Medical and Pharmacy Coverage
Acom Integrated Solutions offers the following Medical plans through Cigna and offers “in and out-of-network” benefits.
Insurance Carrier:
Cigna Medical Insurance
HDHP w/ HSA Plan $6,350 Deductible
Open Access Plus Plan $6,000 Deductible
Medical Plan:
In-Network: Office Visit Copay - Primary Care
Deductible; then 100% Coinsurance
$25 Copay
Office Visit Copay - Specialist Care
Deductible; then 100% Coinsurance
$50 Copay
Urgent Care Copay
Deductible; then 100% Coinsurance
$75 Copay
Emergency Room Care
Deductible; then 100% Coinsurance
$350 Copay
Preventative Visit Copay
$0
$0
Diagnostic Testing & Blood Work
Deductible; then 100% Coinsurance
Deductible; then 100% Coinsurance
Imaging
Deductible; then 100% Coinsurance
Deductible; then 100% Coinsurance
Coinsurance
100%
100%
Employee Deductible
$6,350
$6,000
Family Deductible
$6,350
$12,000
Employee Out-of-Pocket Max
$6,350
$7,900
Family Out-of-Pocket Max
$12,700
$15,800
Inpatient Hospital
Deductible; then 100% Coinsurance
Deductible; then 100% Coinsurance
Outpatient Hospital or Facility
Deductible; then 100% Coinsurance
Deductible; then 100% Coinsurance
Out-of-Network: Coinsurance
70%
70%
Employee Deductible
$10,000
$10,000
Family Deductible
$10,000
$20,000
Employee Out-of-Pocket Max
$21,550
$23,700
Family Out-of-Pocket Max
$43,100
$47,400
Prescription Drugs: ( 30 Day Supply) Tier 1 - Generic
Deductible; then 100% Coinsurance
$15 Copay
Tier 2 - Preferred
Deductible; then 100% Coinsurance
$30 Copay
Tier 3 - Non-Preferred
Deductible; then 100% Coinsurance
$50 Copay
Employee Bi-Weekly Deduction Employee Only
$74.49 $331.79 $269.28 $425.69
$85.97 $350.99 $284.86 $450.32
Employee + Spouse Employee + Child(ren)
Family
8 ACOM INTEGRATED SOLUTIONS 2024 BENEFITS GUIDE
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