2023 Benefits Guide
MEDICAL CIGNA
mycigna.com 1 (800) CIGNA-24
Your medical benefits are provided by Cigna on their Open Access Plus Network. The High Deductible Healthplan offers in network only coverage, whereas the Traditional Plan has both in and out of network benefits. You will always have stronger benefits when visiting in-network providers.
Medical
HSA Open Access Plus
Open Access Plus
In-network
In-network
Annual deductible (Individual/Family)
$2,500 / $5,000
$1,000 / $2,000
Out-of-pocket maximum (Individual/Family)*
$5,000 / $10,000
$3,000 / $6,000
Preventive care
100%, no deductible
100%, no deductible
Primary physician office visit
$30 copay after deductible
$30 copay
Specialist office visit
$50 copay after deductible
$60 copay
Inpatient hospital services
30% after deductible
20% coinsurance
Outpatient hospital services (lab, x-ray, diagnostic)
30% after deductible
20% coinsurance
Advanced diagnostics
30% after deductible
20% coinsurance
Urgent care
30% after deductible
$75 copay
Emergency room care
30% after deductible
$100 copay
Prescription drugs Retail (30-day supply) Generic
30% after deductible
$20 copay
Brand preferred
30% after deductible
$50 copay
Brand non-preferred
30% after deductible
$70 copay
Mail order (90-day supply) Generic
30% after deductible
$40 copay
Brand preferred
30% after deductible
$100 copay
Brand non-preferred
30% after deductible
$140 copay
This is a summary of coverage; please refer to your summary plan description for the full scope of coverage. In-network services are based on negotiated charges; Out-of-network services are based on a percentage of Medicare charges.
* Includes Deductible and Copayments
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