Quantum Care 750

PLAN OVERVIEW

The Quantum Care 750 option is an EPO plan. Employees who enroll in this plan have set copays for health care services such as doctor’s office visits or Urgent Care visits. When you need hospital care or MRIs, CTs or PET scans, you must pay your deductible before the plan pays part of the bill (called co-insurance).

Quantum Care 750 is administered by a Third-Party Administrator (TPA) called Allegiance (owned by Cigna). However, if you are enrolled in this plan, your medical coverage will be managed through Quantum. You may see either vendor name (Allegiance or Quantum) throughout your care. The network for the Quantum Care 750 plan is through Cigna.

WHERE YOU CAN GO FOR CARE

Network Doctors: Doctors in the Cigna Open Access Plus network are considered “network” providers. All network provider services will receive the same level of benefit coverage, i.e., there are no tiers for doctors.
Preferred Hospitals (sometimes called Tier 1): Preferred Hospitals are a select group of hospitals within the Cigna Open Access Plus network. When you use Preferred Hospitals, you will receive the highest level of benefit coverage and pay the lowest out-of-pocket costs. To see a list of Preferred Hospitals, click here.
Network Hospitals (sometimes called Tier 2): Any hospital within the Cigna Open Access Plus network. Your cost is higher when you go to a Network Hospital that is not considered a Preferred Hospital.
Out-of-Network: There is no coverage under this plan option for services or care you receive from a doctor or hospital that is not in network unless it is for a true emergency.

To find a doctor or facility in the Cigna Open Access Plus network:

Visit MyQHresource.com
Click Find a Provider in the bar at the bottom of the screen
On the next page click Find Provider

To get the most up to date information, please contact Quantum at 1-877-MyTHRLink (1-877-698-4754), prompt 2, press 1.

WHAT YOU PAY FOR CARE

Plan Features	Quantum Care 750
	Cigna Open Access Plus Network Doctors, Preferred Hospitals and Free-standing Facilities⁶	Cigna Open Access Plus Network Hospitals¹
Network	National network with preferred hospitals
Deductible	$750 individual $2,250 family	$3,500 individual $10,500 family
Medical and Rx Out-of-Pocket Maximum¹	$6,850 individual / $13,700 family
Office Visits	$30 copay for primary care doctor; $50 copay for specialist
Maternity Office Visits	$30 copay for initial office visit; no cost for additional visits
Inpatient Hospital Care	10% after deductible	70% after deductible
Virtual Care Services: MDLive	$0
Emergency Room	$200 copay, then 10% after deductible
Urgent Care Center	$50 copay
Outpatient Surgery²	Office visit copay applies; 10% after deductible if not in doctor’s office	70% after deductible if not in doctor’s office
Routine Physicals³	$0
Well-Woman/Man Exams³ (Including Pap Test or PSA Test)³	$0
Well-Child Care³ (Including Immunizations)³	$0
Colonoscopy³	$0
Mammography⁴	$0
Outpatient Diagnostic Lab & X-ray (Excluding MRI, CT, PET Scans)²	No additional charge if processed in doctor’s office; 10% after deductible if not in doctor’s office	70% after deductible
MRI, CT & PET Scans²	10% after deductible	70% after deductible
Outpatient Therapy⁵	$30 per visit	$50 per visit

1 Maximum includes deductible, co-insurance, and copays for medical care and prescriptions.

2 When your doctor requests tests or services such as lab work, X-rays, MRIs, CT scans, physical therapy, or rehabilitation at a free-standing facility that isn’t affiliated with a hospital, you should check to make sure they are in-network. Check with your insurance carrier to verify whether a facility and/or doctor is covered under your plan and to learn how much your coinsurance would be.

3 Well exams are covered in full if the claims administrator determines the physical is for preventive care. Additional screenings or services will be considered diagnostic services and will be covered after you pay the applicable copay or deductible and coinsurance. At the time of your preventive care visit, if other services are performed that are not preventive services, as determined by the claims administrator, they will not be paid at 100% even if they are submitted as part of a claim for preventive care.

4 One per year is covered. You pay the coinsurance for additional mammograms.

5 Up to a combined total of 60 visits per year are covered for outpatient physical, occupational, and speech therapy. Pulmonary and rehabilitation services are covered up to 20 visits. Up to 36 cardiac rehabilitation visits are covered.

6 If you have a medical condition that requires care at a facility that is not on the Preferred Hospital list, contact Quantum PRIOR to receiving care/treatment. If expertise is limited at the facilities on the Preferred Hospital list, meaning you are not able to get treatment at a Preferred Hospital, your benefits may be pre-approved to be paid as though you had used a Preferred Hospital (ie: your benefits may pay at a higher level, lowering your cost for services). However, this only applies if Quantum pre-approves the covered services/supplies for the condition to be provided by or arranged by a designated facility/other provider not on the Preferred Hospital list. The pre-approval by Quantum must be completed prior to care being received. If you have any questions or issues, please contact Benefits Support at 1-877-698-4754 prompt 9.

WHAT YOU PAY EACH PAYCHECK

Click here to view your cost per paycheck.

FEATURES

Check out the features of the Quantum plan here.

WHO DO I CONTACT WITH QUESTIONS?

Quantum:
- Phone: 1-877-698-4754, prompt 2, press 1
- Web: MyQHresource.com
Benefits Support
- Speak with a member of Texas Health’s Benefit Support team by calling 1-877-MyTHRLink (1-877-698-4754) prompt 9 or emailing THRBenefitsSupport@texashealth.org.