Jim Ellis offers a medical plan administered by Nova Healthcare Administrators (Nova) using the Cigna PPO network. The plan includes an integration with HealthJoy, a healthcare guidance app that improves your healthcare experience while helping you save both time and money.
The medical plan provides 100% coverage after a copay for services, and the copays apply to the member out-of-pocket maximum. Although the plan includes out-of-network coverage, your costs are significantly reduced if you remain in the Cigna network.
All doctors are not the same. Your new medical plan includes tools and resources to help you and your family members find high quality healthcare.
Mandatory Edison Centers of Excellence program for cancer, orthopedic, spine, and non-acute cardiac procedures. To receive coverage for one of these procedures, members are required to access the Edison Smart Care Centers network. The medical plan also includes access to Edison’s Smart Care Centers for additional conditions on a voluntary basis.
The medical plan provides 100% coverage after a copay for services, and the copays apply to the member out-of-pocket maximum. Although the plan includes out-of-network coverage, your costs are significantly reduced if you remain in the Cigna network. You may access Cigna PPO network information as follows:
In compliance with the Affordable Care Act, preventive care is covered at 100% with no member cost share. There are no pre-existing limitations, and the plan includes unlimited coverage for covered services.
The plan includes an integration with HealthJoy, a healthcare guidance app that improves your healthcare experience while helping you save both time and money. HealthJoy is free for you to use and provided by Jim Ellis. You get on demand access to healthcare concierges, an employee benefits wallet, and more with HealthJoy.
Below are some videos to help you better understand HealthJoy and how to use it.
The following services and much more are available free in the HealthJoy app.
The health plan includes benefits and resource to help you manage your diabetes at a competitive cost.
Members need to call ProAct Pharmacy and set up their account (see mail order tip sheet on the resources page of the benefits website).
Have your physician submit a new 90-day script for any needed supplies.
Once the script is reviewed, approved, and processed, the equipment will be mailed directly to your home.
NOTE: Members will need to wait until after 1/1/23 to contact ProAct. If you call now, you will not show as eligible in the system.
This program can be accessed by enrolling through HealthJoy or by contacting Nova Healthcare.
Address Back and Joint Pain with Free Virtual Exercise Therapy
HealthJoy’s Virtual Exercise Therapy is an effective program for individuals struggling with back, neck, shoulder, knee, hip, hand, wrist, elbow, ankle, and/or foot pain. With guidance and support from a personal coach, you can significantly reduce pain and improve functional abilities in just 15 minutes per day. The MSK program is integrated with HealthJoy for non-complex aches and pains. This program is a supplement to the medical plan and available at no cost to members.
Note: This is not designed to replace Edison (the required Centers of Excellence program for complex illnesses). This is designed to help with non-complex aches and pains.
Your Jim Ellis medical plan includes retail and mail order prescription drug benefits administered by Pharmacy Benefit Dimensions. The prescription drug benefit is included in the medical plan out-of-pocket.
Retail Pharmacy Benefit
The retail pharmacy network includes an extensive listing of retail stores, grocery store pharmacies, and independent pharmacies. To help manage the cost of prescriptions for both our employees and for Jim Ellis, the pharmacy network includes CVS but does not include Walgreens. We encourage employees to obtain prescriptions from grocery-store pharmacies such as Kroger and Publix to reduce your cost and the a plan’s cost.
Mail Order Pharmacy Benefit
Your new plan includes the following options for a 90 day supply:
Prescription Drug Formulary
You can access your prescription drug formulary here.
As a reminder, specialty medications are excluded (not covered) on the pharmacy benefits.
Online Access to Your Prescription Drug Benefit
Access www.pbdrx.com for general and member-specific information including:
Distance and cost should never get in the way of you receiving the best possible medical care. Our employees who are enrolled in medical will have full access to Edison’s Smart Care Network. All possible barriers have been removed for the best care and all travel expenses will be covered for you and a companion. All employees, spouses, and dependent children who are enrolled in the medical plan are eligible. This is ZERO COST HEALTHCARE at AMERICA’S BEST MEDICAL CENTERS for the certain conditions.
Edison specializes in delivering excellent and appropriate care to individuals facing spine, joint & orthopedic, heart/valve, and cancer surgeries for adult and pediatric patients.
