2023 Medical
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.
Nova Healthcare
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:
- www.novahealthcare.com/member
- Find a Provider
- Click on the Cigna Provider directory, select PPO for the plan, and follow search instructions
OR
In-Network Medical Summary
ID Card Sample
Preventive Care and Unlimited Coverage
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.
Nova $0 Preventive Care Services List
Understanding your Healthcare Providers
HealthJoy Benefits Guidance App
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.
- Find a doctor nearby, a specialist with availability, or testing and imaging
- Keep track of your benefit details and cards in the benefits wallet
- Review your prescriptions and medical devices for savings
- Help scheduling your appointment and procedures and reviewing your medical bills
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Diabetic Members
The health plan includes benefits and resources to help you manage your diabetes at a competitive cost.
- Diabetic equipment and supplies are covered on the pharmacy portion of your health plan rather than the medical portion. Your equipment will be obtained from a local in-network pharmacy or ProAct, one of the mail-order pharmacies.
- To fill through ProAct
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Members need to call ProAct Pharmacy and set up their account (see mail order tip sheet on the resources page of the benefits website).
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Have your physician submit a new 90-day script for any needed supplies.
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Once the script is reviewed, approved, and processed, the equipment will be mailed directly to your home.
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- To fill through ProAct
- If the specific supplies are included on the formulary, the applicable tier copay applies.
- Members may receive a free blood glucose meter and unlimited strips and lancets through the Livongo program. Access the program through the HealthJoy app and refer to the Chronic Condition Management programs described below.
- For members who do not participate in Livongo, test strips and lancets, if covered on the formulary, are typically covered at the Tier 2 $60 copay.
- Continuous Glucose Monitors (CGMs) and Insulin Pumps are subject to the Tier 2 copay of $60 for all medical plan members. This copay applies for this equipment for members who do and do not participate in the Livongo diabetes management program. Note: The Freestyle Libre is the formulary CGM, available at the $60 copay.
Diabetes and Other Chronic Care Management
This program can be accessed by enrolling through HealthJoy or by contacting Nova Healthcare.
Virtual Exercise Therapy (MSK Program)
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.
- 100% virtual program for common minor injuries.
- Most commonly used for back, hip, knee injuries and minor pain.
- Daily 15-minute exercises to help manage non-complex musculoskeletal issues plus weekly virtual meetings with a physical therapist.
- No equipment needed.
- A convenient approach to traditional physical therapy.
- Program consists of a 15 minute questionnaire and a virtual interview with a physical therapist.
- Accessible through HealthJoy.
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.
Prescription Drug Coverage
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 plan’s cost.
Mail Order Pharmacy Benefit
Your new plan includes the following options for a 90 day supply:
- Mail order: Mail order is a cost-effective way to receive your maintenance medications. Once enrolled in the new plan, you can request mail order drugs by phone or online, or your provider may send the 90 day script to the mail order vendor.
- 90 day supply retail benefit: Certain medications are accessible at your retail pharmacy in a 90 day supply if the script is written for 90 days. Although not all medications are available for a 90 day supply via the retail benefit, this is another convenient way to access your maintenance medications.
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:
- Access to your claims information and out-of-pocket costs (member login required)
- Medication look-up tool which provides out-of-pocket costs for medications at various pharmacies
- FDA Updates, and more
Edison Centers of Excellence
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 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.
The Edison Centers of Excellence program is mandatory for orthopedic, spine, and joint care and for 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.
Second Opinions
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
Email: ehc@edisonhealthcare.com
Patient Process: https://edisonhealthcare.com/patientprocessvideo
Quick Reference Guide
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.
(877) 500-3212
www.healthjoy.com
Medical Claims Administrator - Nova Healthcare
Your contact for ID Card requests, prior authorizations for treatment, coverage questions, and claims issues.
(855) 206-1040
www.novahealthcare.com/member
Pharmacy Manager - Pharmacy Benefit Dimensions
Your contact for prescription questions and inquiries.
(888) 878-9172
www.pbdrx.com
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 one of these conditions, contact Edison today. Edison provides the best possible care for the most complex conditions with no member costs.
(866) 982-7988
www.edisonhealthcare.com
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.
(877) 500-3212
www.healthjoy.com
Spousal Health Plan Eligibility
- Employees covering new spouses on the health plan for 2023 will be required to provide proof of current marriage (marriage certificate and joint marital document, i.e. mortgage / bank statement, utility bill, etc.).
- Spouses with other employer-sponsored health coverage are not eligible for the Jim Ellis health plan. An affidavit acknowledging no other employer-sponsored health coverage will be required.
- If you are covering a spouse for health coverage, you will receive an email from the Benefits Service Center following Open Enrollment explaining the documentation needed.
Tobacco Surcharge and Cessation
- $25 per month tobacco surcharge applies to employees enrolled in the health plan who use tobacco products.
- To avoid the separate $25 per month surcharge, you must complete the non-tobacco affidavit or be an active participant in tobacco cessation by the deadline.
- Obtain the non-tobacco affidavit from the Resources page or Human Resources.
- Complete and sign the affidavit within 60 days of your benefits effective date (or by the annual due date) to avoid the surcharge.
- Submit the affidavit to Yvonne Teague in Human Resources to ensure it is processed timely.
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.
Employment Termination of Coverage
Your medical plan coverage will terminate on the same date as your employment termination. 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.
Your medical coverage is a COBRA eligible benefit. Under COBRA regulations, you have the right to continue your medical benefits for a maximum period of 18 months from the date of your termination. This allows you to maintain access to the same medical benefits you had as an active employee.
Following your end of employment with Jim Ellis, you will receive a comprehensive COBRA continuation notice. This notice will provide you with additional details and instructions on how to proceed with continuing your medical coverage under COBRA.
American Exchange
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 a more cost effective option for your family.
You can also click here to set an appointment online: American Exchange.
Availability of Machine Readable Files
The Machine Readable Files (MRF's) for the Jim Ellis Nova Health Plan can be found at the below link:
https://jimellis.mrfcentral.com
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.
Price Comparison Tool
Make the Most of Your Health Care Dollars:
- Nova’s online Price Comparison Tool, hosted by Green Light, makes it possible to obtain a cost estimate before a service or procedure takes place. You can also compare costs and quality ratings across different providers to help you make the best decisions for your health and budget.
Get To Know The Price Comparison Tool
- When you search for a medical service or procedure, you’ll see a list of providers who provide that service. You can choose a geographical area to search or look for a specific provider by name. Cost estimates will show how much you can expect to pay (based on your benefit plan, network, deductibles, and copays, if applicable).
How To Register
- Log in to the Consumer Information Center and choose Price Comparison Tool from the Member Resources menu.
- Click on Use the Price Comparison Tool.
- Click Register to create an account. You will need the member ID number from your ID card.
- Once registered, your Price Comparison Tool homepage will include plan-specific information (network, deductibles, and copays, if applicable). Using this information, you can search for care based on a medical service or procedure, geographical area, or provider name and receive a cost estimate of what you can expect to pay.
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.
