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MyHealth360

MyHealth360 provides a comprehensive suite of health and well-being benefits including: two medical plans, prescription drug, dental and vision coverage, and Flexible Spending Accounts (FSAs). 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 Exclusive Medical Plan

In the Piedmont Exclusive Plan, you pay lower bi-weekly premiums than you would in the Piedmont Choice Plan because when you visit a Piedmont-network provider or facility, we have the ability to better manage your care and your cost.

Bi-Weekly Premiums for Coverage

MyHealth360 Medical Plan Coverage Summary

Benefit Summary

Summary of Benefits and Coverage (SBC)

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 Exclusive Plan, you can receive care in two main networks or tiers.

To find a provider, MyHealth360 members can download and open the Castlight mobile app and select “Find Care.” If you are not enrolled in a MyHealth360 plan and are interested in enrolling, you may search for in-network providers and facilities. In your search results, Tier One providers will be clearly labeled with a green checkmark; all other providers are considered Tier Two.

This is the same Tier One network as the Piedmont Choice Plan.

You will receive high-quality care at the most affordable price possible when you use Piedmont Preferred Network (Tier One) providers and services. This includes: All Piedmont Clinic physicians, Piedmont Healthcare facilities, Piedmont-branded urgent care centers, Children’s Healthcare of Atlanta (CHOA) facilities, The Children’s Health Network (TCHN) pediatricians, Kids First Health pediatricians, Middle Georgia Pediatrics, Primary Pediatrics, Wellstar Augusta University pediatric facilities and pediatric network and others, as well as emergency care.

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

This is NOT the same (or as large) as the Tier Two network as the Piedmont Choice Plan.

You will have higher out-of-pocket costs when seeing providers or receiving services at the Tier Two level. The Cigna LocalPlus Network (Tier Two) consists of any providers within this network who are not listed as Tier One.

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

You will not have coverage outside of the Piedmont Preferred Network (Tier One) or Cigna LocalPlus Network (Tier Two) except for:

  • Urgent care centers
  • Emergency care (emergency room and emergency admissions)
  • Medically necessary (and approved) healthcare services not performed at any locations within the network

What if I have an emergency?

How the Piedmont Exclusive Plan Works

This example shows coverage using Piedmont Preferred Network (Tier One) providers:

What else should I know about the Piedmont Exclusive Plan?

Questions about the MyHealth360 medical plans?

If you have questions about your two medical plan options, contact Cigna at 877-601-3835 or visit mycigna.com.

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.

Not sure which plan to choose? Scroll through these examples:

Meet William

Plan: Piedmont Exclusive Plan
Who’s Covered: Employee Only
Premium: $55.56 (full-time, bi-weekly)
Out-of-Network Coverage: Emergency Only
Deductible: $500 (Tier One: Piedmont Preferred Network)
Out-of-Pocket Maximum: $4,000 (Tier One: Piedmont Preferred Network)

Situation:

Since William’s doctor is in the Piedmont Preferred Network, the Piedmont Exclusive Plan offers lower costs across the board. William is on vacation and gets into an accident. His four-day, out-of-state hospital stay costs $900 in copays (emergencies are covered at the highest benefit level). William also needs a wheelchair for $800. He pays the $500 deductible (copays don’t count toward the deductible), and he and the plan split the remaining $300 (he pays 15% – $45).

Meet Martha

Plan: Piedmont Choice Plan
Who’s Covered: Employee + Spouse
Premium: $289.52 (full-time, bi-weekly)
Out-of-Network Coverage: Yes
Deductible: $8,550 (Tier Two: Cigna OAP Network)
Out-of-Pocket Maximum: $17,100 (Tier Two: Cigna OAP Network)

Situation:

Martha is undergoing cancer treatment at Emory. She has seen the same doctor for two years, and she doesn’t want to switch. Martha chooses the Piedmont Choice Plan because she wants to continue receiving care from her cancer doctor, who is in the Cigna Open Access Plus (OAP) Network (Tier Two).

Meet Jill

Plan: Piedmont Exclusive Plan
Who’s Covered: Family
Premium: $292.09 (full-time, bi-weekly)
Out-of-Network Coverage: Emergency Only
Deductible: $1,000 (Tier One: Piedmont Preferred Network)
Out-of-Pocket Maximum: $6,850 (Tier One: Piedmont Preferred Network)

Situation:

Since the family’s doctors and pediatricians are in the Piedmont Preferred Network, the Piedmont Exclusive Plan offers lower costs across the board for Jill and her family, including most healthcare services being covered with copays.

Prescription Drugs

Prescription drug coverage administered directly by Express Scripts is provided automatically when you enroll in one of Piedmont’s medical plan options. The coverage for your medications is the same regardless of the medical plan you choose. Please note: Weight loss drugs are not covered under any MyHealth360 medical plan, and all fertility medications are managed through Progyny rather than Express Scripts.

When it comes to prescriptions, there are six 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 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 Smart90 Anywhere network of retail pharmacies, including Piedmont pharmacies and Oconee Drugs, you can get a 90-day supply of your medication for just two times your 30-day copay amount.
  5. Consider using the Home Delivery Pharmacy mail-order option and the mobile app for your maintenance medications—for 2.5x the 30-day copay for a 90-day supply, rather than receiving refills at a retail pharmacy. Review the Home Delivery FAQs for more details.
  6. 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 Coverage Summary

Prescription Drug Formulary Summary

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.

Other Benefits to Consider

Dental Coverage

Vision Coverage

Flexible Spending Accounts (FSAs)

Location Selection

Current Location:Primary / In-Region Remote

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