Medical & Prescription Drug Plans

CoreSource (medical plan administrator) How do I find out if my healthcare provider is in our network?
Select PPO and Choice PPO Prescription Drug Coverage
Coverage Levels (Tiers) Priority for generics
Monthly Premiums Non-Tobacco User Premium Discount
90-day supply at retail CVS Generic Step Therapy
Prior Authorizations/Quantity Limits Preventive Care
Caremark FastStart program Medical Plan and Prescription Drug ID Cards
Flexible Spending Account (FSA)  

 

CoreSource (St. Jude medical plan administrator)

CoreSource administers claims for the St. Jude medical plan. You have access to a national network of medical providers—called the GWH-CIGNA PPO provider network. To find a doctor, visit http://cigna.benefitnation.net/sarPPO/.

Note: Please use this online provider search directory to find medical providers. Information on the search site relating to dental, vision and other benefits pertain to other clients who use Cigna networks.

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Select PPO and Choice PPO

Whether you are sick or injured, your medical coverage is one of your most valuable benefits. St. Jude pays a major portion of the expenses for your medical coverage through the Select PPO and Choice PPO options. CoreSource and Caremark administer the medical and prescription drug plans, respectively.

While both plans have the same covered services and feature in-network and out-of-network coverage, the main differences are the cost structures of the plans. The PPO plans have different deductibles, out-of-pocket maximums and premiums; giving you the opportunity to select a plan based on how you and your family use your medical benefits. That is, you choose when and how you want to pay for your health care costs.

Health Plan Benefits-At-A-Glance (pdf)

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Coverage Levels (Tiers)

For medical coverage, you can choose from six levels (tiers) of coverage or waive coverage:

Medical Coverage Level Who’s covered
Employee Only Yourself only
Employee + Child(ren) Yourself and your child(ren)
Employee + Spouse Yourself and your spouse
Employee + Spouse + Child(ren) Yourself, your spouse and your children
Employee + SGP Yourself and your same gender domestic partner
Employee/Child(ren) + SGP Yourself, your child(ren) and your same gender domestic partner

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Monthly Premiums

You and St. Jude Children’s Research Hospital share the costs of your medical coverage; St. Jude pays approximately 80%. Your premiums are deducted from 24 paychecks per year on a pre-tax basis. When you pay with pre-tax dollars, you receive a tax break because the money is deducted before federal income taxes and Social Security taxes. The table below shows your monthly contributions if you choose coverage under the plans. The annual costs for the benefit options vary depending on the plans and coverage levels (tiers) you choose.

Benefits
Your Monthly Premium1
Monthly COBRA Rates2
Medical—Select PPO3 Full-time Part-time  
Employee only $72 $144 $522
Employee + Child(ren) $146 $292 $994
Employee + Spouse $194 $388 $1,250
Employee + Spouse +  Child(ren) $232 $464 $1,664
Medical—Choice PPO3 Full-time Part-time  
Employee only $36 $72 $483
Employee + Child(ren) $73 $146 $918
Employee + Spouse $97 $194 $1,160
Employee + Spouse +  Child(ren) $116 $232 $1,544
1Same Gender Domestic Partner Tiers (Full-time/Part-time/COBRA)
Medical-Choice EE+SGP: $97 / $194 / $1,160
Medical-Choice EE/Child(ren)+SGP: $116 / $232 / $1,544
Medical-Select EE+SGP: $194 / $388 / $1,250
Medical-Select EE/Child(ren)+SGP: $232 / $464 / $1,664
2This is the full cost of coverage if you or one of your dependents loses coverage under the plan and becomes eligible for  COBRA.
3Tobacco users on medical plan will pay a $50/month surcharge in addition to rates listed.

 

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Non-Tobacco User Premium Discount

In recognition of the health risks of smoking and tobacco use, St. Jude is a smoke-free campus for employees. In a continuing commitment to promote good health, St. Jude has implemented a premium discount ($50/month) for employees who do not use tobacco products and enroll in the St. Jude medical plan. All employees must complete the Non-Tobacco User Affidavit in the MYBenefits portal upon hire. Employees can avoid the surcharge by completing an 8-week tobacco cessation program, which is provided at no cost to employees. The program is administered by the St. Jude employee wellness program, Living Well. (Living Well will work with employees who cannot complete the 8-week session and need an alternative program.)

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Cost of certain in-network preventive care (i.e. annual checkups, routine vaccinations) are fully paid by St. Jude.

The work you do as a St. Jude employee every single day benefits children around the world. To help you look after your own best health, you no longer pay a co-pay, coinsurance or deductible for in-network preventive services such as:

For details on preventive services, visit www.healthcare.gov. To find an in-network provider of the services mentioned above, visit http://cigna.benefitnation.net/sarPPO/.

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Medical Plan and Prescription Drug ID Cards

Your Medical Plan ID card will also serve as your Prescription Drug Card. This card will show the telephone numbers to call if you have a question about your coverage or need to pre-certify a service or procedure. To protect your privacy, you will receive a unique ID number. However, you may provide your social security number to verify benefits if you prefer.

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How do I find out if my healthcare provider is in our network?

The best way to search for healthcare providers is online through the websites of our benefits vendors because their databases are kept as up-to-date as possible. To search for in-network medical providers, visit http://cigna.benefitnation.net/sarPPO/.

