Medical Benefits
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.cigna.com.
In-Network |
Out-of-Network |
|
|---|---|---|
Deductible |
$1,500/$3,000 |
$3,000/$9,000 |
Out-of-Pocket Max |
$6,500/$13,000 |
$15,000/$45,000 |
Member Coinsurance |
30% |
50% |
Physician Visits |
||
Preventive Care |
Fully Covered |
Deductible + 50% |
Primary Care Visit |
$40 Copay |
Deductible + 50% |
Specialist Visit |
$50 Copay |
Deductible + 50% |
Hospital Services |
||
Physician Services |
Deductible + 30% |
Deductible + 50% |
Inpatient Hospitalization |
Deductible + 30% |
Deductible + 50% |
Outpatient Surgery |
Deductible + 30% |
Deductible + 50% |
Basic Outpatient Diagnostics |
Deductible + 30% |
Deductible + 50% |
Urgent Care |
$100 Copay |
Deductible + 50% |
Emergency Room |
$300 Copay, then Deductible + 30% |
$300 Copay, then Deductible + 30% |
Retail Prescriptions |
||
Tier 1 - Preferred Generic |
$10 |
50% Coinsurance |
Tier 2 - Preferred Brand |
$50 |
50% Coinsurance |
Tier 3 - Non Preferred |
$80 |
50% Coinsurance |
Tier 4 - Specialty |
Preferred: 20% up to a max of $250 |
50% Coinsurance |
Mail Order Prescriptions |
||
Tier 1 - Preferred Generic |
$20 |
50% Coinsurance |
Tier 2 - Preferred Brand |
$100 |
50% Coinsurance |
Tier 3 - Non Preferred |
$160 |
50% Coinsurance |
Tier 4 - Specialty |
Preferred: 20% up to a max of $250 |
50% Coinsurance |
Per Pay Period Cost |
|
|---|---|
Employee Only |
$55.43 |
Employee + Spouse |
$241.47 |
Employee + Child(ren) |
$219.12 |
Employee + Family |
$444.15 |
Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.
Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.cigna.com.
In-Network |
Out-of-Network |
|
|---|---|---|
Deductible |
$3,400/$6,800 |
$6,800/$13,600 |
Out-of-Pocket Max |
$7,500/$15,000 |
$20,000/$60,000 |
Member Coinsurance |
0% |
50% |
Physician Visits |
||
Preventive Care |
Fully Covered |
Deductible + 50% |
Primary Care Visit |
Deductible |
Deductible + 50% |
Specialist Visit |
Deductible |
Deductible + 50% |
Hospital Services |
||
Physician Services |
Deductible |
Deductible + 50% |
Inpatient Hospitalization |
Deductible |
Deductible + 50% |
Outpatient Surgery |
Deductible |
Deductible + 50% |
Basic Outpatient Diagnostics |
Deductible |
Deductible + 50% |
Urgent Care |
Deductible |
Deductible + 50% |
Emergency Room |
$500 Copay + Deductible |
$500 Copay + Deductible |
Retail Prescriptions |
||
Tier 1 - Preferred Generic |
$10 |
Deductible + 50% |
Tier 2 - Preferred Brand |
$50 |
Deductible + 50% |
Tier 3 - Non Preferred |
$80 |
Deductible + 50% |
Tier 4 - Specialty |
Preferred: 20% up to a max of $250 |
Deductible + 50% |
Mail Order Prescriptions |
||
Tier 1 - Preferred Generic |
$20 |
Deductible + 50% |
Tier 2 - Preferred Brand |
$100 |
Deductible + 50% |
Tier 3 - Non Preferred |
$160 |
Deductible + 50% |
Tier 4 - Specialty |
Preferred: 20% up to a max of $250 |
Deductible + 50% |
Per Pay Period Cost |
|
|---|---|
Employee Only |
$48.02 |
Employee + Spouse |
$209.21 |
Employee + Child(ren) |
$189.85 |
Employee + Family |
$384.81 |