• Per-paycheck contributions will apply to the SimplePay Health medical plan in 2025.
• Copays for specialty medications will be $40 for a 30-day supply at retail pharmacies and $80 for a 90-day supply via mail order.
• Urgent care copays are no longer tiered. You will pay $30 for an in-network urgent care visit and $80 for an out-of-network visit.

Looking to take a deeper dive? Review the medical plan comparison chart for details. 

SimplePay Health prescription drug coverage is administered by CVS Caremark. The CVS Caremark network includes major retail pharmacies like Walgreens, Costco, and, naturally, CVS. Your cost depends on the type of prescription you fill (generic, preferred brand, non-preferred brand, specialty) and the length of the fill (30-day or 90-day). With SimplePay Health, you’ll show the pharmacist your ID card and pay $0 when you pick up your prescriptions. You’ll pay your share via your monthly statement from SimplePay Health. 

Even though both Cigna and SimplePay Health use CVS Caremark as their prescription drug administrator, the amount you’ll pay out of pocket for prescriptions is different. Review the medical plan comparison chart for prescription drug copays.

As the name implies, it’s designed to make health insurance simpler. Plus, it could save you some serious cash. 

SimplePay Health uses a national network administered by Aetna, which is different from our current Cigna and Kaiser medical plans. When you need care, you’ll first search for a provider through the SimplePay Health app. 

At the time of your visit, you’ll present your ID card and pay $0 (including prescription pickups). With SimplePay Health, you pay for any covered services you receive through one convenient bill at the end of each month. If you need more time to pay the full bill, you can take advantage of 0% financing. 

For more information, check out the SimplePay Health page.

If you enroll in the SimplePay Health plan, you can’t elect or contribute further to a Health Savings Account (HSA), because the SimplePay Health plan doesn’t meet IRS requirements for HSA contributions. However, if you have HSA funds from 2024 or before, you can continue to use them for health care expenses, even after you move to SimplePay Health. Existing HSA funds are always yours to keep—you don’t forfeit them, and they don’t expire.

However, you can elect a Health Care FSA when you enroll in SimplePay Health. The FSA is a convenient, tax-free way to cover the costs detailed in your monthly SimplePay Health bill. If you enroll in a Health Care FSA for 2025, you’ll get a new virtual debit card issued by Benepass that you can use for your SimplePay Health copays.

You can look up providers and services on the SimplePay Health member portal or through the SimplePay Health app. Before you enroll, take a look at the SimplePay Health website for cost information. Providers are listed in tiers based on their quality rankings. The highest-quality providers cost you less. There’s also a schedule of copays that you can use to see the cost for common services like office visits, prescriptions, and more. If you’d like help evaluating costs, call a SimplePay Health Valet at 800-606-3564 for one-on-one assistance.

Once you find a provider that works for you and start receiving care, you’ll get one bill at the end of each month for all medical and prescription drug copays that you’re responsible for. You can use 2025 FSA and/or prior year HSA funds (if available) to cover the cost of your copays, or you can simply pay out of pocket, just like any other medical plan. If you need more time to pay your full bill, you can take advantage of 0% financing through SimplePay Health. See also “Can you tell me more about the Member Financial Onboarding Agreement?” below.

No, you aren’t required to use in-network providers. However, your copays are more expensive with out-of-network providers, you could be subject to balance billing, and the SimplePay Health plan doesn’t have an annual out-of-pocket maximum for out-of-network care.

First, check to see if your current provider is already in the Aetna network. If not, contact SimplePay Health for a Transition of Care form to continue care with your current doctor for an in-network price (up to six months). You can reach a SimplePay Health Valet at 800-606-3564 or at healthvalet@simplepayhealth.com.

Yes. You can use Mind Matters (powered by Lyra) with SimplePay Health. Mind Matters providers are in-network, so you may continue to see the same provider. Plus, Mind Matters providers are covered at the in-network level even beyond the first 16 sessions per year provided to you at no cost.

Yes! You have access to all Premise Health services, including Cloud Care in Pleasanton and 24/7 virtual care. The best part? It costs you $0. Use the My Premise Health app, visit MyPremiseHealth.com, or call 844-737-0894 to get started.

Absolutely! All Maven services, including support for fertility, surrogacy, adoption, and more are available to you automatically at no cost. If you’re planning to expand your family, or if you already have and could use a little extra support, check out what Maven has to offer.

In most cases, it’s not in your best interest financially to have double medical plan coverage due to rules commonly referred to as “coordination of benefits.” We strongly recommend that you have a detailed conversation with a SimplePay Health Valet before enrolling in secondary coverage. You can reach a Health Valet at 800-606-3564 or via email for assistance.