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Prescription Drug Coverage

You probably know from your own experience that the cost of prescription drugs continues to rise dramatically. To help keep your medical expenses as low as possible, the PPO options include a prescription drug program administered by Caremark. When you enroll in either PPO option, you automatically receive prescription drug coverage.

Both PPO options include copays for retail and mail-order drugs as shown in the Health Plan Benefits At-A-Glance chart.


Rx plan uses a Preferred Drug list (formulary)

The St. Jude Prescription Drug Plan uses Caremark’s three-tiered Preferred Drug list (formulary). Drugs are placed on the formulary based on their clinical effectiveness and safety, as well as cost. Log in to www.caremark.com to download a pdf of the current list of preferred medications.

Your share of the prescription drug plan cost depends on the category of the prescription.

Preferred Drug List FAQs

Caremark updates the preferred drug list throughout the year as scientific and clinical drug information becomes available.

Prescription Drug Plan co-pays
  Retail-Your local pharmacy
(31-day supply)
Caremark Mail Order Program*
(90-day supply)
Generics $5 $10
Preferred brands $25 $50
Non-preferred brands/Specialty drugs  $50 $100
*Caremark's Fast Start program makes switching to mail order easy!

Please click here to download the preferred list or visit www.caremark.com or call Caremark at 1-866-240-4916 to determine if a drug is preferred or non-preferred and to estimate costs for specific drugs.

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Priority for generics

Federal law requires generic and brand drugs to meet the same standards of strength, dosage, safety and effectiveness. Generics typically cost less for both you and St. Jude.

If your doctor prescribes a brand-name drug although a generic is available and you choose to purchase the brand-name prescription, you will pay more for your medicine. Your co-pay will be the total of the generic co-pay, plus the difference between the actual cost of the brand and the generic drug.

Illustrative example of cost difference

Difference in price between brand and generic version of Wellbutrin XL:

Brand-name Wellbutrin costs about $194.31, and the generic equivalent costs $52.99.

$141.32
Plus retail generic co-pay + $5.00
Your cost if you choose to buy the brand-name drug $146.32

Talk to your doctor.  Ask your health care provider to prescribe generics when available.

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Generic Step Therapy

Do medicines that cost more always work better? Nope. In fact, many lower-cost medicines provide great health benefits while saving you money. 

For certain conditions such as ulcers, acid reflux disease, and some types of pain or inflammation, employees and family members enrolled in the plan must try one or more generic alternatives before a brand named drug will be covered. When you submit a prescription for a medication that is not a "first-step" drug, it may be rejected. So ask your doctor about lower-cost alternatives before filing a prescription.

Read Generic Step Therapy to learn which drugs are included in Generic Step Therapy. Note: Current users of the proton pump inhibitors and antidepressants will be grandfathered for one year.

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90-day supplies at retail CVS stores; 31-day supply limit at other local pharmacies (retail)

If you are taking maintenance mediations (i.e. drugs taken daily to treat a chronic condition such as arthritis, diabetes, high cholesterol, high blood pressure and heart disease) ask your doctor to write a 90-day prescription for your medication that can be filled through the CVS Caremark mail order program (see info about Fast Start below). You get a three-month supply for the cost of two months.

St. Jude employees can now fill 90-day prescription supplies at any retail CVS/pharmacy for the same price as mail order. By going to the pharmacy, you will get your prescriptions the same day and be able to talk face-to-face with a pharmacist. You must use a CVS/pharmacy location; not applicable to other network pharmacies.

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Prior Authorizations and Quantity Limits

To promote proper use of medications while deterring overuse, St. Jude uses prior authorizations and quantity limits for select medications.

Prior authorization, which requires prescribers to confirm medical necessity, will be required for ADHD (Attention Deficit Hyperactivity Disorder) medications for those over age 19 and narcolepsy (sleep disorder) class drugs. Be sure your doctor obtains prior approval by calling 1-800-213-0879 before you try filling a prescription for these medications.

Prior Authorization drug list

Quantity limits establish a maximum amount allowed over a period of time for medications that have a potential for overuse and misuse. If your doctor feels it’s medically necessary to exceed the limit, he or she must get prior approval by calling 1-800-213-0879 before the higher quantity can be covered.

Quantity Limits drug list

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Switching to Mail Order is a snap with Caremark’s FastStart®!

Call Caremark toll free at 1-800-875-0867 (M-F, 7 a.m. to 7 p.m.) and let them contact your doctor and switch your prescription to mail order. FastStart® makes it especially convenient—and less expensive—for you to get the medications you take on a regular basis, such as those for managing high blood pressure, cholesterol and diabetes. When you call, be sure to have the medication name and your doctor's contact information handy.

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Flexible Spending Account (FSA)

Flexible spending accounts help you pay for certain health care and dependent care expenses that are not covered by the medical, dental or vision plans—copays, coinsurance and amounts above benefit maximums to name a few. Likewise, many people have regular daycare expenses for dependent children.

Both the health care and dependent care spending accounts are administered by CoreSource. These flexible spending accounts provide tax advantages by letting you set aside pre-tax dollars to pay certain health care and dependent care expenses.

Learn more about FSAs.

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