Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Cigna $3,400 HDHP Base Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,400/$6,600
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
$0
Primary Care Visit
20% after the deductible
Specialist Visit
20% after the deductible
Urgent Care
20% after the deductible
Emergency Room
20% after the deductible
Retail Rx (Per 30-Day Supply)
Generic
$5 copay after deductible
Preferred Brand
$30 copay after deductible
Non-Preferred Brand
$75 copay after deductible
Specialty
Not covered
Pharmacy Network
Member Choice Cigna 90 Now
Formulary/PDL
Advantage
Retail Rx (Per 90-Day Supply)
Generic
$15 copay, deductible does not apply
Preferred Brand
$90 copay, deductible does not apply
Non-Preferred Brand
$225 copay, deductible does not apply
Specialty
Not covered
Mail-Order Rx (Per 90-Day Supply)
Generic
$15 copay, deductible does not apply
Preferred Brand
$90 copay, deductible does not apply
Non-Preferred Brand
$225 copay, deductible does not apply
Specialty
Specialty medications must be filled through home delivery; otherwise you pay the entire cost of the prescription upon your first fill.
Out-of-Network
Deductible (Individual/Family)
$9,000/$18,000
Out-of-Pocket Max (Individual/Family)
$12,000/$24,000
Preventive Care
Not covered
Primary Care Visit
50% coinsurance after deductible
Specialist Visit
50% coinsurance after deductible
Urgent Care
50% coinsurance
Emergency Room
$0 after deductible
Retail Rx (Per 30-Day Supply)
Generic
50% coinsurance after deductible
Preferred Brand
50% coinsurance after deductible
Non-Preferred Brand
50% coinsurance after deductible
Specialty
Not covered
Pharmacy Network
Member Choice Cigna 90 Now
Formulary/PDL
Advantage
Retail Rx (Per 90-Day Supply)
Generic
50% coinsurance after deductible
Preferred Brand
50% coinsurance after deductible
Non-Preferred Brand
50% coinsurance after deductible
Specialty
Not covered
Mail-Order Rx (Per 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Specialty medications must be filled through home delivery; otherwise you pay the entire cost of the prescription upon your first fill.
Monthly Plan Cost
Employee Only: $0.00
Employee and Spouse/DP: $226.11
Employee and Child(ren): $158.20
Employee and Family: $311.33
Cigna $1,000 PPO Buy-Up Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,000/$3,000
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
$25 copay
Specialist Visit
$50 copay
Urgent Care
$50 copay
Emergency Room
$350 copay
Pharmacy Network
Member Choice Cigna 90 Now
Formulary/PDL
Advantage
Retail Rx (Per 30-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$35 copay after deductible
Non-Preferred Brand
$70 copay after deductible
Specialty
Not covered
Retail Rx (Per 90-Day Supply)
Generic
$25 copay, deductible does not apply
Preferred Brand
$88 copay, deductible does not apply
Non-Preferred Brand
$175 copay, deductible does not apply
Specialty
Not covered
Mail-Order Rx (Per 90-Day Supply)
Generic
$25 copay, deductible does not apply
Preferred Brand
$88 copay, deductible does not apply
Non-Preferred Brand
$175 copay, deductible does not apply
Specialty
Specialty medications must be filled through home delivery; otherwise you pay the entire cost of the prescription upon your first fill.
Out-of-Network
Deductible (Individual/Family)
$5,000/$15,000
Out-of-Pocket Max (Individual/Family)
$10,000/$30,000
Preventive Care
50% coinsurance after deductible
Primary Care Visit
50% coinsurance after deductible
Specialist Visit
50% coinsurance after deductible
Urgent Care
50% coinsurance after deductible
Emergency Room
$350 copay
Pharmacy Network
Member Choice Cigna 90 Now
Formulary/PDL
Advantage
Retail Rx (Per 30-Day Supply)
Generic
50% coinsurance after deductible
Preferred Brand
50% coinsurance after deductible
Non-Preferred Brand
50% coinsurance after deductible
Specialty
Not covered
Retail Rx (Per 90-Day Supply)
Generic
50% coinsurance after deductible
Preferred Brand
50% coinsurance after deductible
Non-Preferred Brand
50% coinsurance after deductible
Specialty
Not covered
Mail-Order Rx (Per 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Specialty medications must be filled through home delivery; otherwise you pay the entire cost of the prescription upon your first fill.
Monthly Plan Cost
Employee Only: $273.39
Employee and Spouse/DP: $661.61
Employee and Child(ren): $493.75
Employee and Family: $910.96