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 PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,500
Out-of-Pocket Max (Individual/Family)
$2,250/$4,500
Preventive Care
$0
Primary Care Visit
$25 copay
Specialist Visit
$40 copay
Urgent Care
$50 copay
Emergency Room
$250 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$40 copay
Non-Preferred Brand
$85 copay
Specialty
$45 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$80 copay
Non-Preferred Brand
$170 copay
Specialty
$45 copay for 30-day supply
Out-of-Network
Deductible (Individual/Family)
$500/$1,500
Out-of-Pocket Max (Individual/Family)
$6,500/$13,000
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
$250 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
50% coinsurance
Preferred Brand
50% coinsurance
Non-Preferred Brand
50% coinsurance
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Monthly Plan Cost
Employee Only: $165.00
Employee and Spouse/DP: $533.00
Employee and Child(ren): $405.00
Employee and Family: $752.00
Cigna HDHP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,300/$6,600
Out-of-Pocket Max (Individual/Family)
$3,425/$6,850
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)
Generic
$10 copay after deductible
Preferred Brand
$30 copay after deductible
Non-Preferred Brand
$50 copay after deductible
Specialty
30% after deductible, up to $250 per prescription
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay after deductible
Preferred Brand
$90 copay after deductible
Non-Preferred Brand
$150 copay after deductible
Specialty
30% after deductible, up to $250
Out-of-Network
Deductible (Individual/Family)
$3,300/$6,600
Out-of-Pocket Max (Individual/Family)
$7,000/$14,000
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
$0 after deductible
Retail Rx (Up to 30-Day Supply)
Generic
50% after deductible
Preferred Brand
50% after deductible
Non-Preferred Brand
50% after deductible
Specialty
50% after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Monthly Plan Cost
Employee Only: $117.00
Employee and Spouse/DP: $399.00
Employee and Child(ren): $303.00
Employee and Family: $582.00
Kaiser DHMO (CA Only)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$250/$500
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$30 copay
Urgent Care
$20 copay
Emergency Room
10% coinsurance after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Brand
$30 copay
Specialty
20% coinsurance up to $250 per prescription
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Brand
$60 copay
Specialty
Not covered
Monthly Plan Cost
Employee Only: $143.00
Employee and Spouse/DP: $415.00
Employee and Child(ren): $284.00
Employee and Family: $692.00