Medical Benef i ts - PPO Plan Ci gna - Open Access P l us Ne twor k 1-800-244-6224 www.myc i gna. com Group Number : 3332287 PPO PlanWeekly Premiums Employee Only
Non-Wellness Wellness
$72.20
$58.95
EMP + Spouse
$139.98 $126.73
Phillips & Jordan offers access to medical benefits through Cigna Health and Life Insurance Company. You may choose between two different medical plans: HDHP and PPO Plan. The PPO Plan offers higher premiums, but a lower deductible and out-of-pocket maximum. After reaching your annual deductible, medical expenses will be covered at 80%. By choosing the PPO Plan, you are eligible to set aside money in a Flexible Spending Account (FSA). To receive the maximum benefit from your chosen plan, make sure your medical provider is a member of the network. • In-network providers will file your claims. • By using an out-of-network physician or facility, you will be subject to a higher deductible and responsible for a larger percentage of the charges. You may also have to pay for charges over the usual and customary rate. To find an in-network provider, download the MyCigna app or go to the online directory at www.cigna.com and click on the “Find a Doctor” button to begin your search. Please be sure to carefully review the online directory or call Cigna to confirm that your provider participates in the network. The PPO Plan is not eligible for HSA contributions due to IRS regulations. EMP + Child(ren) $122.27 $109.05 EMP + Family $190.09 $176.84
Medical Benef i ts Compar ison
MEDICAL BENEFITS 1 (All benefits shown In-Network)
HDHP with HSA
PPO Plan
Deductible: Individual / Family
$3,000 / $6,000 (Shared) 2 $2,000 / $4,000 (Embedded) 3
Out-of-Pocket Maximum: Individual / Family SERVICES RECEIVED AT A PRACTITIONER’S OFFICE Preventive Care
$3,000 / $6,000
$3,000 / $6,000
100%
100%
Office Visit For sick visits, please consider Teladoc first SERVICES RECEIVED AT A FACILITY Emergency Room
100% after deductible
80% after deductible
100% after deductible 100% after deductible
80% after deductible 80% after deductible
MOST OTHER SERVICES
PHARMACY Retail Preventive Generics Generics / Preferred Brand / Non-Preferred Brands Mail Order 4 Preventive Generics Generics / Preferred Brand / Non-Preferred Brands
Plan pays 100% 100% after deductible
$10 / $35 / $60
Plan pays 100% 100% after deductible 100% after deductible
3x Retail copay
Specialty Drugs n/a / $35 / $60 1. See your Evidence of Coverage for Out-of-Network Benefits, prior authorization, visit limits and more. 2. Shared Family Deductible - entire family deductible must be met before the plan will pay. 3. Embedded Deductible - each individual is only responsible for the individual deductible amount before the plan will pay (maximum two deductibles).
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