Medical

Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.

Each plan has different:

  • Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
  • Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
  • Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
  • Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Plan Documents
Plan Contacts

Cigna OAP HDHP

Benefit Highlights
In-Network

Deductible (Individual/Family)
$2,800/$3,400 per individual in family, up to $5,000 per family

Out-of-Pocket Max (Individual/Family)
$3,500 / $7,000

Preventive Care
No charge after plan deductible

Primary Care Visit
No charge after plan deductible  

Specialist Visit
No charge after plan deductible  

Urgent Care
No charge after plan deductible  

Emergency Room
No charge after plan deductible 

Retail Rx (Up to 30-Day 1) 

Generic
$10 copay after plan deductible  

Preferred Brand
$40 copay after plan deductible  

Non-Preferred Brand
$60 copay after plan deductible  

Specialty
You pay 30% up to a maximum of $250

Mail-Order Rx (Up to 90-Day Supply) 

Generic
$25 copay after plan deductible  

Preferred Brand
$120 copay after plan deductible  

Non-Preferred Brand
$180 copay after plan deductible  

Specialty
You pay 30% up to a maximum of $750

Monthly Plan Cost

Employee Only: $1,052.55

Employee and Spouse/DP:$2,105.11

Employee and Child(ren): $1,684.08

Employee and Family: $2,894.51

Cigna OAP 2500

Benefit Highlights
In-Network

Deductible (Individual/Family)
$2,500/$5,000

Out-of-Pocket Max (Individual/Family)
$5,000/$10,000

Preventive Care
No charge after deductible

Primary Care Visit
$20 copay 

Specialist Visit
$30 copay 

Urgent Care
$20 copay 

Emergency Room
$150 per visit (waived if admitted) plus 20% coinsurance  

Retail Rx (Up to 30-Day Supply) 

Generic
$15 copay 

Preferred Brand
$40 copay 

Non-Preferred Brand
$60 copay 

Specialty
You pay 30% up to a maximum of $250

Mail-Order Rx (Up to 90-Day Supply) 

Generic
$40 copay 

Preferred Brand
$120 copay 

Non-Preferred Brand
$180 copay

Specialty
You pay 30% up to a maximum of $750

Out-of-Network

Deductible (Individual/Family)
$5,000/$10,000

Out-of-Pocket Max (Individual/Family)
$10,000/$20,000

Preventive Care
40% coinsurance after plan deductible  

Primary Care Visit
40% coinsurance after plan deductible 

Specialist Visit
40% coinsurance after plan deductible 

Urgent Care
40% coinsurance after plan deductible 

Emergency Room
$150 per visit (waived if admitted) plus 20% coinsurance 

Retail Rx (Up to 30-Day Supply) 

Generic
50% up to $250 max 

Preferred Brand
50% up to $250 max 

Non-Preferred Brand
50% up to $250 max 

Specialty
Not covered

Mail-Order Rx (Up to 90-Day Supply) 

Generic
Not covered  

Preferred Brand
Not covered 

Non-Preferred Brand
Not covered 

Specialty
Not covered

Monthly Plan Cost

Employee Only: $869.06

Employee and Spouse/DP: $1,738.14

Employee and Child(ren): $1,390.50

Employee and Family: $2,389.92

Cigna OAP 250

Benefit Highlights
In-Network

Deductible (Individual/Family)
$250/$750 

Out-of-Pocket Max (Individual/Family)
$3,500/$7,000

Preventive Care
No Charge after deductible

Primary Care Visit
$20 copay 

Specialist Visit
$30 copay 

Urgent Care
$20 copay 

Emergency Room
$150 copay (waived if admitted) plus 20% coinsurance  

Retail Rx (Up to 30-Day Supply) 

Generic
$10 copay 

Preferred Brand
$30 copay  

Non-Preferred Brand
$50 copay 

Specialty
Not covered

Mail-Order Rx (Up to 90-Day Supply) 

Generic
$25 copay  

Preferred Brand
$90 copay 

Non-Preferred Brand
$150 copay  

Specialty
You pay 30% up to a maximum of $750

Out-of-Network

Deductible (Individual/Family)
$250/$750 

Out-of-Pocket Max (Individual/Family)
$7,000/$14,000

Preventive Care
40% coinsurance after plan deductible  

Primary Care Visit
40% coinsurance after plan deductible 

Specialist Visit
40% coinsurance after plan deductible 

Urgent Care
40% coinsurance after plan deductible 

Emergency Room
$150 copay (waived if admitted) plus 20% coinsurance

Retail Rx (Up to 30-Day Supply) 

Generic
50% up to $250 

Preferred Brand
50% up to $250 

Non-Preferred Brand
50% up to $250 

Specialty
Not covered

Mail-Order Rx (Up to 90-Day Supply) 

