Overview
Your medical plan options include a range of coverage levels and costs, so you can choose the one that’s best for you. You can enroll as a new hire, newly eligible for coverage, during Open Enrollment, or if you have a qualifying life event.
Key features
All of our medical plans provide:
Comprehensive, affordable coverage
for a wide range of health care services.
Free in-network preventive care
with services such as annual physicals, recommended immunizations, and routine screenings all 100% covered.
Prescription drug coverage
provided by Cigna.
Financial protection
through annual out-of-pocket maximums that limit how much you’ll pay each year.
2026 medical plans
HDHP 1700 and HDHP 6000
Administered by: Cigna
The HDHP 1700 and HDHP 6000 offset a high deductible with a tax-free Health Savings Account (HSA) (with contributions from Rady Children's Health).
Cigna PPO
Administered by: Cigna
Offers a lower deductible in exchange for higher premiums.
Cigna Full Network HMO
Administered by: Cigna
Receive coverage for in-network care only, coordinated by your primary care provider (PCP). You’ll have access to the Cigna Full HMO Network of providers.
SIMNSA
Administered by: SIMNSA
For employees who would like to receive care in Mexico.
How much does Rady Children's Health medical coverage cost?
Rady Children's Health pays a generous portion of the cost of your medical coverage. You’ll pay the remaining amount through pre-tax premiums from your paycheck. The amount you pay will depend on which plan you choose and whether you cover just yourself or family members, too. You can view your plan costs on the SharePoint sites for Orange County and San Diego.
Plan Comparison
Use this interactive side-by-side plan comparison to understand key differences between the plans.
| Cigna Full Network HMO | Cigna PPO | Cigna HDHP 1700 | Cigna HDHP 6000 | ||
|---|---|---|---|---|---|
| HSA features | |||||
| HSA-eligible | No | No | Yes | Yes | |
| Rady Children's Health contribution to HSA | None | None | $630 for individual coverage or $1,260 for coverage with dependents | $630 for individual coverage or $1,260 for coverage with dependents | |
| Annual deductible | |||||
| In-network | Individual: $500 Family: $1,000 |
Individual: $1,000 Family: $2,000 |
Individual: $1,700 Individual within a family: $3,400 Family: $3,400 |
Individual: $6,000 Individual within a family: $6,000 Family: $12,000 |
|
| Out-of-network | N/A | Individual: $1,000 Family: $2,000 |
Individual: $3,400 Individual within a family: $6,800 Family: $6,800 |
Individual: $10,000 Individual within a family: $10,000 Family: $20,000 |
|
| Coinsurance | |||||
| In-network | You pay 20%, plan plays 80% | You pay 20%, plan plays 80% | You pay 10% or 20%, plan plays 90% or 80% | You pay 30%, plan plays 70% | |
| Out-of-network | N/A | You pay 40%, plan pays 60% | You pay 30% or 40%, plan pays 70% or 60% | You pay 50%, plan pays 50% | |
| Annual out-of-pocket maximum | |||||
| In-network | Individual: $1,500 Family: $3,000 |
Individual: $4,000 Family: $8,000 |
Individual: $3,400 Family: $6,000 |
Individual: $7,500 Family: $15,000 |
|
| Out-of-network | N/A | Individual: $6,000 Family: $12,000 |
Individual: $9,000 Family: $18,000 |
Individual: $15,000 Family: $30,000 |
|
| Health care visits: Your costs | |||||
| Preventive care | You pay nothing in-network; covered 100% | You pay nothing in-network; covered 100% | You pay nothing in-network; covered 100% | You pay nothing in-network; covered 100% | |
| Primary care (in-network) | $30; deductible does not apply | You pay 20% after deductible | You pay 10% after deductible | You pay 30% after deductible | |
| Primary care (out-of-network) | N/A | You pay 40% after deductible | You pay 30% after deductible | You pay 50% after deductible | |
| Specialist (in-network) | $50; deductible does not apply | You pay 20% after deductible | You pay 10% after deductible | You pay 30% after deductible | |
| Specialist (out-of-network) | N/A | You pay 40% after deductible | You pay 30% after deductible | You pay 50% after deductible | |
| Telehealth (in-network) | Same as Primary/Specialist | Same as Primary/Specialist | Same as Primary/Specialist | Same as Primary/Specialist | |
| Telehealth (out-of-network) | N/A | Same as Primary/Specialist | Same as Primary/Specialist | Same as Primary/Specialist | |
| Urgent care (in-network) | $50; deductible does not apply | $50; deductible does not apply | You pay 10% after deductible | You pay 30% after deductible | |
| Urgent care (out-of-network) | N/A | $50; deductible does not apply | You pay 10% after deductible | You pay 30% after deductible | |
| Emergency room (in- and out-of-network) | $200; deductible does not apply | $200; deductible does not apply | You pay 20% after deductible | You pay 30% after deductible | |
| Physical, Occupational & Speech Therapy |
60-day combined visit maximum per year | 60-day combined visit maximum per year | 60-day combined visit maximum per year | 60-day combined visit maximum per year | |
| Chiropractic (in-network) | $50 copay; deductible does not apply; 30 visits annual limit | You pay 20% after deductible; 30 visits annual limit | You pay 10% after deductible; 30 visits annual limit | You pay 30% after deductible; 30 visits annual limit | |
| Chiropractic (out-of-network) | N/A | You pay 40% after deductible; 30 visits annual limit | You pay 30% after deductible; 30 visits annual limit | You pay 50% after deductible; 30 visits annual limit | |
| Prescriptions – 30-day supply at retail pharmacy: Your costs | |||||
| Generic | $15; deductible does not apply | $15; deductible does not apply | $15 after deductible | $10 after deductible | |
| Brand | $50; deductible does not apply | $50; deductible does not apply | $40 after deductible | $30 after deductible | |
| Non-formulary | $75; deductible does not apply | $45; deductible does not apply | $60 after deductible | $50 after deductible | |
HDHP Plans
The HDHP 1700 and HDHP 6000 pair high-deductible coverage with a tax-free Health Savings Account (HSA) that helps you save money and plan ahead for future medical expenses. This combination gives you more control over your money and rewards you for making healthy, cost-conscious choices.
