Medical
Your medical coverage is provided through Assured Benefits Administrators. Below are the main highlights of the plan. For a full summary and description of all covered services, please refer to the Summary of Benefits & Coverage (SBC) at the end of this guide. You can find and search for in-network providers at www.cigna.com. Your cost per-pay period for each tier of coverage can be found at the bottom of the page.
| BENEFITS | IN-NETWORK |
|---|---|
| DEDUCTIBLE | |
| INDIVIDUAL | $0* |
| FAMILY | $0* |
| COINSURANCE | |
| CARRIER | 70% |
| INSURED | 30% |
| OUT-OF-POCKET MAXIMUM | |
| INDIVIDUAL | $500* |
| FAMILY | $1,000* |
| COPAYMENT/COINSURANCE (PER OCCURRENCE) | IN-NETWORK |
| ROUTINE PHYSICALS/PREVENTIVE/WELLNESS | No Charge |
| PRIMARY CARE (Family practice, pediatrician, OB-GYN) | $30 |
| SPECIALTY CARE | $40 |
| URGENT CARE | $40 |
| EMERGENCY ROOM | $250 + Deductible + 30% Coinsurance |
| PRESCRIPTION DRUG COPAYMENTS | IN-NETWORK |
| RX DEDUCTIBLE | N/A |
| GENERIC | $10 |
| PREFERRED BRAND NAME | $30 |
| NON-PREFERRED BRAND NAME | Deductible + 30% Coinsurance |
| SPECIALTY | Deductible + 30% Coinsurance |
*Primary health plan is provided by ABA with a deductible of $5,000 for individual and $10,000 for family. Out-of-pocket maximum is $7,350 for individual and $14,700 for family. Secondary health is provided by Magna with a deductible of $0 for both individual and family. The secondary health deductible replaces the primary medical deductible. The benefit limit for the secondary plan is $7,350 for individual and $14,700 for family therefore, the max-out-of-pocket is $0 for both individual and family.
| Coverage Tier | Cost per Semi-Monthly |
|---|---|
| Employee Only | $0 |
| Employee + Spouse | $160.19 |
| Employee + Child(ren) | $117.84 |
| Family | $273.51 |