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 Gold PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$1,000/$2,000
Out-of-Pocket Max (Individual/Family)
$5,000/$10,000
Preventive Care
No charge
Primary Care Visit
$20 copay
Specialist Visit
$40 copay
Urgent Care
$30 copay
Emergency Room
$150 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$15
Preferred Brand
$30
Non-Preferred Brand
$60
Specialty
Covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30
Preferred Brand
$60
Non-Preferred Brand
$150
Specialty
Covered
Out-of-Network
Deductible (Individual/Family)
$3,000/$6,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
No charge
Primary Care Visit
40% coinsurance
Specialist Visit
40% coinsurance
Urgent Care
40% coinsurance
Emergency Room
40% coinsurance
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
Weekly Plan Cost
(Includes medical, dental, and vision coverage)
Employee: $42.00
Employee + Spouse: $99.00
Employee + Child(ren): $95.00
Employee + Family: $132.00
Cigna Silver PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,000/$6,000
Out-of-Pocket Max (Individual/Family)
$8,550/$17,100
Preventive Care
No charge
Primary Care Visit
$30 copay
Specialist Visit
$60 copay
Urgent Care
$50 copay
Emergency Room
$150 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$20
Preferred Brand
$40
Non-Preferred Brand
$80
Specialty
Covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
$40
Preferred Brand
$80
Non-Preferred Brand
$200
Specialty
Covered
Out-of-Network
Deductible (Individual/Family)
$6,000/$12,000
Out-of-Pocket Max (Individual/Family)
$12,000/$24,000
Preventive Care
No charge
Primary Care Visit
50% coinsurance
Specialist Visit
50% coinsurance
Urgent Care
50% coinsurance
Emergency Room
50% coinsurance
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
Weekly Plan Cost
(Includes medical, dental, and vision coverage)
Employee: $30.00
Employee + Spouse: $69.00
Employee + Child(ren): $65.00
Employee + Family: $88.00