Medical and Prescription Drugs Plans (2024)

Ardent offers several medical plan options from which to choose, including a Preferred Provider Organization (PPO) plan, an Exclusive Provider Organization plan (EPO)*, an Open Access Plan (OAP) with Value-Based Pricing, and a High Deductible Health Plan (HDHP).These plans are administered by UMR, HealthScope, or HealthFirst, depending on the Ardent Facility that employs you.

The key to choosing the best plan for you and your family is understanding how plans work to maximizeyour coverage and savings opportunities. Each plan covers the same services but differs in the amount deducted per paycheck, your cost when receiving care, and how care is covered.

Your medical plan options:

HIGH DEDUCTIBLE HEALTH PLAN (HDHP)

Lower premiums and higher deductibles than traditional plans. In the HDHP, you must pay all costs from providers up to the deductible amount; thenthis plan begins to pay at the coinsurance level.

  • If you elect the HDHP, you can enroll in a Health Savings Account (HSA) to pay for eligible healthcareexpenses with tax-free dollars. Ardent will match your HSA contribution - up to $500 for individual coverage and up to $1,000 for all other coverages.

EXCLUSIVE PROVIDER ORGANIZATION (EPO)

An EPO plan offers members in-network coverage only. EPO plans don’t cover out-of-network care unless it’s an emergency. The plan does not require referrals from your primary care physician. This plan has copays, coinsurance and deductibles.

  • If you elect the EPO plan, you can contribute to a Health Care Flexible Spending Account (FSA) to pay for eligible expenses with pre-tax dollars.

PREFERRED PROVIDER ORGANIZATION (PPO)

PPO is a type of health plan that lets you choose where you go for carewithout a referral from your primary care physician.

A traditional PPO plan hascopays, coinsurance, and deductibles.

  • If you elect a PPO plan, you can contribute to a Health Care Flexible Spending Account (FSA) to pay for eligible expenses with pre-tax dollars.

OPEN ACCESS PLAN (OAP) WITH VALUE-BASED PRICING

Open Access Plans offer similar benefits to PPO plans. This plan does not require a referral from your primary care physician and has copays, coinsurance, and deductibles. This plan offers two network tiers, the Ardent Network and the Open Access which allows you the freedom to see any provider with built-in price protection.

  • If you elect the OAP, you can contribute to a Health Care Flexible Spending Account (FSA) to pay for eligible expenses with pre-tax dollars.

OAP plan member guide

OAP plan Frequently Asked Questions

What is Value-Based Pricing

Get the Most from Your Plans

Participate in the Wellness Program

You can earn significant rewards toward your medical premiums and get important information about your health when participating in our Wellness Program.

Get Care at an Ardent Facility

Ardent offers employees the best costs at facilities and providers that are part of our company and at some designated partner facilities. While not all specialties and services are available in the Ardent Network, employees will pay the least when they see Ardent Network providers. You also support our company and our team members!

Maximize Your Preventive Care Benefits

Preventive care—including immunizations and annual physicals—can keep you from getting seriously ill. Take advantage of preventive care services to help you maintain your health and prevent disease.

All Ardent medical plans cover in-network preventive care services, such as annual check-ups, immunizations, and age-appropriate screenings at 100 percent, so you pay nothing for these services that help keep you healthy.

Prescription Drug Coverage

All plans include prescription drug coverage, but the cost applies differently, depending on your chosen plan. OptumRX administers our prescription drug benefits. OptumRX will help you fill, refill, understand, and manage your prescriptions. OptumRX offers a convenient home delivery service and in-store pickup for receiving prescription drugs that you take on an ongoing basis. You can manage your prescriptions and track orders 24/7 at the OptumRX website.

Visit OptumRX to find participating pharmacies.

Quantum Health

Ardent partners with Quantum Health to provide you with one place to start when you need help with healthcare benefits. Care Coordinators do things like:

  • Get answers to claims, billing, and benefits questions
  • Find in-network providers
  • Verify coverage and get prior approval if needed
  • Contact providers to coordinate your treatment
  • Review your care options
  • Replace ID cards

Quantum Health is your one resource to contact whenever you need help with your benefits, and they are just a tap, click, or call away. Visit www.ardentcarecoordinators.com orcall your Care Coordinators at 888-295-9299.

Click here to learn more about Quantum Health

Teladoc

Teladoc is a telemedicine service that offers convenient and confidential access to doctors 24 hours a day, 7 days a week, 365 days a year - from anywhere by phone or video. Our plan offers visits for mental health (psychiatry and therapy), dermatology, and general medicine. The cost will vary depending on your Ardent medical plan.

Visit Teladoc.com or call 1-800-TELADOC (835-2362).

Benefits Plans Details

For complete details of the health care plan, please refer to the Summary Plan Description or Summary of Benefits.

See our Eligibility and Enrollment page for details on who can enroll in health care coverage.

Need contact information? Click here for details.

Medical Plan Exclusions

No coverage will be offered at the Northwest Texas Healthcare System (TX), Presbyterian Health Services (NM), or Ascension St. John (OK) except for emergency, mental health, and alcohol/drug treatment.

No coverage will be offered at the St. Francis Health System (OK) except for emergency, mental health, alcohol/ drug treatment, and pediatric services (for members under age 17).

No coverage will be offered at Akumin Amarillo/PreferredImaging (TX).

No coverage will be offered at CHRISTUS Trinity Mother Frances Health System except for emergency and NICU services for newborns under 34 weeks.

Services at Texas Spine and Joint will be covered out-of-network (based on the plan elected), except for emergency services and Ear, Nose, and throat (ENT) procedures.

Medical and Prescription Drugs Plans (2024)
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