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CIGNA Medical Insurance

A choice of two medical plan options through Cigna Healthcare is available to all full-time employees. Benefits will be effective on the first of the month following date of hire and terminate at the end of the month of their employment termination date. Students and dependents are terminated at the end of the birth month in which they turn 26. General plan benefits are noted within this package but, for specific benefit information, please reference your specific plan’s evidence of coverage.

Out-of Network

OAP Plus In Network Only

OAP Plus HDHP Deductible (Indiv/Fam)

Out-of Network

OAP Plus

In-Network

In-Network

In-Network

Deductible (Indiv/Fam)

Deductible (Indiv/Fam)

$1,400/ 2,800

$0

$300 / 600

$0

$2,800/ 5,600

Plan pays 100%

Plan pays 80%

Plan pays 100%

Plan pays 90%

Plan pays 70%

Coinsurance

Coinsurance

Coinsurance

$1,500 / 3,000

$1,000 /2,000

$2,800 / 5,600

Out-of-Pocket

$1,000 / 2,000

Out-of-Pocket

Out-of-Pocket

$5,600/11,200

Office Visit Emergency Services Urgent Care

$30

N/A

Office Visit Emergency Services Urgent Care

$30

Office Visit Emergency Services Urgent Care

10%

30%

$250 copay, Waived if admitted

$250 copay

Plan pays 90% after ded

$50 copay, Waived if admitted

$50 copay

Plan pays 90% after ded

Plan pays 90% after ded

Inpatient Hospital

Plan pays 100%

Deductible, then 80%

Inpatient Hospital

Plan pays 100%

Inpatient Hospital

Plan pays 70% after ded

Prescription Drug

Prescription Drug

Prescription Drug

$15 / $ 40 / $ 60

$10 / $ 30 / $ 60

$15 / $ 40 / $ 60

N/A

N/A

VSP Vision Insurance

A choice of one voluntary vision plan through VSP is available to all full-time employees. Benefits will be effective on the first of the month following date of hire and terminate at the end of the month of their employment termination date. General plan benefits are noted within this package but, for specific benefit information, please reference your specific plan’s evidence of coverage.

Basic Vision PPO

Voluntary Vision - VSP

$10

$10

Examination Copay

N/A

$25

Materials Copay

Covered in Full

Covered in Full

Exam

Exams-Lenses-Frames- Contacts

12-0-0-0

12-12-24-12

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