A mandatory program for cancer, orthopedic, spine, and non-acute cardiac procedures. To receive coverage for one of these procedures, members are required to access the Edison Smart Care Centers network. The medical plan also includes access to Edison’s Smart Care Centers for additional conditions on a voluntary basis.
A thorough medical review is provided before traveling to an Edison’s Smart Care Center.
Travel with Ease
Edison will coordinate all of your travel, cover all costs, and provide you a prepaid card for your food and incidentals. Traveling for care has never been this easy!
Why are Edison’s medical centers considered the best of the best?
Medical centers that are recognized as the top in the world based on risk-adjusted quality outcomes.
Multi-disciplinary teams who deliver a fully vetted diagnosis, the best possible treatment, and extraordinary surgical outcomes.
Team-based diagnosis / treatment plan for all and doctors who are paid a salary rather than procedure based compensation.
Get to know Edison
We encourage you to reach out and learn how Edison can help you and your family today. We understand how frightening a new diagnosis can be, which is why we have partnered with Edison to give you the best resources and care possible!
Phone: (866) 982-7988
Patient Process: https://edisonhealthcare.com/patientprocessvideo
Benefits Guidance App - Health Joy
Provides access to all of your Jim Ellis benefits, including benefit summaries and contact information. Use HealthJoy to find providers, obtain medical and prescription cost estimates, and access medical plan details including tracking your out-of-pocket. Use HealthJoy to access Teledoc for 24/7 convenient access to licensed physicians for non-complex issues like colds, sinus infections, minor injuries, and skin conditions.
Medical Claims Administrator - Nova Healthcare
Your contact for ID Card requests, prior authorizations for treatment, coverage questions, and claims issues.
Pharmacy Manager - Pharmacy Benefit Dimensions
Your contact for prescription questions and inquiries.
Centers of Excellence - Edison Healthcare
Your contact for complex healthcare conditions including cancer, cardiac, spine, orthopedic, transplant, regenerative medicine, and complex pediatric conditions and diagnoses. Unsure if your serious condition is a good fit for Edison? Contact Edison to learn more. Note: the Edison Healthcare Centers of Excellence Program is mandatory for spine, ortho, cancer, and acute cardiac conditions. If you have a one of these conditions, contact Edison today. Edison provides the best possible care for the most complex conditions with no member costs.
Telemedicine - Teladoc
24/7 convenient access to licensed physicians for non-complex issues like colds, sinus infections, minor injuries, and skin conditions. Jim Ellis medical members access Teladoc through the HealthJoy benefit guidance app.
If you use tobacco products and complete the smoking cessation program, the tobacco surcharge will be waived. A free tobacco cessation program is offered through Truth Initiative's EX Program. The EX Program is a personalized and convenient digital quit-tobacco program built in collaboration with Mayo Clinic that helps you beat your addiction and live tobacco-free whether you smoke, vape, dip or chew.
It’s FREE from Jim Ellis. Plus, you could avoid a $25/month surcharge! Get started today at Go.TheEXProgram.com/JimEllis
Note: Tobacco products include all forms of tobacco, including but not limited to cigarettes, e-cigarettes containing nicotine, vapes containing nicotine, and chewing tobacco.
For employment separations, the medical plan coverage end date is the date of separation. In certain cases, medical plan premiums may be paid by employees through the end of the pay period, but the medical plan coverage end date could be prior to the end of the pay period.
Health Insurance Enrollment Available Through American Exchange
American Exchange has partnered with Jim Ellis Atlanta as an option to provide employees with an insurance enrollment and advisory service for Individual Marketplace plans. By calling (888) 995-1674, you will be directed to a local Licensed Agent who can help you understand your health insurance options. The call is 100% free and individual rates may be more cost effective option for your family.
You can also click here to set an appointment online: American Exchange.
The Machine Readable Files (MRF's) for the Jim Ellis Nova Health Plan can be found at the below link:
This link is not expected to change. Applicable in-network and allowed amount files will be updated monthly, as required by the regulation, and any future changes needed to the Table of Contents file will be made as well.
Make the Most of Your Health Care Dollars:
Get To Know The Price Comparison Tool
How To Register
Questions? Nova can help! Whether you have questions or you would like to get a price estimate by phone, just call the Customer Service phone number found on your ID card.