Medical

Jim Ellis offers two medical plan options: the High Medical Plan and the Low Medical Plan. Nova Healthcare Administrators is the third party administrator, and Cigna PPO is the network.  The medical plans includes an integration with HealthJoy, a healthcare guidance app that improves your healthcare experience while helping you save both time and money. We encourage all medical plan members to use the HealthJoy app when medical services are needed.

Although the plan includes out-of-network coverage, your costs are significantly reduced if you remain in the Cigna PPO network.

Quality Matters:

All doctors are not the same.  Your medical plan includes tools and resources to help you and your family members find high-quality healthcare. 


The Edison Centers of Excellence program is mandatory for cancer (new diagnoses), orthopedic, spine, joint, 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.

In-Network Medical Summary


       

The low medical plan is new effective 1/1/2024.

Understanding your Healthcare Providers


Nova Healthcare


The High Medical Plan provides 100% coverage after a copay, and the copays apply to the out-of-pocket maximum. The Low Medical Plan has copays for office visits, and most other services are subject to a deductible.  Although the plans includes out-of-network coverage, your costs are significantly reduced if you remain in the Cigna PPO network.  You may access Cigna PPO network information as follows:

OR

Sample ID Card


You will provide your Nova Healthcare ID Card to your Cigna PPO doctor or hospital when you schedule medical care, and pay your copay at the time of service.

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


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 team members and for Jim Ellis, the pharmacy network includes CVS but does not include Walgreens. We encourage team members to obtain prescriptions from grocery store pharmacies such as Kroger and Publix to reduce team members' cost and the plan’s cost.

90-Day Supply Pharmacy Benefit

Your plan includes the following options for a 90-day supply:

  • Mail order: Mail order is a cost-effective way to receive your maintenance medications.
  • 90-day supply retail benefit: Certain maintenance 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.

As a reminder, specialty medications are excluded (not covered) on the pharmacy benefit.

International Pharmacy Program - ENGEDI RX


Jim Ellis offers an international pharmacy program, administered by ENGEDI RX, which helps covered health plan members obtain certain medications at zero cost.

If you’re taking a medication that is eligible for this program, you will be required to obtain your prescription through ENGEDI RX in 2024 or pay a higher price. Questions? Call ENGEDI RX at (800) 663-8029.

Centers of Excellence Program


The Edison program is mandatory for cancer (new diagnoses), orthopedic, spine, joint, and non-acute cardiac procedures and conditions. In order for these conditions to be covered on the health plan, medical plan members must engage with Edison and visit a Smart Care Center for care.

Distance and cost should never get in the way of you receiving the best possible medical care. Our team members 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 team members, 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 diagnosis types listed below.

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 and treatment plan with doctors who are paid a salary rather than paid by procedure.

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

HealthJoy Benefits Guidance App


HealthJoy is the virtual access point for all your healthcare navigation and team member benefits needs. This resource is provided by Jim Ellis to help you make the most of your benefits. HealthJoy connects you and your family with the right benefits at the right moment in your care journey, saving you time, money, and frustration. 

HealthJoy offers 24/7 access to their healthcare concierge team. In addition, you have access to a benefits wallet that contains pertinent benefits information. The app and resources helps you:

  • Locate in-network providers
  • Find extra savings on your prescriptions
  • Navigate your benefits.
  • Chat with a HealthJoy representative through the HealthJoy app or by calling (877) 500-3212

Below are some videos to help you better understand HealthJoy and how to use it

Scan the HealthJoy QR Code to dowload the HealthJoy app:

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
      • 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.

 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


The Jim Ellis medical plans include Livongo's Chronic Care Management program, which supports chronic conditions such as diabetes and hypertension. The program provides help for members at risk for developing diabetes or hypertension by addressing lifestyle and behavioral drivers. 

Virtual Exercise Therapy (MSK Program)


Virtual MSK Therapy is an exercise program for minor back and joint pain. The program includes:

  • Virtual tools and resources, plus guidance from a personal coach
  • Exercises take approximately 15 minutes per day
  • Addresses back, neck, shoulder, knee, hip, hand, wrist, elbow, ankle and foot pain
  • Provides a convenient alternative to in person therapy and surgery

Spousal Health Plan Eligibility


  • Employees covering new spouses on the health plan for 2024 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 team members 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 team members 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 team member.

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 team members 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.