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 Health Savings Account (HSA) Open Access Plus CDHP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room
10% 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
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
Out-of-Network
Deductible (Individual/Family)
$3,000/$6,000
Out-of-Pocket Max (Individual/Family)
$9,000/$18,000
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Per-Pay-Period Plan Cost
Employee Only: $0.00
Employee + Spouse/DP: $116.80
Employee + Child(ren): $66.05
Employee + Family: $166.86
Cigna Open Access Plus (PPO)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$20 copay
Urgent Care
$25 copay
Emergency Room
$150 copay after deductible (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay
Preferred Brand
$90 copay
Non-Preferred Brand
$150 copay
Out-of-Network
Deductible (Individual/Family)
$1,000/$2,000
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
$150 copay after deductible (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Per-Pay-Period Plan Cost
Employee Only: $53.73
Employee + Spouse/DP: $248.21
Employee + Child(ren): $153.12
Employee + Family: $354.59
Kaiser HMO (CA)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$30 copay
Specialist Visit
$30 copay
Urgent Care
$30 copay
Emergency Room
$150 copay per visit
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay
Preferred/Non-Preferred Brand
$30 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$30 copay
Preferred/Non-Preferred Brand
$60 copay
Per-Pay-Period Plan Cost
Employee Only: $37.40
Employee + Spouse/DP: $181.00
Employee + Child(ren): $112.19
Employee + Family: $246.82
Kaiser HMO (WA)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$30 copay
Specialist Visit
$30 copay
Urgent Care
$30 copay
Emergency Room
$150 copay
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay
Preferred Brand
$30 copay
Mail-Order Rx (Up to 100-Day Supply)
Generic
$30 copay
Preferred Brand
$60 copay
Per-Pay-Period Plan Cost
Employee Only: $27.23
Employee + Spouse/DP: $131.80
Employee + Child(ren): $81.69
Employee + Family: $179.72