If your first year enrolling in SimplePay, then yes, and this is important! You must complete the financial agreement no later than November 30. Otherwise, you won’t be eligible to remain in the SimplePay Health plan beginning January 1. The Member Financial Onboarding Agreement is a legal requirement, because the plan provides the funding for your copays up front, and you’re responsible for paying the plan back.

If this is you enrolled in SimplePay last year, you do not need to complete the financial agreement again.

An important benefit of your SimplePay Health plan is a financial line of credit, available to you up to the amount of your out-of-pocket maximum. This line of credit allows you, if you like, to spread payment of your out-of-pocket health care expenses over an extended time period at a 0% interest rate. This can help avoid the need to use high-interest-rate financing to pay for your out-of-pocket costs. And don’t worry, there’s no credit check, and no impact to your credit report.

Since this is a financial line of credit, you’ll be required to electronically review and sign a financial disclosure and authorization document and to provide your preferred account and method for payments. This account will remain on file and can be used either for convenience or to process late payments. Of course, you can still pay your monthly statements by mail or online if you want. You’re required to complete this financial authorization document to participate in the SimplePay Health plan.

When you receive your monthly statement, you can choose whether to pay it in full or pay the minimum amount due. If you pay in full, you’ll receive a 1.5% credit on your next monthly statement. If not, you’ll be asked to pay the minimum amount due (typically $100, or your balance, whichever is less). If the minimum amount ever becomes unaffordable, please reach out to your SimplePay Health Valet for assistance in reducing the minimum amount due.

SimplePay Health is a comprehensive medical plan, but simpler. There’s no catch, but there are a few things to consider.

Are you contributing to your Health Savings Account (HSA) to save for health care in retirement? You can’t make HSA contributions while you’re enrolled in SimplePay Health, because IRS regulations require you to be enrolled in a “qualified high-deductible health plan.” You can still save on taxes by using a Flexible Spending Account (FSA) instead.

Do you have providers that aren’t in the SimplePay Health network? Depending on how much those providers charge for their services, you could still come out ahead, but take the time to find out so you’re not surprised in January.

With SimplePay Health, you’ll miss out on all the math of traditional medical plans—like figuring out deductibles, coinsurance percentages, network discounts, and receiving multiple bills each month. Because as fun as that sounds, SimplePay Health eliminates all that for you and tells you your copay up front.

Have a worry or concern we haven’t addressed? Reach out to a SimplePay Health Valet at 800-606-3564 or at healthvalet@simplepayhealth.com for assistance.

• Your contribution rates will slightly increase.
• ID cards for all Cigna plans are now digital-only. You won’t receive an ID card in the mail.
• The annual in-network out-of-pocket maximum in the Cigna Core Plan and Smart Plan is increasing.
• Per federal law, the deductible in the Cigna Smart Plan is increasing.
• Copays are changing for specialty drugs. A 30-day supply at a retail pharmacy will cost $80, and a 90-day supply via mail order will cost $160.

Looking to take a deeper dive? Sign up for a one-on-one appointment, read the plan summaries, and review the medical plan comparison chart.

You bet! Sign up for a one-on-one appointment with Olga Reyna, your dedicated Benefits Buddy for all things Cigna. You can also contact Cigna 24/7/365 at 877-505-5870.

• Per federal law, the deductible in the Kaiser Smart Plan is increasing.
• If you live in Georgia or California, fertility services will cost you less out of pocket in the Kaiser Traditional Plan (to align with the Colorado benefit).
• Your contribution rates will increase.

Looking to take a deeper dive? Read the plan summaries, and review the medical plan comparison chart.
 

Kaiser takes an under-one-roof approach to health care. That means your primary care physician—and doctors they refer you to—will be Kaiser doctors. Those doctors likely all work in the same building, and they’ll coordinate your care together. Here’s the catch: Unless it’s an emergency, your care is only covered when you visit Kaiser doctors and facilities (no coverage for out-of-network services).

If you’re considering enrolling in a Kaiser plan, keep these things in mind:

• All your doctors must be Kaiser doctors, so you may have to switch from the providers you visit now.
• You’ll need to visit Kaiser facilities for medical care. Do you and your dependents live near a Kaiser facility? How often might you need to travel out of Kaiser coverage areas?
• Your prescriptions must be filled at Kaiser pharmacies.
• The Kaiser Traditional Plan has no deductible and the lowest out-of-pocket maximum of all Workday medical plans.

You bet. Get in touch with Kaiser by texting 773-974-3113, Monday through Friday, 6:00 a.m. to 6:00 p.m. Pacific time, or by calling 800-324-9208 to speak to a representative Monday through Friday, 7:00 a.m. to 6:00 p.m. Pacific time.