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 Medical OAP PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,500/$3,000
Out-of-Pocket Max (Individual/Family)
$3,750/$7,500
Preventive Care
$0
Primary Care Visit
$45
Specialist Visit
$50
Urgent Care
$50
Emergency Room
$100
Retail Rx (Up to 30-Day Supply)
Generic
$25
Preferred Brand
$45
Non-Preferred Brand
$60
Mail-Order Rx (Up to 90-Day Supply)
Generic
$50
Preferred Brand
$90
Non-Preferred Brand
$120
Out-of-Network
Deductible (Individual/Family)
$3,000/$6,000
Out-of-Pocket Max (Individual/Family)
$10,000/$20,000
Preventive Care
40%
Primary Care Visit
40%
Specialist Visit
40%
Urgent Care
$50
Emergency Room
$100
Retail Rx (Up to 30-Day Supply)
Generic
50%
Preferred Brand
50%
Non-Preferred Brand
50%
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Plan Cost
Weekly
Employee Only: $41.79
Employee and Spouse: $126.67
Employee and Child(ren): $101.86
Employee and Family: $188.58
Biweekly
Employee Only: $83.59
Employee and Spouse: $253.35
Employee and Child(ren): $203.73
Employee and Family: $377.15
Cigna Medical OAP HDHP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,500/$5,000
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
$0
Primary Care Visit
$0*
Specialist Visit
$0*
Urgent Care
$0*
Emergency Room
$0*
Retail Rx (Up to 30-Day Supply)
Generic
$0*
Preferred Brand
$0*
Non-Preferred Brand
$0*
Mail-Order Rx (Up to 90-Day Supply)
Generic
$0*
Preferred Brand
$0*
Non-Preferred Brand
$0*
*After Deductible
Out-of-Network
Deductible (Individual/Family)
$5,000/$10,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
30%
Primary Care Visit
30%
Specialist Visit
30%
Urgent Care
$0
Emergency Room
$0
Retail Rx (Up to 30-Day Supply)
Generic
$0
Preferred Brand
$0
Non-Preferred Brand
$0
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Plan Cost
Weekly
Employee Only: $31.38
Employee and Spouse: $88.82
Employee and Child(ren): $73.45
Employee and Family: $130.53
Biweekly
Employee Only: $62.77
Employee and Spouse: $177.64
Employee and Child(ren): $149.91
Employee and Family: $261.05
Cigna Medical OAP EPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,500/$3,000
Out-of-Pocket Max (Individual/Family)
$3,750/$7,500
Preventive Care
$0
Primary Care Visit
$45
Specialist Visit
$50
Urgent Care
$50
Emergency Room
$100
Retail Rx (Up to 30-Day Supply)
Generic
$25
Preferred Brand
$45
Non-Preferred Brand
$60
Mail-Order Rx (Up to 90-Day Supply)
Generic
$50
Preferred Brand
$90
Non-Preferred Brand
$120
Plan Cost
Weekly
Employee Only: $36.26
Employee and Spouse: $101.20
Employee and Child(ren): $82.48
Employee and Family: $166.04
Biweekly
Employee Only: $75.52
Employee and Spouse: $202.39
Employee and Child(ren): $164.96
Employee and Family: $332.08