Medical Benefits Plan Comparison
Cigna HDHP w/ HSA Purple Team
Cigna Mid Red Team
Cigna Buy Up Plan Blue Team
Kaiser HMO Plan
In-Network Only
In-Network Only
In-Network Only
In-Network Only
Primary Care Visit
Plan pays 100% after Deductible
$25 Copay
$20 Copay
$15 Copay
Specialist Office Visit
Plan pays 100% after Deductible
$50 Copay
$40 Copay
$15 Copay
Urgent Care Visit
Plan pays 100% after Deductible
$60 Copay
$50 Copay
$15 Copay
$10/$30/$30/20% Coinsurance Up to $250 Copay/ Prescription
Prescription Drugs Retail Prescription Drugs Mail Order Emergency Room
Plan pays 100% after Deductible
$15/$35/$70/$150 $10/$30/$60/$150
Plan pays 100% after Deductible
$30/$70/$140/$150 $20/$60/$120/$150
$20/$60/$60
Plan pays 100% after Deductible
$300 Copay
$200 Copay
$200 Copay
Inpatient Services
Plan pays 100% after Deductible
Deductible & Coinsurance
Plan pays 100% after Deductible
$250 Copay/Admission
Outpatient Services
Plan pays 100% after Deductible
Deductible & Coinsurance
Plan pays 100% after Deductible
$15 Copay/Procedure
Labs: Covered 100% X-ray: Deductible & Coinsurance
Labs: Covered 100% X-ray: Covered 100% after Deductible
Outpatient Lab & X-ray
Plan pays 100% after Deductible
No Charge
Plan pays 100% after Deductible
Deductible & Coinsurance
Radiology
$100 Copay
No Charge
Coinsurance
0%
20%
0%
0%
Lifetime Maximum
Unlimited
Unlimited
Unlimited
Unlimited
Annual Out-of- Pocket Maximum
$3,500/$7,000
$3,000/$6,000
$2,000/$4,000
$1,500/$3,000
Annual Deductible
$3,500/$7,000
$1,000/$2,000
$500/$1,000
N/A
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