Generic
Not covered  

Preferred Brand
Not covered 

Non-Preferred Brand
Not covered 

Specialty
Not covered

Monthly Plan Cost

Employee Only: $1,365.46

Employee and Spouse/DP: $2,730.94

Employee and Child(ren): $2,184.75

Employee and Family: $3,755.02

Cigna OAP IN

Benefit Highlights
In-Network

Deductible (Individual/Family)
None

Out-of-Pocket Max (Individual/Family)
$3,500/$7,000

Preventive Care
No Charge after the deductible

Primary Care Visit
$20 copay

Specialist Visit
$30 copay

Urgent Care
$20 copay

Emergency Room
$100 copay (waived if admitted) plus 20% coinsurance

Retail Rx (Up to 30-Day Supply)

Generic
$10 copay

Preferred Brand
$25 copay

Non-Preferred Brand
$45 copay

Specialty
You pay 30% up to a maximum of $250

Mail-Order Rx (Up to 90-Day Supply)

Generic
$25 copay

Preferred Brand
$75 copay

Non-Preferred Brand
$135 copay

Specialty
You pay 30% up to a maximum of $750

Monthly Plan Cost

Employee Only: $1,422.36

Employee and Spouse/DP: $2,844.74

Employee and Child(ren): $2,275.78

Employee and Family: $3,911.50

Kaiser Deductible HMO HDHP (CA Only)

Benefit Highlights
In-Network

Deductible (Individual/Family)
$3,300/$6,600

Out-of-Pocket Max (Individual/Family)
$3,300/$6,600

Preventive Care
No Charge 

Primary Care Visit
No charge after Plan Deductible

Specialist Visit
No charge after Plan Deductible

Urgent Care
No charge after Plan Deductible

Emergency Room
No charge after Plan Deductible

Retail Rx (Up to 100-Day Supply) 

Generic
No charge for up to a 100-day supply after Plan Deductible

Preferred Brand
No charge for up to a 100-day supply after Plan Deductible  

Non-Preferred Brand
No charge for up to a 30-day supply after Plan Deductible

Specialty
Not covered  

Mail-Order Rx (Up to 100-Day Supply) 

Generic
No charge for up to a 100-day supply after Plan Deductible

Preferred Brand
No charge for up to a 100-day supply after Plan Deductible

Non-Preferred Brand
No charge for up to a 30-day supply after Plan Deductible

Specialty
Not covered

Monthly Plan Cost

Employee Only: $639.28

Employee and Spouse/DP: $1,406.42

Employee and Child(ren): $1,278.56

Employee and Family: $1,917.84

Kaiser HMO (CA Only)

Benefit Highlights
In-Network

Deductible (Individual/Family)
None  

Out-of-Pocket Max (Individual/Family)
$1,500/up to $3,000 

Preventive Care
No Charge 

Primary Care Visit
$20 copay 

Specialist Visit
$20 copay 

Urgent Care
$20 copay 

Emergency Room
$50 copay (waived if admitted)  

Retail Rx (Up to 30-Day Supply) 

Generic
$10 copay 

Preferred Brand
$30 copay  

Non-Preferred Brand
$30 copay 

Specialty
Not covered

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$20 copay 

Preferred Brand
$60 copay 

Non-Preferred Brand
$60 copay 

Specialty
Not covered

Monthly Plan Cost

Employee Only: $749.45

Employee and Spouse/DP: $1,648.79

Employee and Child(ren): $1,498.90

Employee and Family: $2,248.35

Kaiser Deductible HMO HDHP (CO Only)

Benefit Highlights
In-Network

Deductible (Individual/Family)
$1,700 Individual / $3,400 Family

Out-of-Pocket Max (Individual/Family)
$3,400 Individual / $6,800 Family

Preventive Care
No Charge

Primary Care Visit
10%* coinsurance

Specialist Visit
10%* coinsurance

Urgent Care
10%* coinsurance

Emergency Room
10%* coinsurance

Retail Rx (Up to 30-Day Supply) 

Generic
$10* copay

Preferred Brand
$30 copay  

Non-Preferred Brand
$60 copay after plan deductible

Specialty
10%* coinsurance up to a maximum of $250

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$20* copay

Preferred Brand
$60 copay 

Non-Preferred Brand
$120* copay

Specialty
10%* coinsurance up to a maximum of $250

Monthly Plan Cost

Employee Only: $

Employee and Spouse/DP: $

Employee and Child(ren): $

Employee and Family: $

Kaiser HMO (CO Only)

Benefit Highlights
In-Network

Deductible (Individual/Family)
None  

Out-of-Pocket Max (Individual/Family)
$2,000 Individual / $4,000 Family

Preventive Care
No Charge 

Primary Care Visit
$20 copay 

Specialist Visit
$30 copay 

Urgent Care
$30 copay 

Emergency Room
$250 per visit waived if admitted

Retail Rx (Up to 30-Day Supply) 

Generic
$10 copay

Preferred Brand
$30 copay  

Non-Preferred Brand
$60 copay 

Specialty
20% coinsurance up to a maximum of $250

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$20 copay

Preferred Brand
$60 copay 

Non-Preferred Brand
$120 copay 

Specialty
20% coinsurance up to a maximum of $250

Monthly Plan Cost

Employee Only: $803.52

Employee and Spouse/DP: $1,767.74

Employee and Child(ren): $1,607.04

Employee and Family: $2,410.56

*After deductible

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