Medical

Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.

Each plan has different:

  • Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
  • Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
  • Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
  • Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Plan Documents
Plan Contacts

Cigna CDHP

Benefit Highlights
In-Network

Deductible (Individual/Family)
$1,650/$3,300

Out-of-Pocket Max (Individual/Family)
$3,300/$6,600

Preventive Care
$0 (deductible waived) 

Primary Care Visit
10% after deductible 

Specialist Visit
10% after deductible 

Urgent Care
10% after deductible 

Emergency Room
10% after deductible 

Retail Rx (Up to 30-Day Supply) 

Generic
$5 copay 

Preferred Brand
$40 copay 

Non-Preferred Brand
$60 copay 

Specialty
30% up to $250 

Mail-Order Rx (Up to 90-Day Supply) 

Generic
$15 copay 

Preferred Brand
$120 copay 

Non-Preferred Brand
$180 copay 

Specialty
30% up to $250 

Out-of-Network

Deductible (Individual/Family)
$4,500/$9,000 

Out-of-Pocket Max (Individual/Family)
$9,000/$18,000 

Preventive Care
30% after deductible 

Primary Care Visit
30% after deductible 

Specialist Visit
30% after deductible 

Urgent Care
30% after deductible 

Emergency Room
10% after deductible 

Retail Rx (Up to 30-Day Supply) 

Generic
Not covered 

Preferred Brand
Not covered 

Non-Preferred Brand
Not covered 

Specialty
Not covered 

Mail-Order Rx (Up to 90-Day Supply) 

Generic
Not covered 

Preferred Brand
Not covered 

Non-Preferred Brand
Not covered 

Specialty
Not covered 

Semi-Monthly Per-Pay-Period Plan Cost (+ VSP Vision)

Employee Only: $0.00

Employee and Spouse: $107.50

Employee and Child(ren): $90.50

Employee and Family: $227.00

Cigna PPO

Benefit Highlights
In-Network

Deductible (Individual/Family)
$250/$750 

Out-of-Pocket Max (Individual/Family)
$2,500/$5,000 

Preventive Care
$0 (deductible waived) 

Primary Care Visit
$20 copay (deductible waived) 

Specialist Visit
$40 copay (deductible waived) 

Urgent Care
$20 copay (deductible waived) 

Emergency Room
$150 copay + 10% after deductible (copay waived if admitted) 

Retail Rx (Up to 30-Day Supply) 

Generic
$5 copay 

Preferred Brand
$30 copay 

Non-Preferred Brand
$50 copay 

Specialty
30% up to $250 

Mail-Order Rx (Up to 90-Day Supply) 

Generic
$15 copay 

Preferred Brand
$90 copay 

Non-Preferred Brand
$150 copay 

Specialty
30% up to $250 

Out-of-Network

Deductible (Individual/Family)
$750/$2,250 

Out-of-Pocket Max (Individual/Family)
$7,500/$15,000 

Preventive Care
30% after deductible 

Primary Care Visit
30% after deductible 

Specialist Visit
30% after deductible 

Urgent Care
30% after deductible 

Emergency Room
$150 copay + 10% after deductible (copay waived if admitted) 

Retail Rx (Up to 30-Day Supply) 

Generic
Not covered 

Preferred Brand
Not covered 

Non-Preferred Brand
Not covered 

Specialty
Not covered 

Mail-Order Rx (Up to 90-Day Supply) 

Generic
Not covered 

Preferred Brand
Not covered 

Non-Preferred Brand
Not covered 

Specialty
Not covered 

Semi-Monthly Per-Pay-Period Plan Cost (+ VSP Vision)

Employee Only: $104.00

Employee and Spouse: $342.00

Employee and Child(ren): $272.50

Employee and Family: $563.50

Cigna EPO

Benefit Highlights
In-Network

Deductible (Individual/Family)
$250/$750 

Out-of-Pocket Max (Individual/Family)
$2,500/$5,000 

Preventive Care
$0 (deductible waived) 

