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Local Consumer-Driven Health Plan 

 

The Local Consumer-Driven Health Plan (LCDHP) is a new benefit option, often referred to as a high-deductible health plan, which requires members to be more responsible for managing their healthcare including how they spend their healthcare dollars. LCDHP is administered by Cigna and offers a comprehensive range of benefits including a nationwide network of physicians, hospitals and ancillary providers. The plan design offers both in and out-of-network benefits; however, utilizing in-network providers will result in cost savings to the member. Note: Notification to Cigna, the LCDHP notification administrator, is required for certain medical services in order to avoid penalties. Contact Cigna at (800) 962-0051 for direction.

Members interested in more information regarding the LCDHP benefit levels should refer to this benefit chart. Plan highlights are listed below:

  • An annual collective plan year deductible (includes medical and pharmacy) applies to all nonpreventive medical services, nonpreventive prescriptions and behavioral health services.
  • There are two plan year deductibles, one for in-network and one for out-of-network. Each plan year deductible (i.e., in-network vs. out-of-network) is exclusive and separate from the other.
  • Members with one or more dependents on their coverage must satisfy the family annual plan year deductible before services will be covered at the plan’s benefit levels of 90% in-network and 70% out-of-network.
  • Preventive medical services obtained through an in-network provider are covered at 100% and are not subject to the annual plan year deductible. Preventive medical services obtained out-of-network are not covered.
  • Preventive medications are covered at the applicable coinsurance level and are not subject to the annual plan year deductible. Refer to the Express Scripts website for a list of preventive medications.
  • The plan has two out-of-pocket maximums, one for all eligible in-network services and one for all eligible out-of-network services. Each out-of-pocket maximum (i.e., in-network vs. out-of-network) is exclusive and separate from the other. Plan coinsurance and deductibles are applied to the out-of-pocket maximums. Benefits will be paid at 100% up to the allowed charges after the applicable out-of-pocket maximum has been met.

The LCDHP utilizes Magellan for behavioral health benefits and Express Scripts for prescription benefits.

Updated 04/30/14