As an added bonus, Rady Children's Health will contribute to your HSA — $630 for individual coverage or $1,260 for coverage with dependents. With these plans, you can see any provider you wish, but you will pay less when you stay in network.
How the HDHP 1700 and HDHP 6000 work
You pay the plan premiums from your paycheck to have coverage. When you receive in-network preventive care, you pay nothing — it’s covered in full! If you need non-preventive care, it works like this:
Use your HSA to save money and plan ahead!
Contributing to your HSA is a great way to budget for deductibles and other out-of-pocket expenses while also saving money — your HSA contributions are tax-free!*
Keep in mind:
- You can only spend HSA money already deposited into your account. If you don’t have enough money in your HSA when you need it, you can pay another way and reimburse yourself later to take full advantage of your HSA’s tax savings
- You will never forfeit any money left in your HSA — it rolls over each year. To save for your health care costs in retirement or prepare for future expenses, set aside a little extra each paycheck to grow your balance
- You can change your HSA contribution amount throughout the year, if needed
- You can pair your HSA with a tax-free Limited Purpose Flexible Spending Account (FSA) to save even more
*HSA contributions are not subject to federal income tax, but are currently subject to state income tax in CA and NJ. Consult with your tax advisor to understand the potential tax implications of enrolling in an HSA. Money in an HSA can be withdrawn tax-free as long as it is used to pay for qualified health-related expenses. If money is used for ineligible expenses, you will pay ordinary income tax on the amount withdrawn, plus a 20% penalty tax if you withdraw the money before age 65.
PPO Plan
The Cigna PPO offers a slightly lower deductible in exchange for higher premiums. You can see any provider, but you’ll pay less by staying in network.
How the Cigna PPO works
You pay the plan premiums from your paycheck to have coverage. When you receive in-network preventive care, you pay nothing — it’s covered in full! If you need non-preventive care, it works like this:
Save money with an FSA!
Take advantage of tax-free savings for health care payments with a Health Care Flexible Spending Account (FSA).
HMO Plan
The Cigna Full Network HMO provides coverage only when you receive care from providers within the HMO network. You'll have an in-network primary care provider (PCP) who will coordinate your care to help manage costs. To find an in-network provider, visit Cigna.
SIMNSA is available for employees who would like to receive care in Mexico. For more information, review a health providers list and U.S. urgent care locations.
How the HMO plan works
You pay the plan premiums from your paycheck to have coverage. When you receive in-network preventive care, you pay nothing — it’s covered in full! If you need non-preventive care, it works like this:
Do you have a PCP?
An HMO requires you to select a primary care provider (PCP) who will manage your care and provide referrals if you need to see a specialist. Find a doctor>>
Save money with an FSA!
Take advantage of tax-free savings for health care payments with a Health Care Flexible Spending Account (FSA).
Prescription Drugs
When you enroll in a Rady Children's Health medical plan, you automatically receive prescription drug benefits through Cigna.
Drug tiers
The cost of your prescription drugs under each medical plan depends on the tier of the medication — generic, brand, or non-formulary. All prescription carriers have a formulary, or list of drugs based on effectiveness and cost. This list will determine how your prescriptions are covered. Keep in mind that the formulary may change as a result of regular reviews and updates.
Pay less for your prescriptions
Ask your doctor about generic medications.
They’re generally just as effective as brand-name medications, but typically cost 80-85% less.
Use the home delivery feature.
Save time and money on maintenance medication for chronic conditions — such as an allergy, high blood pressure, or diabetes — with the convenient, cost-saving home delivery prescription programs through Cigna.
Take advantage of additional savings.
With the Cigna 90 Now program, you can save when you choose to fill a 90-day supply of your long-term medications at CVS pharmacies. You’ll take fewer trips to the pharmacy and pay for your prescriptions only once every three months.
Why use home delivery?
