Medical Plan Options
| Basic HSA | HSA+ | PPO | |
|---|---|---|---|
| Embedded In Network Benefits | |||
| Deductible (Individual/Family) | $6,500/$13,000 | $3,000/$6,000 | $1,000/$2,000 |
| HSA Contribution* *can earn up to $500/$1000 | $100 / $200 | $100 / $200 | N/A |
| Out-of-Pocket Maximum (Individual/Family) | $7,500/$15,000 | $6,000/$12,000 | $2,000/$4,000 |
| Coinsurance | 75% | 80% | 90% |
| PCP / Specialist Visit | Deductible then 75% | Deductible then 80% | $15 copay / $20 copay |
| ER Visit | Deductible then 75% | Deductible then 80% | $100 copay |
| Urgent care | Deductible then 75% | Deductible then 80% | $50 copay |
| Inpatient | Deductible then 75% | Deductible then 80% | Deductible then 90% |
| Outpatient | Deductible then 75% | Deductible then 80% | Deductible then 90% |
| Lab / X-Ray | Deductible then 75% | Deductible then 80% | Deductible then 90% |
| CT/PET/MRI | Deductible then 75% | Deductible then 80% | Deductible then 90% |
| Pharmacy Deductible | Combined with Med | Combined with Med | Combined with Med |
| Tier 1 (Generic) | Deductible then $15 | Deductible then $10 | $5 copay no deductible |
| Tier 2 (Preferred Brand) | Deductible then $30 | Deductible then $40 | $10 copay no deductible |
| Tier 3 (Non-Preferred Brand) | Deductible then $45 | Deductible then $60 | $20 copay no deductible |
| Tier 4 (Specialty) | Deductible then 25% up to $125 | Deductible then 20% up to $125 | 10% coinsurance up to $125 |
| 90-day Retail / Mail Order | 2X retail | 2X retail | 2X retail |
| Out-of-Network Benefits | |||
| Deductible (Individual/Family) | $8,000/$16,000 | $8,000/$16,000 | $3,000/$6,000 |
| Out-of-Pocket Maximum (Individual/Family) | $10,000/$20,000 | $10,000/$20,000 | $4,000/$8,000 |
| Coinsurance | 50% | 50% | 70% |
| Rx | Not covered | Not covered | Not covered |
Employees can elect the medical and prescription drug plan without enrolling in the dental or vision plan.
Employee Contributions
| Weekly Employee Contribution | Bi-weekly Employee Contribution | |
|---|---|---|
| Medical Basic HSA Plan | ||
| Employee | $0.00 | $0.00 |
| Employee + spouse | $33.32 | $66.64 |
| Employee + child(ren) | $30.15 | $60.29 |
| Family | $47.60 | $95.20 |
| Medical HSA+ Plan | ||
| Employee | $31.02 | $62.05 |
| Employee + spouse | $65.15 | $130.30 |
| Employee + child(ren) | $58.94 | $117.89 |
| Family | $93.07 | $186.15 |
| Medical PPO Plan | ||
| Employee | $105.78 | $211.56 |
| Employee + spouse | $211.03 | $422.06 |
| Employee + child(ren) | $190.93 | $381.86 |
| Family | $301.47 | $602.94 |
Working Spouse Adjustments
| Weekly Employee Contribution | Bi-weekly Employee Contribution | |
|---|---|---|
| Basic HSA Plan | ||
| EE + spouse with Adjustment | $56.40 | $112.80 |
| Employee + family with adjustment | $70.68 | $141.35 |
| HSA+ Plan | ||
| EE + spouse with Adjustment | $88.23 | $176.46 |
| Employee + family with adjustment | $116.15 | $232.30 |
| PPO Plan | ||
| EE + spouse with Adjustment | $234.11 | $468.21 |
| Employee + family with adjustment | $324.55 | $649.09 |
Virtual Care
Between your responsibilities at work and in your day-to-day life, you stay busy. And, while you may plan to maintain or even improve your health, it’s not always easy to make time for routine and preventive care. After all, doctors’ appointments traditionally involve time and travel — and that usually means taking time off of work. Virtual primary care is through MDLIVE. This convenient new option makes it easy to connect to a board-certified primary care physician (PCP) for routine care, plus preventive care with a virtual wellness screening — all on a schedule that works for you. Best of all, virtual primary care is available to you and your eligible dependents as part of your health benefits.
- Connect to care from just about anywhere via video or phone
- Get virtual primary care 7 days a week, 365 days a year, including flexible hours
- Access board-certified physicians for routine care, as well as preventive care with a wellness screening
- Choose your provider and build a relationship with the same PCP for follow-ups
- Receive prescriptions, if appropriate, that can be sent to a local or home-delivery pharmacy
- Schedule an appointment through myCigna.com in just minutes
- Undergo labs, blood work and biometrics at local facilities
- Receive referrals to specialists, when appropriate
Virtual primary care visits are quick, easy and affordable. To schedule an appointment:
- Access MDLIVE by logging into myCigna.com and click on “Talk to a doctor.” You can also call MDLIVE at 888.726.3171.
- Select virtual medical care
- Make an appointment whenever it’s convenient
Appointments are available via video or phone, whenever it’s most convenient for you. Wellness screenings are also available at no additional cost to you or your eligible dependents ages 18+, as part of preventive care.
1. Cigna provides access to virtual care through national telehealth providers as part of your plan. This service is separate from your health plan’s network and may not be available in all areas or under all plans. Referrals are not required. Video may not be available in all areas or with all providers. Refer to plan documents for complete description of virtual care services and costs. Virtual primary care through MDLIVE is only available for Cigna medical members aged 18 and older.
2. Limited to LabCorp and Quest labs contracted with MDLIVE for virtual primary care.
3. For customers who have a non-zero preventive care benefit, MDLIVE virtual wellness screenings will not cost $0 and will follow their preventive benefit.
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, or its affiliates. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.
961212 10/21 © 2021 Cigna. Some content provided under license.
Resources
Tip:
Choose other care for EMERGENCIES & anything that needs a hands-on exam, needs a test, cancer or other complicated conditions, chronic conditions, sprains/broken bones or injuries requiring bandaging, etc.–