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
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,650/$3,300
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
10% coinsurance after deductible
Specialist Visit
10% coinsurance after deductible
Urgent Care
10% coinsurance after deductible
Emergency Room
$250 copay and 10% coinsurance after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 after deductible
Preferred Brand
$35 after deductible
Non-Preferred Brand
$70 after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay after deductible
Preferred Brand
$70 copay after deductible
Non-Preferred Brand
$140 copay after deductible
Out-of-Network
Deductible (Individual/Family)
$4,500/$8,400
Out-of-Pocket Max (Individual/Family)
$10,500/$15,000
Preventive Care
30% coinsurance after deductible
Primary Care Visit
30% coinsurance after deductible
Specialist Visit
30% coinsurance after deductible
Urgent Care
30% coinsurance after deductible
Emergency Room
$250 copay and 10% coinsurance 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
Monthly Plan Cost
Employee Only: $0.00
Employee and Spouse: $257.00
Employee and Child(ren): $222.00
Employee and Family: $351.00
Cigna PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
$25 copay
Specialist Visit
$25 copay
Urgent Care
$50 copay
Emergency Room
$250 copay and 10% coinsurance after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay
Preferred Brand
$35 copay
Non-Preferred Brand
$70 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay, deductible does not apply
Preferred Brand
$70 copay, deductible does not apply
Non-Preferred Brand
$140 copay, deductible does not apply
Out-of-Network
Deductible (Individual/Family)
$1,500/$3,000
Out-of-Pocket Max (Individual/Family)
$10,500/$21,000
Preventive Care
30% coinsurance after deductible
Primary Care Visit
30% coinsurance after deductible
Specialist Visit
30% coinsurance after deductible
Urgent Care
30% coinsurance after deductible
Emergency Room
$250 copay and 10% coinsurance 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
Monthly Plan Cost
Employee Only: $13.00
Employee and Spouse: $338.00
Employee and Child(ren): $294.00
Employee and Family: $459.00
Cigna HMO/EPO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$35 copay
Urgent Care
$50 copay
Emergency Room
$250 copay and 10% coinsurance after deductible
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
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Monthly Plan Cost
Employee Only: $64.00
Employee and Spouse: $394.00
Employee and Child(ren): $330.00
Employee and Family: $540.00
Kaiser HMO (CA)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$35 copay
Urgent Care
$20 copay
Emergency Room
$100 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$35
Specialty
20% coinsurance with $150 max
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$50
Monthly Plan Cost
Employee Only: $14.00
Employee and Spouse: $326.00
Employee and Child(ren): $273.00
Employee and Family: $456.00
Kaiser HMO (GA)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,500/$3,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$30 copay
Urgent Care
$30 copay
Emergency Room
$100 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$35
Non-Preferred Brand
$40
Specialty
20% coinsurance, up to $150
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$70
Specialty
Not covered
Monthly Plan Cost
Employee Only: $13.00
Employee and Spouse: $318.00
Employee and Child(ren): $267.00
Employee and Family: $445.00
Kaiser HMO (HI)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$2,500/$7,500
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$15 copay
Urgent Care
$15 copay
Emergency Room
$75 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$35
Non-Preferred Brand
$35
Specialty
$200
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$70
Non-Preferred Brand
$70
Specialty
Not covered
Monthly Plan Cost
Employee Only: $13.00
Employee and Spouse: $314.00
Employee and Child(ren): $264.00
Employee and Family: $439.00