Medical Plan Highlights and Changes Open Access Plus In-Network
Open Access Plus
(OAPIN)
(OAP)
Single
Deductible
The most you’ll pay next year out-of-pocket
Copays apply Copays apply
$5,000
$6,000
HRA contribution from employer Inpatient Hosp Outpatient Fac INN: In-Network OON: Out of Network
Family
n/a $200/day –max 4
15%
$200
15%
$10,000 $12,000
n/a
Single $500 INN/ $1,000 OON
Family $1,500 INN/ $3,000 OON
$10,000 $5,000 $5775 $11,550 INN/ INN/
CIGNA Choice Fund® with Health Reimbursement Arrangement (HRA)*
Single
Emp + Spouse
Family
$1,000 INN/ $3,000 OON
Emp + Child $2,000 INN/ $4,000 OON
$3,000 INN/ $6,000 OON
$3,000 INN/
$6,000 INN/
$9,000 INN/
$6,000
$12,000
$18,000
$10,000
$20,000
$11,550
$23,100
OON
OON
OON
OON
OON
n/a
n/a
$500
$1,000
$1,500
CYD 15% INN
CYD 15% INN CYD 15% INN CYD 15% INN CYD 15% INN
CYD 30% OON CYD 30% OON CYD: Calendar Year Deductible CCN: CIGNA Care Network
CYD 30% OON
CYD 30% OON
PCP: Primary Care Physician
No changes to Prescription Copays. Remember, you also have access to Convenience Clinics, for a PCP copay, located at many drug stores and pharmacies. Please refer to your Benefit Certificate booklet for a comprehensive view of your plan benefits.
CYD 30% OON
Medical Plan Highlights and Changes (continued)
Benefit
Open Access Plus In-Network (OAPIN)
Open Access Plus (OAP) IN-Network
OAP with Choice Fund (HRA) IN-Network
OUT of Network
Office Visit :
$20 PCP
$15 PCP
CYD 15% CCN
PCP:
$30 $40 Spec CCN
$25 $30 Spec CCN
CYD 20% Non CCN
Specialist – CIGNA Care Network
$45 $60 Spec. Non CCN
$40 $45 Spec Non CCN
CYD then 30%
OUT of Network
CYD then 30%
Specialist- Non CIGNA Care Network Coinsurance (e.g., inpatient) CCN Non-CCN Ambulatory/Surgical Centers Emergency Room Urgent Care INN: In-Network OON: Out of Network
CYD then 15% N/A
15%
$75 copay then 100% $150
$200
$35 $50
CYD then 15% CYD then 30%
CYD then 15% $75 copay then 100%
CYD then 30%
$150
$150
$35
$35
CYD: Calendar Year Deductible CCN: CIGNA Care Network
CYD then 20% CYD then 15%
CYD then 15%
CYD then 30%
CYD then 30% CYD then 15%
PCP: Primary Care Physician