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 Open Access Plus (OAP) IN
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$100/$300
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$25 copay
Urgent Care
$25 copay
Emergency Room
$200 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$25 copay
Non-Preferred Brand
$40 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10 copay
Preferred Brand
$50 copay
Non-Preferred Brand
$80 copay
Cigna PPO
Benefit Highlights
In-Network
Deductible (Individual/Family)
$300/$600
Out-of-Pocket Max (Individual/Family)
$2,500/$5,000
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$25 copay
Urgent Care
10% coinsurance
Emergency Room
$200 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$25 copay
Non-Preferred Brand
$40 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10 copay
Preferred Brand
$50 copay
Non-Preferred Brand
$80 copay
Out-of-Network
Deductible (Individual/Family)
$300/$600
Out-of-Pocket Max (Individual/Family)
$7,500/$15,000
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
10% after deductible
Emergency Room
$200 copay
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
Cigna High Deductible Health Plan (HDHP) with Health Savings Account (HSA)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000 ($3,200 individual within a family)
Preventive Care
$0
Primary Care Visit
10% coinsurance after deductible
Specialist Visit
10% coinsurance after deductible
Urgent Care
10% coinsurance after deductible
Emergency Room
10% coinsurance after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$25 copay after deductible
Non-Preferred Brand
$40 copay after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$50 copay after deductible
Non-Preferred Brand
$80 copay after deductible
Out-of-Network
Deductible (Individual/Family)
$2,000/$4,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000 ($6,000 individual within a family)
Preventive Care
30% coinsurance after deductible
Primary Care Visit
30% coinsurance after deductible
Specialist Visit
30% coinsurance after deductible
Urgent Care
10% coinsurance after deductible
Emergency Room
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
HMSA PPO (Hawaii Only)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0
Out-of-Pocket Max (Individual/Family)
$2,500/$7,500
Preventive Care
$0
Primary Care Visit
$12 copay after deductible
Specialist Visit
$12 copay after deductible
Urgent Care
$12 copay after deductible
Emergency Room
20% coinsurance after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$7 copay after deductible
Preferred Brand
$30 copay after deductible
Non-Preferred Brand
$30 copay after deductible
Specialty
Preferred: $100 copay after deductible
Non-preferred: $200 copay after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
$11 copay after deductible
Preferred Brand
$65 copay after deductible
Non-Preferred Brand
$65 copay after deductible
Specialty
N/A
Out-of-Network
Deductible (Individual/Family)
$100/$300
Out-of-Pocket Max (Individual/Family)
$2,500/$7,500
Preventive Care
30% coinsurance
Primary Care Visit
30% coinsurance after deductible
Specialist Visit
30% coinsurance after deductible
Urgent Care
30% coinsurance after deductible
Emergency Room
20% 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