Medical
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need 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 HDHP Classic
Plan Information
Plan Name: Cigna Choice Fund Open Access Plus H.S.A. Plan (Classic HDHP)
Policy Number: #3345399
Effective Date: 01/01/2025
Network: Cigna Open Access Plus
Benefit Highlights
In-Network | Out-of-Network |
|---|---|
| Deductible (Individual/Family) | Deductible (Individual/Family) |
| $2,200/$4,400 | $4,000/$8,000 |
| Out-of-Pocket Max (Individual/Family) | Out-of-Pocket Max (Individual/Family) |
| $3,200/$6,400 | $6,400/$12,800 |
| Preventive Care | Preventive Care |
| $0 copay | 40% coinsurance |
| Primary Care Visit | Primary Care Visit |
| 20% coinsurance | 40% coinsurance |
| Specialist Visit | Specialist Visit |
| 20% coinsurance | 40% coinsurance |
| Urgent Care | Urgent Care |
| 20% coinsurance | 20% coinsurance |
| Emergency Room | Emergency Room |
| 20% coinsurance | 20% coinsurance |
Retail Rx (Up to 30-Day Supply) | Retail Rx (Up to 30-Day Supply) |
|---|---|
| Generic | Generic |
| 20% coinsurance | 40% coinsurance |
| Preferred Brand | Preferred Brand |
| 20% coinsurance | 40% coinsurance |
| Non-Preferred Brand | Non-Preferred Brand |
| 20% coinsurance | 40% coinsurance |
| Specialty | Specialty |
| 20% coinsurance | 40% coinsurance |
Mail-Order Rx (Up to 90-Day Supply) | Mail-Order Rx (Up to 90-Day Supply) |
|---|---|
| Generic | Generic |
| 20% coinsurance | 40% coinsurance |
| Preferred Brand | Preferred Brand |
| 20% coinsurance | 40% coinsurance |
| Non-Preferred Brand | Non-Preferred Brand |
| 20% coinsurance | 40% coinsurance |
| Specialty | Specialty |
| 20% coinsurance only available at a 30-day supply | 40% coinsurance only available at a 30-day supply |
Plan Documents
Contact Information
Cigna HDHP Value
Plan Information
Plan Name: Cigna Choice Fund Open Access Plus HSA Plan (Value HDHP)
Policy Number: #3345399
Effective Date: 01/01/2025
Network: Cigna Open Access Plus
Benefit Highlights
In-Network | Out-of-Network |
|---|---|
| Deductible (Individual/Family) | Deductible (Individual/Family) |
| $4,000/$8,000 | $8,000/$16,000 |
| Out-of-Pocket Max (Individual/Family) | Out-of-Pocket Max (Individual/Family) |
| $7,500/$11,000 | $15,000/$22,000 |
| Preventive Care | Preventive Care |
| $0 copay | 30% coinsurance |
| Primary Care Visit | Primary Care Visit |
| 20% coinsurance | 40% coinsurance |
| Specialist Visit | Specialist Visit |
| 20% coinsurance | 40% coinsurance |
| Urgent Care | Urgent Care |
| 20% coinsurance | 20% coinsurance |
| Emergency Room | Emergency Room |
| 20% coinsurance | 20% coinsurance |
Retail Rx (Up to 30-Day Supply) | Retail Rx (Up to 30-Day Supply) |
|---|---|
| Generic | Generic |
| 20% up to $30 | 50% coinsurance |
| Preferred Brand | Preferred Brand |
| 30% up to $125 | 50% coinsurance |
| Non-Preferred Brand | Non-Preferred Brand |
| 50% up to $250 | 50% coinsurance |
| Specialty | Specialty |
| 20% coinsurance | 50% coinsurance |
Mail-Order Rx (Up to 90-Day Supply) | Mail-Order Rx (Up to 90-Day Supply) |
|---|---|
| Generic | Generic |
| 20% up to $90 | 50% coinsurance |
| Preferred Brand | Preferred Brand |
| 30% up to $375 | 50% coinsurance |
| Non-Preferred Brand | Non-Preferred Brand |
| 50% up to $750 | 50% coinsurance |
| Specialty | Specialty |
| 20% coinsurance only available at a 30-day supply | 50% coinsurance |
Plan Documents
Contact Information
Cigna PPO
Plan Information
Plan Name: Cigna Open Access Plus (PPO)
Policy Number: #3345399
Effective Date: 01/01/2025
Network: Cigna Open Access Plus
Benefit Highlights
In-Network |
Out-of-Network |
|---|---|
| Deductible (Individual/Family) | Deductible (Individual/Family) |
| $750/$1,500 | $1,500/$3,000 |
| Out-of-Pocket Max (Individual/Family) | Out-of-Pocket Max (Individual/Family) |
| $3,000/$6,700 | $6,000/$13,400 |
| Preventive Care | Preventive Care |
| $0 copay | 30% coinsurance |
| Primary Care Visit | Primary Care Visit |
| $25 copay | 40% coinsurance |
| Specialist Visit | Specialist Visit |
| $40 copay | 40% coinsurance |
| Urgent Care | Urgent Care |
| $75 copay | $75 copay |
| Emergency Room | Emergency Room |
| $150 copay | $150 copay |
Retail Rx (Up to 30-Day Supply) |
Retail Rx (Up to 30-Day Supply) |
|---|---|
| Generic | Generic |
| $10 copay | 30% coinsurance |
| Preferred Brand | Preferred Brand |
| $30 copay | 30% coinsurance |
| Non-Preferred Brand | Non-Preferred Brand |
| $50 copay | 30% coinsurance |
| Specialty | Specialty |
| $100 copay | 30% coinsurance |
Mail-Order Rx (Up to 90-Day Supply) |
Mail-Order Rx (Up to 90-Day Supply) |
|---|---|
| Generic | Generic |
| $30 copay | 30% coinsurance |
| Preferred Brand | Preferred Brand |
| $90 copay | 30% coinsurance |
| Non-Preferred Brand | Non-Preferred Brand |
| $150 copay | 30% coinsurance |
| Specialty | Specialty |
| $100 copay only available at a 30-day supply | 30% coinsurance |