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 OAP HDHP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,000/$6,000
Out-of-Pocket Max (Individual/Family)
$3,300/$6,400
Preventive Care
No charge
Primary Care Visit
$15 copay after deductible
Specialist Visit
$15 copay after deductible
Urgent Care
No charge after deductible
Emergency Room
$100 copay after deductible (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay after deductible
Preferred Brand
$30 copay after deductible
Non-Preferred Brand
$60 copay after deductible
Specialty
30% coinsurance after deductible up to $250
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay after deductible
Preferred Brand
$90 copay after deductible
Non-Preferred Brand
$180 copay after deductible
Specialty
30% coinsurance after deductible up to $250 (30-day supply only)
Out-of-Network
Deductible (Individual/Family)
$5,600/$11,200
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
20% coinsurance after deductible
Primary Care Visit
20% coinsurance after deductible
Specialist Visit
20% coinsurance after deductible
Urgent Care
20% coinsurance after deductible
Emergency Room
$100 copay after deductible (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Monthly Plan Cost
Employee Only: $76.00
Employee and Spouse/DP: $248.00
Employee and Child(ren): $197.00
Employee and Family: $381.00
Cigna OAP
Benefit Highlights
In-Network
Deductible (Individual/Family)
$500/$1,500
Out-of-Pocket Max (Individual/Family)
$2,000/$6,000
Preventive Care
No charge
Primary Care Visit
$20 copay
Specialist Visit
$30, deductible does not apply
Urgent Care
$30 copay
Emergency Room
$150 copay (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$3o copay
Non-Preferred Brand
$60 copay
Specialty
30% coinsurance
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay
Preferred Brand
$90 copay
Non-Preferred Brand
$180 copay
Specialty
30% coinsurance (30-day supply only)
Out-of-Network
Deductible (Individual/Family)
$1,000/$3,000
Out-of-Pocket Max (Individual/Family)
$4,000/$12,000
Preventive Care
30% coinsurance after deductible
Primary Care Visit
30% coinsurance after deductible
Specialist Visit
30% coinsurance after deductible
Urgent Care
30% coinsurance after deductible
Emergency Room
$150 copay (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
Monthly Plan Cost
Employee Only: $134.00
Employee and Spouse/DP: $432.00
Employee and Child(ren): $333.00
Employee and Family: $618.00
Kaiser HDHP
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$3,400/$6,800
Out-of-Pocket Max (Individual/Family)
$3,400/$6,800
Preventive Care
No charge
Primary Care Visit
No charge after deductible
Specialist Visit
No charge after deductible
Urgent Care
No charge after deductible
Emergency Room
No charge after deductible
Retail Rx (Up to 30-Day Supply)
Generic
No charge after deductible
Preferred Brand
No charge after deductible
Non-Preferred Brand
No charge after deductible
Specialty
No charge after deductible
Mail-Order Rx (Up to 100-Day Supply)
Generic
No charge after deductible
Preferred Brand
No charge after deductible
Non-Preferred Brand
No charge after deductible
Specialty
No charge after deductible
Monthly Plan Cost
Employee Only: $60.00
Employee and Spouse/DP: $203.00
Employee and Child(ren): $165.00
Employee and Family: $319.00
Kaiser HMO
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0.00/$0.00
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
No charge
Primary Care Visit
$30 copay
Specialist Visit
$30 copay
Urgent Care
$30 copay
Emergency Room
$150 copay
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$35 copay
Non-Preferred Brand
$35 copay
Specialty
20% coinsurance, up to $150
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$70 copay
Non-Preferred Brand
$70 copay
Specialty
Not covered
Monthly Plan Cost
Employee Only: $106.00
Employee and Spouse/DP: $305.00
Employee and Child(ren): $220.00
Employee and Family: $416.00