MEDICAL INSURANCE
National Aviation Academy offers medical coverage through Cigna. You have three plan options to choose from. To find participating providers go to www.cigna.com and click on “Find a Doctor”, then follow the prompts to complete the search within the “Open Access Plus (OAP)” network. The chart below provides a briefly overview of the medical plan offered.
MID COPAY PLAN
HIGH COPAY PLAN
H.S.A. PLAN
IN-NETWORK
Open Access Plus (OAP)
DEDUCTIBLE (your first dollar cost for covered in-network claims) Deductible (Individual / Family)
$2,500 / $5,000
$2,000 / $4,000
$1,000 / $3,000
COINSURANCE (Coinsurance is a cost sharingon claims that comes once you’vemet your deductible. The cost sharing is betweenyou and Cigna.) (Cigna / Member) 80% / 20% 80% / 20%
80% / 20%
OUT OF POCKET MAXIMUM (once met all in-network covered services are covered by the plan) MaximumOut-of-Pocket (Individual / Family) $6,500 / ($7,350) $13,000
$6,000 / $12,000
$3,500 / $7,000
Maximum Includes
Deductible, Coinsurance, Prescription Costs & Copays
PREVENTIVE CARE Wellness, Immunizations, Mammography, Colonoscopy, etc.
Covered 100%, no cost to you
OFFICE VISITS Referral Required
No
Virtual Visits
$45 - $49
$30 Copay
$25 Copay
Office Visits (Illness/Injury)
Covered 80% after deductible
$30 Copay
$25 Copay
Specialist Visits
Covered 80% after deductible
$55 Copay
$45 Copay
HOSPITAL SERVICES Inpatient Hospital
Covered 80% after deductible
Covered 80% after deductible
Covered 80% after deductible
Outpatient Surgery
Covered 80% after deductible
Covered 80% after deductible
Covered 80% after deductible
Emergency Room
Covered 80% after deductible
$300 Copay
$200 Copay
Urgent Care
Covered 80% after deductible
$60 Copay
$50 Copay
DIAGNOSTIC TESTING Lab
Covered 80% after deductible
Covered 100%
Covered 100%
X-Ray
Covered 80% after deductible
$50 Copay
Covered 100%
Advanced Imaging
(MRI, CAT, PET, etc.)
Covered 80% after deductible
$300 Copay
$200 Copay
Medical deductible first, then
PRESCRIPTIONS
Retail (30 day supply) Tier 1 / 2 / 3
$10 / $50 / $80
$10 / $30 / $50 / 20% to $250
$10 / $30 / $50 / 20% to $250
H.S.A compatible?
Yes
No
No
OUT-OF-NETWORK 1
All plans have out of network benefits, please refer to plan summaries for details. Semi Monthly Cost for Coverage
Employee Only
$79.50
$167.50
$198.50
Employee + Spouse
$400.50
$637.50
$711.50
Employee + Child(ren)
$270.50
$453.50
$513.50
Employee + Family
$579.50
$887.50
$986.50
1 Charges are subject to balance billing
This chart is intended only to highlight the benefits available and should not be relied upon to fully determine your coverage. If the below illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage. 3
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