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 HSA-Compatible High Deductible Health Plan (HDHP)
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,500/$5,000
(Individual/Individual within a Family/Family)
$5,000/$6,550/$10,000
Preventive Care
$0
Primary Care Visit
20% coinsurance after deductible
Specialist Visit
20% coinsurance after deductible
Urgent Care
20% coinsurance after deductible
Emergency Room
20% coinsurance after deductible
Retail Rx (Up to 30-Day Supply)
Generic
30% coinsurance after deductible
Preferred Brand
40% coinsurance after deductible
Non-Preferred Brand
50% coinsurance after deductible
Mail-Order Rx (Up to 90-Day Supply)
Generic
30% coinsurance after deductible
Preferred Brand
40% coinsurance after deductible
Non-Preferred Brand
50% coinsurance after deductible
Out-of-Network
Deductible (Individual/Family)
$2,500/$5,000
(Individual/Individual within a Family/Family)
$5,000/$6,550/$10,000
Preventive Care
Ages 0-16: 40% coinsurance after deductible
Ages 17+: Not covered
Primary Care Visit
40% coinsurance after deductible
Specialist Visit
40% coinsurance after deductible
Urgent Care
20% coinsurance after deductible
Emergency Room
20% 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
Cigna OAP IN
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$750/$2,250
Preventive Care
$0
Primary Care Visit
$30 copay
Specialist Visit
$40 copay
Urgent Care
$50 copay
Emergency Room
$100 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$15 copay
Preferred Brand
30% coinsurance with a maximum of $60
Non-Preferred Brand
50% coinsurance with a maximum of $75
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay
Preferred Brand
30% coinsurance with a maximum of $75
Non-Preferred Brand
50% coinsurance with a maximum of $150
Kaiser HMO (California)
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
$20 copay
Emergency Room
$100 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$20 copay
Non-Preferred Brand
$20 copay (if authorized)
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$40 copay
Non-Preferred Brand
Not covered
Kaiser HMO (Colorado)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$2,000/$4,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$30 copay
Urgent Care
$30 copay
Emergency Room
$250 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay
Specialty
20% coinsurance not to exceed $250
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Specialty
Not covered
Kaiser HMO (Portland, OR)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$1,750/$3,500
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$25 copay
Urgent Care
$25 copay
Emergency Room
$250 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay (if authorized)
Specialty
20% coinsurance not to exceed $250
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$120 copay
Specialty
Not covered
Kaiser HMO (Seattle, WA)
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$2,000/$4,000
Preventive Care
$0
Primary Care Visit
$20 copay
Specialist Visit
$30 copay
Urgent Care
$20 copay
Emergency Room
$250 copay (waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$60 copay (if authorized)
Specialty
20% coinsurance not to exceed $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
2x prescription cost share
Preferred Brand
2x prescription cost share
Non-Preferred Brand
2x prescription cost share
Specialty
2x prescription cost share