Medical Benefits

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.cigna.com.

	In-Network	Out-of-Network
Deductible i (Individual/Family)	$1,000/$2,000	$2,000/$4,000
Member Coinsurance	20%	40%
Out-of-Pocket Max i(Individual/Family)	$2,500/$5,000	$5,000/$10,000
Physician Visits
Primary Care Visit	$25 Copay / $0 for Child For children under 19 years of age	Deductible then 40%
Specialist Visit	$50 Copay	Deductible then 40%
Routine Preventive	Covered 100%	Not Covered
Hospital Services
Inpatient Hospitalization	Deductible then 20%	Deductible then 40%
Physician Services	Deductible then 20%	Deductible then 40%
Outpatient Surgery	Deductible then 20%	Deductible then 40%
Outpatient Diagnostics	Deductible then 20%	Deductible then 40%
Urgent Care	$25 Copay	Deductible then 40%
Emergency Room	$100 Copay + 20%	$100 Copay + 20%

Prescription Card
Retail	$15 / $45 / $85 / $200
Mail Order	$38 / $113 / $213 / $200

Weekly Rates	Employee Cost	Employer Cost
Employee Only	$46.35	$185.02
Employee + Spouse	$139.05	$444.00
Employee + Child(ren)	$115.88	$330.66
Employee + Family	$162.23	$499.48

Downloads

Benefit Summary

Summary of Benefits and Coverage

Certificate

Plan Comparison Calculator

Plan Comparison Tool

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.cigna.com.

	In-Network	Out-of-Network
Deductible (Individual/Family)	$2,000/$6,000	$6,000/$12,000
Member Coinsurance	20%	40%
Out-of-Pocket Max (Individual/Family)	$5,000/$10,000	$10,000/$20,000
Physician Visits
Primary Care Visit	$40 Copay / $0 for Child For children under 19 years of age	Deductible then 40%
Specialist Visit	$80 Copay	Deductible then 40%
Routine Preventive	Covered 100%	Not Covered
Hospital Services
Inpatient Hospitalization	Deductible then 20%	Deductible then 40%
Physician Services	Deductible then 20%	Deductible then 40%
Outpatient Surgery	Deductible then 20%	Deductible then 40%
Outpatient Diagnostics	Deductible then 20%	Deductible then 40%
Urgent Care	$45 Copay	Deductible then 40%
Emergency Room	$100 Copay + 20%	$100 Copay + 20%

Prescription Card
Retail	$15 / $45 / $85 / $200
Mail Order	$38 / $113 / $213 / $200

Weekly Rates	Employee Cost	Employer Cost
Employee Only	$23.67	$195.81
Employee + Spouse	$94.99	$458.09
Employee + Child(ren)	$71.23	$352.36
Employee + Family	$118.73	$508.97

Downloads

Benefit Summary

Summary of Benefits Coverage

Certificate

Plan Comparison Tool

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please visit www.cigna.com.

	In-Network	Out-of-Network
Deductible (Individual/Family)	$3,400/$6,800	$6,600/$13,200
Member Coinsurance	30%	50%
Out-of-Pocket Max (Individual/Family)	$5,000/$10,000	$10,000/$20,000
Physician Visits
Primary Care	Deductible then 30%	Deductible then 50%
Specialist Visit	Deductible then 30%	Deductible then 50%
Routine Preventive	Covered 100%	Not Covered
Hospital Services
Inpatient Hospitalization	Deductible then 30%	Deductible then 50%
Physician Services	Deductible then 30%	Deductible then 50%
Outpatient Surgery	Deductible then 30%	Deductible then 50%
Outpatient Diagnostics	Deductible then 30%	Deductible then 50%
Urgent Care	Deductible then 30%	Deductible then 50%
Emergency Care	Deductible then 30%	Deductible then 30%