Primary Care Visit
$20 copay (deductible waived) 

Specialist Visit
$40 copay (deductible waived) 

Urgent Care
$20 copay (deductible waived) 

Emergency Room
$150 copay + 10% after deductible (copay waived if admitted) 

Retail Rx (Up to 30-Day Supply) 

Generic
$5 copay 

Preferred Brand
$30 copay 

Non-Preferred Brand
$50 copay 

Specialty
30% up to $250 

Mail-Order Rx (Up to 90-Day Supply) 

Generic
$15 copay 

Preferred Brand
$90 copay 

Non-Preferred Brand
$150 copay 

Specialty
30% up to $250 

Out-of-Network

Deductible (Individual/Family)
$750/$2,250 

Out-of-Pocket Max (Individual/Family)
$7,500/$15,000 

Preventive Care
30% after deductible 

Primary Care Visit
30% after deductible 

Specialist Visit
30% after deductible 

Urgent Care
30% after deductible 

Emergency Room
$150 copay + 10% after deductible (copay waived if admitted) 

Retail Rx (Up to 30-Day Supply) 

Generic
Not covered 

Preferred Brand
Not covered 

Non-Preferred Brand
Not covered 

Specialty
Not covered 

Mail-Order Rx (Up to 90-Day Supply) 

Generic
Not covered 

Preferred Brand
Not covered 

Non-Preferred Brand
Not covered 

Specialty
Not covered 

Semi-Monthly Per-Pay-Period Plan Cost (+ VSP Vision)

Employee Only: $40.50

Employee and Spouse: $212.50

Employee and Child(ren): $166.00

Employee and Family: $373.00

Kaiser HMO (CA)

Benefit Highlights
In-Network Only

Deductible (Individual/Family)
$0

Out-of-Pocket Max (Individual/Family)
$1,500/$3,000 

Preventive Care
$0 

Primary Care Visit
$20 copay 

Specialist Visit
$20 copay 

Urgent Care
$20 copay 

Emergency Room
$50 copay (waived if admitted) 

Retail Rx (Up to 30-Day Supply) 

Generic
$15 copay 

Preferred Brand
$35 copay 

Non-Preferred Brand
$35 copay (prior authorization required) 

Specialty
$35 copay 

Mail-Order Rx (Up to 100-Day Supply) 

Generic
$30 copay 

Preferred Brand
$70 copay 

Non-Preferred Brand
$70 copay (prior authorization required) 

Specialty
$35 copay 

Semi-Monthly Per-Pay-Period Plan Cost (+ VSP Vision)

Employee Only: $40.50

Employee and Spouse: $212.50

Employee and Child(ren): $166.00

Employee and Family: $373.00

Kaiser HMO (OR)

Benefit Highlights
In-Network Only

Deductible (Individual/Family)
$0

Out-of-Pocket Max (Individual/Family)
$1,500/$3,000 

Preventive Care
$0 

Primary Care Visit
$20 copay ($5 copay for first 3 visits) 

Specialist Visit
$20 copay 

Urgent Care
$20 copay 

Emergency Room
$50 copay (waived if admitted) 

Retail Rx (Up to 30-Day Supply) 

Generic
$10 copay 

Preferred Brand
$20 copay 

Non-Preferred Brand
$40 copay 

Specialty
Applicable generic, preferred brand and non-preferred brand drug costs shares apply 

Mail-Order Rx (Up to 90-Day Supply) 

Generic
$20 copay 

Preferred Brand
$40 copay 

Non-Preferred Brand
$80 copay 

Specialty
Applicable generic, preferred brand and non-preferred brand drug costs shares apply 

Semi-Monthly Per-Pay-Period Plan Cost (+ VSP Vision)

Employee Only: $40.50

Employee and Spouse: $212.50

Employee and Child(ren): $166.00

Employee and Family: $373.00

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