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 / HSA
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,300/$6,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
$0
Primary Care Visit
20% after deductible
Specialist Visit
20% after deductible
Urgent Care
20% after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
20% after deductible
Preferred Brand
20% after deductible
Non-Preferred Brand
20% after deductible
Specialty
20% after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
20% after deductible
Preferred Brand
20% after deductible
Non-Preferred Brand
20% after deductible
Specialty
20% after deductible
Out-of-Network
Deductible (Individual/Family)
$6,600/$12,000
Out-of-Pocket Max (Individual/Family)
$10,000/$20,000
Preventive Care
40% after deductible
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Urgent Care
40% after deductible
Emergency Room
20% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
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
Plan Cost
Employee Only: $0.00
Employee and Spouse: $165.98
Employee and Child(ren): $135.80
Employee and Family: $301.78
Cigna PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
$0
Primary Care Visit
$25 copay
Specialist Visit
$40 copay
Urgent Care
$50 copay
Emergency Room
$150 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Specialty
20% up to $200
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Specialty
20% up to $400 maximum
Out-of-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$8,000/$16,000
Preventive Care
40% after deductible
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Urgent Care
$100 copay
Emergency Room
$150 copay
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
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
Plan Cost
Employee Only: $57.30
Employee and Spouse: $277.92
Employee and Child(ren): $237.81
Employee and Family: $458.42
Kaiser HDHP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,300/$6,600
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
No charge
Primary Care Visit
20% after deductible
Specialist Visit
20% after deductible
Urgent Care
20% after deductible
Emergency Room
20% after deductible
Retail RX (Up to 30-Day Supply)
Generic
Deductible then $15 copay
Preferred Brand
Deductible then $35 copay
Non-Preferred Brand
Deductible then $70 copay for CO/GA/MD/OR/WA; Deductible then $35 copay for CA
Specialty
Deductible then 20% up to $250 for CA/CO/GA/OR/WA; Deductible then 20% up to $150 for MD (Mid-Atlantic)
Mail-Order RX (Up to 90-Day Supply)
Generic
Deductible then $30 copay
Preferred Brand
Deductible then $70 copay
Non-Preferred Brand
Deductible then $140 copay for CO/GA/MD/OR/WA; Deductible then $70 copay for CA
Specialty
Deductible then 20% up to $250 for CA/CO/GA/OR/WA; Deductible then 20% up to $150 for MD (Mid-Atlantic)
Plan Cost
Employee Only: $0.00
Employee and Spouse: $165.00
Employee and Child(ren): $135.00
Employee and Family: $299.50
Kaiser DHMO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$3,500/$7,000
Preventive Care
No charge
Primary Care Visit
$20 copay
Specialist Visit
$30 copay
Urgent Care
$30 copay for CO/GA/MD/OR;
$20 copay for CA & WA
Emergency Room
$200 copay waived if admitted
Retail RX (90-day supply for CO/GA/MD/OR/WA; 100-day supply for CA)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay for CO/GA/MD/OR/WA; $30 copay for CA
Specialty
20% up to $250 for CA/CO/GA/OR/WA; 20% up to $150 for MD (Mid-Atlantic)
Mail-Order RX (90-day supply for CO/GA/MD/OR/WA; 100-day supply for CA)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay for CO/GA/MD/OR/WA; $60 copay for CA
Specialty
20% up to $250 for CA/CO/GA/OR/WA;
20% up to $150 for MD (Mid-Atlantic)
Plan Cost
Employee Only: $57.00
Employee and Spouse: $276.00
Employee and Child(ren): $236.00
Employee and Family: $455.00