CIGNA MEDICAL INSURANCE JohnsonCo offers the following plans through Cigna. Please reference the Summary Plan Description for more details. Insurance Carrier: Cigna Medical Insurance
HDHP + HSA You pay:
Mid Plan - HMO You pay:
Buy-Up Plan You pay:
In-Network:
Deductible (first dollar cost for covered in-network services) Individual / Family $5,000 / $10,000
$6,000 / $12,000
$3,000 / $6,000
Coinsurance (after you reach your deductible) Plan Pays 80%
80%
100%
Out-of-Pocket Maximum (includes deductibles, copays, prescription costs, and coinsurance) Individual / Family $6,750 / $13,500 $8,000 / $16,000
$6,500 / $13,000
Plan Features Preventive Care Primary Care Visits
Covered in full
Covered in full
Covered in full
20% after deductible 20% after deductible
$50 copay $80 copay
$35 copay $60 copay
Specialist Visits
$50 copay - urgent & primary care $80 copay - specialty visits $50 copay + 20% coinsurance
$35 copay - urgent & primary care $60 copay - specialty visits
MDLive Virtual Care
20% after deductible
Urgent Care
20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible 20% after deductible
$75 copay
Emergency Room Inpatient Hospital Outpatient Surgery Labs and X-rays Advanced Imaging Prescription Benefits Rx Deductible
$350 copay
$350 copay
20% after deductible 20% after deductible 20% after deductible 20% after deductible
0% after deductible 0% after deductible
No charge
0% after deductible
Combined with medical
N / A
$150 Individual / $300 Family
Tier 1 - $10 copay Tier 2 - $30 copay Tier 3 - $60 copay Tier 4 - 20% up to $250
Tier 1 - $10 copay Tier 2 - $40 copay Tier 3 - $70 copay Tier 4 - 25% Tier 1 - $30 copay Tier 2 - $120 copay Tier 3 - $210 copay
Retail 30-day supply
20% after deductible
Tier 1 - $30 copay Tier 2 - $90 copay Tier 3 - $180 copay
Mail Order 90-day supply
20% after deductible
Employee Contributions (per paycheck cost for coverage) Employee Only $52.70
$84.41 $284.90
$99.48 $316.55
$218.31
Employee + Spouse
Employee + Child(ren)
$188.20
$248.45
$277.08
$383.93
$458.06
$504.02
Family
JohnsonCo 2025 Benefits Guide |
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