MEDICAL
The Concrete Company offers the following plans through Cigna. Please reference the Summary Plan Description for more details.
Insurance Carrier: Medical Plan:
Cigna Medical Insurance
HSA/HDHP
GOLD / COPAY
In-Network: Office Visit Copay - Primary Care Office Visit Copay - Specialist Care Urgent Care Copay Emergency Room Care (waived if admitted) Preventative Visit Copay Coinsurance Employee Deductible Family Deductible Employee Out-of-Pocket Max Family Out-of-Pocket Max Inpatient Hospital Outpatient Hospital or Facility Out-of-Network: Coinsurance Employee Deductible Family Deductible Employee Out-of-Pocket Max Family Out-of-Pocket Max Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic Tier 2 - Preferred Tier 3 - Non-Preferred Tier 4 - Specialty
Deductible; then 80% Coinsurance Deductible; then 80% Coinsurance Deductible; then 80% Coinsurance Deductible; then 80% Coinsurance 100% Coinsurance; No Deductible 80%
$25 Copay $50 Copay $60 Copay
$150 Copay; then 80% Coinsurance 100% Coinsurance; No Deductible 80% $2,500 $7,500 $5,000 $10,000 Deductible; then 80% Coinsurance $150 Copay; Ded. then 80% Coinsurance
$3,500 $7,000 $6,300 $12,600
Deductible; then 80% Coinsurance Deductible; then 80% Coinsurance
60% $7,000 $14,000 $18,900 $37,800
60% $5,000 $15,000 $15,000 $30,000
Deductible; then 80% Coinsurance Deductible; then 80% Coinsurance Deductible; then 80% Coinsurance Deductible; then 80% Coinsurance
$15 Copay $40 Copay $75 Copay 80% Coinsurance
RATES: Employee Only Employee + Spouse Employee + Child(ren) Family
Weekly $53.31 $130.85 $118.38 $186.92
Weekly $102.18 $215.58 $194.40 $305.31
6 The Concrete Company Benefit Guide |
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