Medical

Your Health Matters

Cigna Medical Plan Options

Choose from one of two medical plans to cover yourself and your dependents. All plans are through Cigna and include prescription coverage.

PPO Plan

With this PPO plan, you will:

Have the freedom to visit any In-Network physician without a referral needed
Have coverage for both In and Out of Network providers
Have preventive services covered at 100%

Services	PPO Plan	HSA Plan

Deductible	$250 individual / $500 family	$2,800 individual / $5,600 family
Annual Out-of-Pocket Maximum	$2,500 individual / $5,000 family	$3,500 individual /$ 7,000 family
Coinsurance	20%	0%
Primary Care Visits	$25 Copay	$35 Copay after Deductible
Preventive Care	No Charge	No Charge
Specialist Visits	$50 Copay	$50 Copay after Deductible
INpatient Visit	20% after Deductible	0% after Deductible
Outpatient Services	20% after Deductible	0% after Deductible
Emergency Room	$Copay	0% after Deductible
Urgent Care	$75 Copay	$50 Copay after Deductible
Rx Retail
Low Cost / Generic	$10 Copay	$20 Copay after Deductible
Preferred Brand	$40 Copay	$40 Copay after Deductible
Non-Preferred Brand	$70 Copay	$70 Copay after Deductible
Specialty	50% after Deductible	50% after Deductible
Rx Mail Order
Generic	$20 Copay	$40 Copay after Deductible
Preferred Brand	$80 Copay	$80 Copay after Deductible
Non-Preferred Brand	$140 Copay	$140 Copay after Deductible
Specialty	50% after Deductible	50% after Deductible

Resources

Benefit Summary PPO Plan

Benefit Summary HDHP Plan

Cigna Virtual Care Flyers

Cigna RX Information

Cigna Misc. Flyers

Cigna ID Card Information

HIPAA Facets Limitations Documents No PCL Flyer