Medical Insurance
Jefferson Center offers four (4) medical insurance plan options. Employees may choose between two (2) Kaiser Permanente plans or two (2) Cigna Healthcare plans. Please take the time to understand the features and differences of each plan so that you choose the coverage that is best for you and your family. Each Cigna medical plan includes in-network benefits only, which means you must obtain medical / prescription drug care from contracted in-network ( Local Plus ) providers for coverage under the health plan. Locate a Cigna Local Plus network provider at www.cigna.com . The Kaiser medical plans include in-network benefits only, with exception of the $1,500 Deductible plan option which allows for up to ten (10) out-of-network provider visits per calendar year , which means you can choose any provider that you would like. However, you will pay less out of your pocket when you choose a Kaiser HMO network provider. Locate a Kaiser HMO network provider at www.kp.org. The table below summarizes the key features of the medical plans. The coinsurance amounts listed reflect the amount you pay for services. Please refer to the official pan documents for additional information on coverage and exclusions.
KAISER DHMO PLUS 1500
KAISER DHMO 500
Deductible (individual/family) - Embedded Out-of-pocket maximum (individual/family) - Embedded
$500 / $1,000
$1,500 / $3,000
$2,000 / $4,000
$4,500 / $9,000
Coinsurance
90% / 10%
90% / 10%
Covered at 100% in- network
Covered at 100% in- network
Preventive care
Office visits (primary care/ specialist)
$25 / $35
Deductible / Coinsurance Deductible / Coinsurance Deductible / Coinsurance
Emergency Room
$250 copay $100 copay
Urgent Care
Diagnostic Lab: Plan pays 100% X-ray: Deductible/ Coinsurance
Diagnostic Lab/x-ray
Deductible / Coinsurance
Inpatient hospital
Deductible / Coinsurance Surgical Center: $500 OP Hospital: Deductible / Coinsurance Deductible / Coinsurance
Deductible / Coinsurance Surgical Center: $500 OP Hospital: Deductible / Coinsurance Deductible / Coinsurance Deductible / Coinsurance $15 / $25 / $40 / 20% up to $250
Outpatient hospital
Inpatient Mental Health Outpatient Mental Health
$25 copay
$15 / $25 / $40 / 20% up to $250
Rx (generic/preferred/brand/specialty)
CIGNA HMO 500
CIGNA HMO 1500
Deductible (individual/family) – Embedded
$500 / $1,000
$1,500 / $3,000
Out-of-pocket maximum (individual/family) - Embedded
$2,000 / $4,500
$4,500 / $9,000
Coinsurance
90% / 10%
90% / 10%
Preventive care
Covered at 100% in-network
Covered at 100% in-network
Office visits (primary care/ specialist)
$25 / $35
Deductible / Coinsurance
Emergency Room
$250 copay
Deductible / Coinsurance
Urgent Care
$100 copay
Deductible / Coinsurance
Diagnostic Lab/x-ray
Plan pays 100%
Deductible / Coinsurance
Inpatient & Outpatient Hospital
Deductible / Coinsurance
Deductible / Coinsurance
Inpatient Mental Health
Deductible / Coinsurance
Deductible / Coinsurance
Outpatient Mental Health
$35 copay
Deductible / Coinsurance
Rx (generic/preferred/brand/specialty)
$15 / $25 / $40 / 20% up to $100 $15 / $25 / $40 / 20% up to $100
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