offers menopause and midlife care. For more information, see the benefits overview and Progyny Member Guide. You can also call 833-233-0722 or visit progyny.com/benefits.

Why Progyny?

Partnering with Progyny closely aligns with our systemwide goal of improving and advancing maternal fetal health in Georgia and beyond.

Still not sure how the plan works? Scroll through these examples:

Meet William

Plan: Piedmont PRN Plan
Who’s Covered: Employee Only
Premium: $105.29 (monthly)
Out-of-Network Coverage: Emergency only
Deductible/Out-of-Pocket Maximum: $9,200 (in-network only: Cigna LocalPlus Network)

Situation:

William is on vacation and gets into an accident. His one-day, out-of-state hospital stay costs $5,000 (emergencies are covered at the highest benefit level). Remember, William pays the full, upfront cost for any health care services until he reaches the deductible/out-of-pocket maximum. If he needs additional care, William will need to pay $4,200 more before the plan pays for in-network care in full for the rest of 2025.

Meet Martha

Plan: Piedmont PRN Plan
Who’s Covered: Employee + Spouse
Premium: $971.07 (monthly)
Out-of-Network Coverage: Emergency only
Deductible/Out-of-Pocket Maximum: Unlimited (out-of-network care)

Situation:

Martha wants to continue receiving care from her cancer doctor, who is not in the Cigna LocalPlus Network. She will pay the full, upfront cost of care for all out-of-network services.

Meet Jill

Plan: Piedmont PRN Plan
Who’s Covered: Family
Premium: $1,547.84 (monthly)
Out-of-Network Coverage: Emergency only
Deductible/Out-of-Pocket Maximum: $18,400 (in-network only: Cigna LocalPlus Network)

Situation:

Jill and her family have a very unhealthy year. Her husband receives multiple surgeries (triggering the individual family deductible embedded in the plan – $9,200). His in-network follow-up care is covered at 100%. The rest of the family exceeds the $18,400 deductible/out-of-pocket maximum, so their in-network care is covered in full for the rest of 2025.

Prescription Drugs

Prescription drug coverage administered directly be Express Scripts is provided automatically when you enroll in the Piedmont PRN Plan. If your medication is not on the no-cost generic preventive medications listing, you will you pay the full cost until you reach your deductible/out-of-pocket maximum. Any prescription drug costs you pay for on your own will contribute towards your annual deductible/out-of-pocket maximum.

Please note: All fertility medications are managed through Progyny.

When it comes to prescriptions, there are five easy guidelines to follow:

  1. Register with Express Scripts for online account access.
  2. Use generic drugs when you can. Take a look at the drug pricing tool and mobile app; be sure to ask your physician or pharmacist if a generic substitute is available—it could save you money!
  3. Take advantage of preventive medication at no cost to you. To help you maintain a steady treatment regimen, certain preventive medicines are paid at 100% with no deductible when you visit an in-network pharmacy. This includes many diabetes, cholesterol, blood pressure and other select medication categories.
  4. When you use the broad Express Scripts network of retail pharmacies, including Piedmont pharmacies, Oconee Drugs, Walgreens and Walmart retail pharmacies, you can get a 90-day supply of your medication for just two times your 30-day copay amount.
  5. Remember to explore drug options with your physician to avoid costly name-brand and specialty drug copays that may not be necessary. If you must use brand or specialty drugs, to help offset the cost, take advantage of manufacturer coupons.

Prescription Drug Formulary

Prescription Drug Exclusions List

List of No-Cost Generic Medications

How the prescription drug deductible works:

  • You must meet a $150 (per member) annual deductible for brand-name prescriptions (preferred and non-preferred) before benefits begin.
  • This is a separate deductible from the medical plan deductible.
  • You will not need to meet this deductible for generic prescriptions.
Piedmont Direct Pharmacy

We offer life-changing specialty pharmacy services designed to simplify every aspect of your care. From obtaining financial assistance, to navigating through your insurance benefits, coordinating with providers, and managing refills, Piedmont Specialty Pharmacy patient liaisons are ready to help you and your family.

Our team can answer and address insurance-related questions and conduct prior authorizations for complex, rare and chronic medical conditions that require specialized medication therapy.

For more information, visit Piedmont Direct Pharmacy, call 833-551-2024 (Monday through Friday, 8am – 4:30pm) or email piedmontdirect@piedmont.org.

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