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 High Deductible Health Plan
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
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
$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)
$4,500/$9,000
Preventive Care
40% after deductible
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Urgent Care
20% 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
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Monthly Plan Cost
Earnings Under $75,000
Employee Only: $70.94
Employee and Spouse/DP: $711.43
Employee and Child(ren): $418.18
Employee and Family: $1,093.87
Earnings Between $75,000 – $119,999.99
Employee Only: $128.38
Employee and Spouse/DP: $841.54
Employee and Child(ren): $506.04
Employee and Family: $1,309.19
Earnings Between $120,000 – $179,999.99
Employee Only: $211.42
Employee and Spouse/DP: $990.42
Employee and Child(ren): $595.97
Employee and Family: $1,511.64
Earnings Greater than or Equal to $180,000
Employee Only: $256.46
Employee and Spouse/DP: $1,116.06
Employee and Child(ren): $679.06
Employee and Family: $1,684.67
Kaiser HMO
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
$30 copay
Specialist Visit
$30 copay
Urgent Care
$30 copay
Emergency Room
$150 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$25 copay
Non-Preferred Brand
$25 copay
Specialty
$25 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$50 copay
Non-Preferred Brand
$50 copay
Specialty
Not covered
Monthly Plan Cost
Earnings Under $75,000
Employee Only: $86.13
Employee and Spouse/DP: $640.28
Employee and Child(ren): $444.65
Employee and Family: $1,067.13
Earnings Between $75,000 – $119,999.99
Employee Only: $155.87
Employee and Spouse/DP: $749.01
Employee and Child(ren): $542.45
Employee and Family: $1,216.00
Earnings Between $120,000 – $179,999.99
Employee Only: $283.24
Employee and Spouse/DP: $940.40
Employee and Child(ren): $716.48
Employee and Family: $1,477.74
Earnings Greater than or Equal to $180,000
Employee Only: $295.15
Employee and Spouse/DP: $961.30
Employee and Child(ren): $737.33
Employee and Family: $1,506.94