Group Number
3347033
Provided By
Cigna
Provider Website
Customer Service
Medical Benefits
The High Deductible Health Plan Base Plan has an option to enroll in a Health Savings Account (HSA), a tax-advantaged, individually owned account. The plan includes a network of hospitals and physicians who have agreed to allow substantially greater discounts to Cigna plan subscribers.
If services are received from an in-network Cigna provider, eligible expenses will be paid at the 80% coinsurance level after deductible. If you receive services from a provider outside the Cigna network, eligible expenses will be paid at the 60%/40% coinsurance level after deductible.
To locate an in-network medical provider, please visit mycigna.com or call 800-997-1654.
Cigna Open Access Plus Network |
HDHP Base Plan |
|---|---|
Deductible |
$4,000/$8,000 |
Member Coinsurance |
80% |
Out-of-Pocket Max |
$5,000/$10,000 |
Primary Office Visit |
Deductible + Coinsurance |
Specialist Office Visit |
Deductible + Coinsurance |
Routine Preventive |
100% Covered |
Urgent Care |
Deductible + Coinsurance |
Inpatient Hospital |
Deductible + Coinsurance |
Emergency Room |
Deductible + Coinsurance |
Prescription Drugs |
Deductible + Coinsurance |
Mail Order |
Deductible + Coinsurance |
Monthly Premium |
Total Premium |
Employer Pays |
Employee Pays w/ Wellness Discount |
Employee Pays w/o Wellness Discount |
|---|---|---|---|---|
Individual |
$836.00 |
$686.00 (80%) |
$100.00 |
$150.00 |
Employee + Spouse |
$1,779.00 |
$1,245.00 (70%) |
$484.00 |
$534.00 |
Employee + Child(ren) |
$1,612.00 |
$1,128.00 (70%) |
$434.00 |
$484.00 |
Family |
$2,235.00 |
$1,564.00 (70%) |
$621.00 |
$671.00 |
Employer will contribute to the HSA $25.00 monthly for employee only election and |
The High Deductible Health Plan Buy-Up Plan has an option to enroll in a Health Savings Account (HSA), a tax-advantaged, individually owned account. The plan includes a network of hospitals and physicians who have agreed to allow substantially greater discounts to Cigna plan subscribers.
If services are received from an in-network Cigna provider, eligible expenses will be paid at the 100% coinsurance level after deductible. If you receive services from a provider outside the Cigna network, eligible expenses will be paid at the 60%/40% coinsurance level after deductible.
To locate an in-network medical provider, please visit mycigna.com or call 800-997-1654.
Cigna Open Access Plus Network |
HDHP Buy-Up Plan |
|---|---|
Deductible |
$3,400/$6,800 |
Member Coinsurance |
100% |
Out-of-Pocket Max |
$3,400/$6,800 |
Primary Office Visit |
Deductible |
Specialist Office Visit |
Deductible |
Routine Preventive |
100% Covered |
Urgent Care |
Deductible |
Inpatient Hospital |
Deductible |
Emergency Room |
Deductible |
Prescription Drugs |
Deductible |
Mail Order |
Deductible |
Monthly Premium |
Total Premium |
Employer Pays |
Employee pays w/Wellness Discount |
Employee pays w/o Wellness Discount |
|---|---|---|---|---|
Individual |
$913.00 |
$730.00 (82%) |
$133.00 |
$183.00 |
Employee + Spouse |
$1,942.00 |
$1,359.00 (70%) |
$533.00 |
$583.00 |
Employee + Child(ren) |
$1,760.00 |
$1,231.00 (70%) |
$479.00 |
$529.00 |
Family |
$2,440.00 |
$1,708.00 (70%) |
$682.00 |
$732.00 |
This is an In-Network only plan that provides no Out-of-Network benefits, with a lower deductible than the HDHP plans.
To locate an in-network medical provider, please visit mycigna.com or call 800-997-1654.
Cigna Local Plus Network |
In-Network Only Plan |
|---|---|
Deductible |
$2,000/$4,000 |
Member Coinsurance |
100% |
Out-of-Pocket Max |
$2,000/$4,000 |
Primary Office Visit |
$20 Copay |
Specialist Office Visit |
$20 Copay |
Routine Preventive |
100% Covered |
Urgent Care |
$25 Copay |
Inpatient Hospital |
Deductible |
Emergency Room |
Deductible |
Prescription Drugs |
Tier 1 - $15 Copay |
Mail Order |
Tier 1 - $15Copay |
Monthly Premium |
Total Premium |
Employer Pays |
Employee Pays w/ Wellness Discount |
Employee Pays w/o Wellness Discount |
|---|---|---|---|---|
Individual |
$913.00 |
$730.00 (80%) |
$133.00 |
$183.00 |
Employee + Spouse |
$1,845.00 |
$1,292.00 (70%) |
$503.00 |
$553.00 |
Employee + Child(ren) |
$1,668.00 |
$1,167.00 (70%) |
$451.00 |
$501.00 |
Family |
$2,543.00 |
$1,717.00 (70%) |
$686.00 |
$736.00 |
Group Number
3347033
Provided By
Cigna
Provider Website
Customer Service