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Comparative FeaturesHDHP/HSA Option
In-NetworkOut-of-Network
Deductible  
Individual$2,000

N/A (In- and out-of-network Deductible

cross-accumulate

Family$4,000
Out-of-Pocket (OOP) Maximum  

Individual

$3,425

N/A (In- and out-of-network Deductible

cross-accumulate

Family$6,850
 Includes the deductible
SPU Funding to offset Deductible for HSA Plan

Individual HSA Plan:  Up to $1,660 (assuming 12-months of participation and employee meets full dollar-for-dollar match)

Family HSA Plan: Up to $3,320 (assuming 12-months of participation and employee meets full dollar-for-dollar match)

SPU Funding to offset Deductible for HRA Plan

Individual HRA Plan:  Up to $1,260 (assuming 12-months of participation and employee meets full dollar-for-dollar match)

Family HRA Plan: Up to $2,520 (assuming 12-months of participation and employee meets full dollar-for-dollar match)

Coinsurance - You pay:10%40%
Office Visit

No copay; You pay 10% AFTER Deductible

No copay; You pay 40% AFTER Deductible

Preventive Care

  • Routine Physicals (Adult exams)
  • Routine Well-Child Exams
  • Routine Mammograms
  • Routine DRE/Prostate Antigen Test/Exam for males
  • Routine Colorectal Cancer Screening

 

 

Covered 100%; deductible waived

Diagnostic mammograms covered under Diagnostic Lab/Xray

 

In-Network Diagnostic Lab/Xray Outpatient

No copay; You pay 10% AFTER Deductible

No copay; You pay 40% AFTER Deductible

Urgent Care Provider (both In and Out-of-Network)

No copay; You pay 10% AFTER Deductible

Emergency Room (both In and Out-of-Network)

No copay; You pay 10% AFTER Deductible

Ambulance (both In and Out-of-Network)

No copay; You pay 10% AFTER Deductible

Hospital - Inpatient (both In and Out-of-Network)

No copay; You pay 10% AFTER Deductible

Prescription Drugs

 

In-Network - Pharmacy – Retail

10% (generic) /20% (preferred brand)/30% (non-preferred brand) AFTER Deductible

  • Full cost of prescriptions accumulate towards the deductible
  • Specific Generic Preventive drugs covered at 100% with deductible waived
  • Other Brand-Name Preventive drugs require you pay 20% or 30% with deductible waived

 

Not covered

Pharmacy – Cigna Mail Order Drug (90 day supply)

10% (generic) /20% (preferred brand) /30% non-preferred brand) AFTER Deductible

  • Full cost of prescriptions accumulate towards the deductible 
  • Specific Generic Preventive drugs covered at 100%, deductible waived 
  • Other Brand-Name Preventive drugs require you pay 20% or 30% with deductible waived
  • Shop pharmacies for lowest price

 

Not covered