Medical and Pharmacy Coverage
Emsere offers the following Medical plans through Cigna and offers “in and out-of-network” benefits.
Insurance Carrier:
Cigna Medical Insurance
Medical Plan: In-Network: Employee Deductible
Gold PPO Plan
Silver HSA Plan
$1,000
$3,000
Family Deductible
$2,000
$6,000
Coinsurance
90%
80%
Employee Out-of-Pocket Max
$4,000 (includes deductible)
$6,000 (includes deductible)
Family Out-of-Pocket Max
$8,000 (includes deductible)
$12,000 (includes deductible)
Office Visit Copay - Primary Care
$20 Copay
Deductible; then 20% Coinsurance
Office Visit Copay - Specialist Care
$50 Copay
Deductible; then 20% Coinsurance
Urgent Care Copay
$75 Copay
Deductible; then 20% Coinsurance
Emergency Room Care
$250 Copay; then 10% Coinsurance
Deductible; then 20% Coinsurance
Preventative Visit Copay
$0
$0
Independent Facility Lab: $75 Independent Facility X-ray: $150 All Other Places : Ded/Coins
Diagnostic Testing & Blood Work
Deductible; then 20% Coinsurance
Imaging
$150 Copay
Deductible; then 20% Coinsurance
Inpatient Hospital
Deductible; then 10% Coinsurance
Deductible; then 20% Coinsurance
Outpatient Hospital or Facility
Deductible; then 10% Coinsurance
Deductible; then 20% Coinsurance
Out-of-Network: Coinsurance
70%
60%
Employee Deductible
$2,500
$5,000
Family Deductible
$5,000
$10,000
Employee Out-of-Pocket Max
$8,000
$6,000
Family Out-of-Pocket Max
$16,000
$12,000
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
$0
$0
Tier 2 - Preferred
$35
$35
Tier 3 - Non-Preferred
$50
$50
Tier 4 - Specialty
$100
$100
Employee Bi-Weekly Deduction Employee Only
$23.00
$0.00
Employee + Spouse
$217.00
$177.00
Employee + Child(ren)
$210.00
$195.00
Family
$281.00
$233.00
4 EMSERE - FULLY EQUIPPED 2024 BENEFITS GUIDE
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