Medical and Pharmacy Coverage
Infratech Corporation offers the following Medical plans
through Cigna and offers “in and out-of-network” benefits.
Insurance Carrier:
Cigna Medical Insurance
Medical Plan:
$1,500 / 80% Buy-Up Plan
$3,500 / 100% Base Plan
$5,000 / 100% HDHPQ Plan
In-Network: Office Visit Copay - Primary Care
$30
$30
Plan pays 100%
Office Visit Copay - Specialist Care
$60
$60
Plan pays 100%
Urgent Care Copay
$75
$75
Plan pays 100%
Emergency Room Care
$350
$350
Plan pays 100%
Preventative Visit Copay
$0
Plan pays 100%
Plan pays 100%
Diagnostic Testing & Blood Work
Plan pays 80%
Plan pays 100%
Plan pays 100%
Imaging
Plan pays 80%
Plan pays 100%
Plan pays 100%
Coinsurance
80%
100%
100%
Employee Deductible
$1,500
$3,500
$5,000
Family Deductible
$4,500
$10,500
$10,000
Employee Out-of-Pocket Max
$4,500 (includes deductible)
$7,900 (includes deductible)
$6,900 (includes deductible)
Family Out-of-Pocket Max
$9,000 (includes deductible)
$15,800 (includes deductible)
$13,800 (includes deductible)
Inpatient Hospital
Plan pays 80%
Plan pays 100%
Plan pays 100%
Outpatient Hospital or Facility
Plan pays 80%
Plan pays 100%
Plan pays 100%
Out-of-Network: Coinsurance
60%
70%
70%
Employee Deductible
$4,500
$10,000
$10,000
Family Deductible
$13,500
$20,000
$20,000
Employee Out-of-Pocket Max
$13.500
$23,700
$20,700
Family Out-of-Pocket Max
$27,000
$47,400
$41,400
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
$15
$15
$15
Tier 2 - Preferred
$45
$45
$35
Tier 3 - Non-Preferred
$85
$85
$60
Tier 4 - Specialty
25% Coinsurance up to $300
25% Coinsurance up to $300
25% Coinsurance up to $300
Employee Weekly Deduction Employee Only
$40.36
$39.40
$5.00
Employee + Spouse
$142.84
$140.01
$50.00
Employee + Child(ren)
$115.52
$112.97
$40.00
Family
$167.81
$163.77
$70.00
4 INFRATECH CORPORATION 2023 BENEFITS GUIDE
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