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 HDHP Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,400/$6,000
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
$0, after deductible
Specialist Visit
$0, after deductible
Urgent Care
$0, after deductible
Emergency Room
$0, after deductible
Retail Rx (Up to 30-Day Supply)
Tier 1
$10 copay after the deducible
Tier 2
$35 copay after the deducible
Tier 3
$70 copay after the deducible
Tier 4
Specialty medications must be filled through home delivery; otherwise you pay the entire cost of the prescription upon your first fill. Some exceptions may apply.
Retail Rx (Up to 90-Day Supply)
Tier 1
$25 copay after the deducible
Tier 2
$88 copay after the deducible
Tier 3
$175 copay after the deducible
Tier 4
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Tier 1
$25 copay after the deducible
Tier 2
$88 copay after the deducible
Tier 3
$175 copay after the deducible
Tier 4
Not covered
Out-of-Network
Deductible (Individual/Family)
$9,000/$18,000
Out-of-Pocket Max (Individual/Family)
$12,000/$24,000
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
$0
Retail Rx (Up to 30-Day Supply)
Tier 1
Not covered
Tier 2
Not covered
Tier 3
Not covered
Tier 4
Not covered
Retail Rx (Up to 90-Day Supply)
Tier 1
Not covered
Tier 2
Not covered
Tier 3
Not covered
Tier 4
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Tier 1
Not covered
Tier 2
Not covered
Tier 3
Not covered
Tier 4
Not covered
Monthly Plan Cost
(Note: The company contributes to your Health Savings Account.)
Employee Only: $80.00
Employee and Spouse/DP: $525.00
Employee and Child(ren): $475.00
Employee and Family: $725.00
Cigna SimplePlan
Benefit Highlights
In-Network (Network Only Plan)
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
$0
Primary Care Visit
$80
Specialist Visit
$125
Urgent Care
$250
Emergency Room
$1,000
Retail Rx (Up to 30-Day Supply)
Tier 1
$40
Tier 2
$70
Tier 3
$150
Tier 4
$250
Mail-Order Rx (Up to 90-Day Supply)
Tier 1
$120
Tier 2
$210
Tier 3
$450
Tier 4
$750
Monthly Plan Cost
Employee Only: $180.00
Employee and Spouse/DP: $565.00
Employee and Child(ren): $515.00
Employee and Family: $810.00