Medical
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need care.
Video Tutorial: Watch this video for a guide on creating links for the floating sidebar and managing columns in the accordions: Video Link. NOTE: Most times you will not have to change the size of the quick links box. If you do, adjust the width percentage only or it’ll likely mess up.
Updates:
- Plan Names: We’re now using named plans instead of “Med Plan 1, 2, 3.”
- Accordion Layout: The layout has changed to two columns, as the third plan has been removed.
- Mobile Version: The mobile accordion has been integrated with the original, now including tablet and mobile versions. Remember to remove columns on these versions.
Quick Tasks:
- Update Plan Names: Ensure plan names are updated to match the new names, shortening them in quick links if necessary.
- Medical Plan Headers: Update the headers to match the new plan names.
- Fill in Details: Complete all blanks, link the Medical Benefit Summary in the Documents tab, and fill in the phone number and website from the contacts.
PLEASE DELETE THIS TEXTBOX ONCE DONE
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.
Cigna OAP HDHP
Plan Information
Plan Name: Cigna OAP HDHP
Policy Number: 3340367
Effective Date: 01/01/2025
Network: Cigna
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$2,800/$3,300 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 Supply)
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
Plan Documents
Contact Information
Cigna OAP 2500
Plan Information
Plan Name: Cigna OAP 2500
Policy Number: 3340367
Effective Date: 01/01/2025
Network: Cigna
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
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
$25 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
N/A
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
N/A
Plan Documents
Contact Information
Cigna OAP 250
Plan Information
Plan Name: Cigna OAP 250
Policy Number: 3340367
Effective Date: 01/01/2025
Network: Cigna
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
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
N/A
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
N/A
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
N/A
Contact Information
Cigna OAP IN
Plan Information
Plan Name: Cigna OAP IN
Policy Number: 3340367
Effective Date: 01/01/2025
Network: Cigna
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
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
Contact Information
Kaiser Deductible HMO HDHP
Plan Information
Plan Name: Kaiser Deductible HMO HDHP
Policy Number: 665937 (NCA) / 236347 (SCA)
Effective Date: 01/01/2025
Network: Kaiser
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
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
N/A
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
N/A
Plan Documents
Contact Information
Kaiser HMO (CA Only)
Plan Information
Plan Name: Kaiser HMO (CA Only)
Policy Number: 665937 (NCA) / 236347 (SCA)
Effective Date: 01/01/2025
Network: Kaiser
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
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
N/A
Mail-Order Rx (Up to 100-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$60 copay
Specialty
N/A