MEDICAL COVERAGE
Infratech Corporation is pleased to offer the following medical plans. 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: Primary Care Visits
$30 copay
$30 copay
Plan pays 100%
Specialist Care Visits
$60 copay
$60 copay
Plan pays 100%
Urgent Care
$75 copay
$75 copay
Plan pays 100%
Emergency Room Care
$350 copay
$350 copay
Plan pays 100%
Preventative Visit Copay
$0
Plan pays 100%
Plan pays 100%
Diagnostic Testing (X-Ray / Blood Work)
Plan pays 80%
Plan pays 100%
Plan pays 100%
Advanced Imaging
Plan pays 80%
Plan pays 100%
Plan pays 100%
Plan 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 copay
$15 copay
$15 copay
Tier 2 - Preferred
$45 copay
$45 copay
$35 copay
Tier 3 - Non-Preferred
$85 copay
$85 copay
$60 copay
Tier 4 - Specialty
25% coinsurance up to $300
25% coinsurance up to $300
25% coinsurance up to $300
Employee Weekly Deduction Employee Only
$47.31
$46.15
$12.00
Employee + Spouse
$155.77
$152.31
$65.00
Employee + Child(ren)
$133.85
$124.62
$58.00
Family
$170.77
$168.46
$87.00
4 | Infratech Corporation 2024 Benefits Guide
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