- Free shipping on prescriptions
- No waiting in line at the pharmacy
- Reduced cost for a three-month supply
- Convenient, automatic refills
Prescription programs
Your pharmacy benefits include several programs aimed at ensuring your safety and making sure you receive the most clinically appropriate and cost-effective medication.
Prescription tools
Visit your prescription plan website or download the mobile app to manage your prescriptions, order refills, sign up for home delivery, and more. Get started by creating an online account on the Cigna website.
Find a Doctor
Using in-network providers saves you money. Here’s how to find doctors in your medical plan network.
Cigna
If you are already a Cigna member, log into Cigna to search your plan’s network. Otherwise, follow these steps to find a doctor:
- Visit the Cigna website and click on “Find a Doctor” at the top of the screen
- Under “How Are You Covered,” select “Employer or School”
- Change the geographic location to the city/state, or ZIP code where you want to search
- Select the search type and enter a name, specialty, or other search term
- You may also choose to search by distance, years in practice, specialty, languages spoken, and more
- Click on one of the suggestions or click on the magnifying glass to see your results
- Answer any clarifying questions
- Select your plan’s network
- That’s it! Choose the provider you’d like to see and contact them to schedule an appointment
Don’t have a personal doctor? You should. Here’s why.
- Better health. Yearly health screenings can reduce your risk for many serious conditions. Preventive care is free, so there’s no excuse to skip it
- Greater savings. Having a doctor you can call helps you avoid costly trips to the emergency room
- Peace of mind. Your personal doctor gets to know you and your health history, provides advice you can trust, and helps coordinate your care
Telehealth
Your medical plan gives you access to telehealth services through MDLIVE through Cigna. Consider using telehealth for non-emergency medical or behavioral health care — it’s available from the comfort of your home or wherever you are.
Telehealth is a great option when:
- You don’t feel up to going to the doctor’s office
- You can’t get to your doctor because you’re traveling
- You need care after hours (nights, weekends, holidays)
Try telehealth for fast, affordable care
MDLIVE through Cigna provides convenient telehealth services anytime, anywhere. You have 24/7 access to board-certified doctors by phone or video using the MDLIVE through Cigna mobile app or website. Doctors can diagnose, treat, and prescribe medication when needed for many common conditions. The cost for a telehealth appointment varies by medical plan, but is typically less than going to an urgent care center.
Talkspace
If you are enrolled in a Cigna medical plan, you have access to Talkspace online therapy. Choose a therapist from a list of recommended, licensed providers and receive support day or night from the convenience of your smart device. You can exchange unlimited messages (talk, voice, and video) with your personal therapist immediately after registration for help with issues like:
- Stress
- Anxiety
- Depression
- Trauma and grief
- Sleep
- And more
To get started, visit Talkspace and complete a QuickMatch survey to review your matches and choose your personal therapist.
Ginger
If you are enrolled in a Cigna medical plan, you also have access to Ginger virtual mental healthcare. With Ginger, coaches, therapists, and psychiatrists work as a team to coordinate the best, personalized care right from your smartphone, whenever you need it.
Ginger offers confidential mental healthcare through behavioral health coaching via text-based chats, self-guided learning activities and content, and, if needed, video-based therapy and psychiatry. Support is available 24/7/365 from anywhere.
To get started, visit Ginger.
Tools & Resources
Your medical plan offers additional features to help you get the most from your coverage.
Cigna Transparency in Coverage
Click here to download Cigna’s legal compliance documents.
Online tools
Log in to your medical plan website to:
- Find a doctor
- Compare costs
- Manage claims
- And much more
Get started by setting up an online account for your plan — Cigna.
Important Benefit Notices
Important Health Coverage Tax Document: 2025 1095-C forms
Effective this year, Rady Children's Health will no longer automatically mail forms 1095-C to the home address(es) on file of current and former employees.
Below are instructions for accessing your form 1095-C or requesting a copy be mailed to you. Please note that your form 1095-B for the calendar year 2025 will come directly from the medical plan vendor (Anthem for San Diego employees or Cigna for Orange County employees), so you should contact them directly with any questions about form 1095-B.
San Diego employees:
- Active employees can access an electronic copy to download/print by logging into PeopleSoft Employee Self-Service and following these steps: Click on the “Benefit Details" tile and click on the “Affordable Care Act" menu on the left. Click “View Form 1095-C" to access/download/print a copy of your 2025 1095-C.
- To request a hard copy form 1095-C to be mailed to you or if you have questions, please email benefits@rchsd.org or call 858-966-1700 ext. 245801. You can also send your request to 3020 Children's Way MC 5040 San Diego, CA 92123. If you are a former employee, please make sure to include the mailing address of where the form should be sent in your request.
Orange County employees:
- Active employees can access an electronic copy to download/print by logging into Workday, choosing “Benefits and Pay" from the Menu in the top left, and clicking “ACA Forms" under the Benefits header.
- To request a hard copy form 1095-C to be mailed to you or if you have questions, please email benefits@choc.org or call 714-509-3765. You can also send your request to 1201 W. La Veta Ave. Attn HR, Orange CA, 92868. If you are a former employee, please make sure to include the mailing address of where the form should be sent in your request.