Medical Plans
Medical Plans

Cigna Health
Phone
(866) 494-2111
Website
my.cigna.com
PPO | Open Access Plus Plan
Network: Open Access Plus
Group/Policy #: 00634624
Plan design shown below represents in-network benefits
*Plan Design Subject to the Deductible
- Deductible | $750 Individual ($2,250 Family)
- Maximum Out of Pocket | $8,050 Individual ($16,100 Family)
- Primary Care Doctor | $30 copay per visit
- Specialist | $50 copay per visit
- Virtual Care | $30 copay per visit
- Urgent Care | $50 copay per visit
- Hospital | 20% coinsurance*
- X-Ray and Labs | 20% Coinsurance*
- Emergency Room | $200 copay + 20% per visit (Copay waived if admited to hospital)
All family members contribute towards the family deductible. An individual cannot have claims covered under the plan coinsurance until the total family deductible has been satisfied.
After each eligible family member meets his or her individual out-of-pocket maximum, the plan will pay 100% of their covered expenses. Or, after the family out-of-pocket maximum has been met, the plan will pay 100% for each eligible family member’s covered expenses.
HSA Plan - High Deductible Health Plan
Network: Open Access Plus
Group/Policy #: 00634624
Plan design shown below represents in-network benefits
*Plan Design Subject to the Deductible
- Deductible** | $2,000 Individual ($4,000 Family)
- Maximum Out-of-Pocket*** | $8,050 Individual ($16,100 Family)
- Primary Care Doctor | 20% Coinsurance*
- Specialist | 20% Coinsurance*
- Virtual Care | 20% Coinsurance*
- Urgent Care | 20% Coinsurance*
- Hospital | 20% Coinsurance*
- X-Ray and Labs | 20% Coinsurance*
- Emergency Room | 20% Coinsurance*
**All family members contribute towards the family deductible. An individual cannot have claims covered under the plan coinsurance until the total family deductible has been satisfied.
***After each eligible family member meets his or her individual out-of-pocket maximum, the plan will pay 100% of their covered expenses. Or, after the family out-of-pocket maximum has been met, the plan will pay 100% for each eligible family member’s covered expenses.