Below is a brief summary of all medical plan options. For more details, review the benefit summaries found at the bottom of the page.
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Cigna 1500 Choice Fund with HRA
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Individual Deductible
In-Network:
Individual: $1,500
Individual in Family: N/A
Non-Network:
$3,000
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Family Deductible
In-Network:
$3,000
Non-Network:
$6,000
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Individual Out-of-Pocket Maximum
In-Network:
$3,500
Non-Network:
$7,000
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Family Out-of-Pocket Maximum
In-Network:
$7,000
Non-Network:
$14,000
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Employer Fund
Individual: $750
Family: $1,500
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Coinsurance
In-Network:
20% after deductible
Non-Network:
40% after deductible
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Doctor's Office
In-Network:
$25 copay
Non-Network:
40% after deductible
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Specialist's Office
In-Network:
$50 copay
Non-Network:
40% after deductible
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Retail Prescription Drugs
30-day supply
In-Network:
Generic: $10 copay
Preferred Brand: $30 copay
Non-Preferred Brand: $50 copay
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Retail Prescription Drugs
90-day supply
In-Network:
Generic: $25 copay
Preferred Brand: $75 copay
Non-Preferred Brand: $125 copay
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Mail Order Prescription Drugs
90-day supply
In-Network:
Generic: $25 copay
Preferred Brand: $75 copay
Non-Preferred Brand: $125 copay
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Bi-Weekly Employee Contributions (Effective 7/1/2020)
Wellness
EE Only: $71.22
EE + Spouse: $192.58
EE + Child(ren): $179.77
EE + Family: $279.71
Non-Wellness
EE Only: $96.22
EE + Spouse: $217.58
EE + Child(ren): $204.77
EE + Family: $304.71
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Cigna 2000 Choice Fund with HSA
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Individual Deductible
In-Network:
Individual: $2,000
Individual in Family: $2,700
Non-Network:
$4,000
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Family Deductible
In-Network:
$4,000
Non-Network:
$8,000
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Individual Out-of-Pocket Maximum
In-Network:
$4,000
Non-Network:
$8,000
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Family Out-of-Pocket Maximum
In-Network:
$8,000
Non-Network:
$16,000
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Employer Fund
Individual: $750
Family: $1,500
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Coinsurance
In-Network:
20% after deductible
Non-Network:
40% after deductible
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Doctor's Office
In-Network:
20% after deductible
Non-Network:
40% after deductible
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Specialist's Office
In-Network:
20% after deductible
Non-Network:
40% after deductible
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Retail Prescription Drugs
30-day supply
In-Network:
Generic: $10 copay
Preferred Brand: $30 copay
Non-Preferred Brand: $50 copay
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Retail Prescription Drugs
90-day supply
In-Network:
Generic: $25 copay
Preferred Brand: $75 copay
Non-Preferred Brand: $125 copay
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Mail Order Prescription Drugs
90-day supply
In-Network:
Generic: $25 copay
Preferred Brand: $75 copay
Non-Preferred Brand: $125 copay
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Bi-Weekly Employee Contributions (Effective 7/1/2020)
Wellness
EE Only: $59.76
EE + Spouse: $170.28
EE + Child(ren): $156.95
EE + Family: $242.88
Non-Wellness
EE Only: $84.76
EE + Spouse: $195.28
EE + Child(ren): $181.95
EE + Family: $267.88
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Cigna 2500 Choice Fund with HRA
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Individual Deductible
In-Network:
Individual: $2,500
Individual in Family: N/A
Non-Network:
$5,000
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Family Deductible
In-Network:
$5,000
Non-Network:
$10,000
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Individual Out-of-Pocket Maximum
In-Network:
$5,000
Non-Network:
$10,000
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Family Out-of-Pocket Maximum
In-Network:
$10,000
Non-Network:
$20,000
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Employer Fund
Individual: $750
Family: $1,500
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Coinsurance
In-Network:
20% after deductible
Non-Network:
40% after deductible
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Doctor's Office
In-Network:
20% after deductible
Non-Network:
40% after deductible
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Specialist's Office
In-Network:
20% after deductible
Non-Network:
40% after deductible
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Retail Prescription Drugs
30-day supply
In-Network:
Generic: $10 copay
Preferred Brand: $30 copay
Non-Preferred Brand: $50 copay
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Retail Prescription Drugs
90-day supply
In-Network:
Generic: $25 copay
Preferred Brand: $75 copay
Non-Preferred Brand: $125 copay
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Mail Order Prescription Drugs
90-day supply
In-Network:
Generic: $25 copay
Preferred Brand: $75 copay
Non-Preferred Brand: $125 copay
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Bi-Weekly Employee Contributions (Effective 7/1/2020)
Wellness
EE Only: $44.66
EE + Spouse: $158.19
EE + Child(ren): $131.55
EE + Family: $202.93
Non-Wellness
EE Only: $69.66
EE + Spouse: $183.19
EE + Child(ren): $156.55
EE + Family: $227.93
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Cigna Southern CA Select HMO
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Individual Deductible
In-Network:
Individual: None
Individual in Family: None
Non-Network:
N/A
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Family Deductible
In-Network:
None
Non-Network:
N/A
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Individual Out-of-Pocket Maximum
In-Network:
$3,000
Non-Network:
N/A
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Family Out-of-Pocket Maximum
In-Network:
$6,000
Non-Network:
N/A
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Employer Fund
Individual: N/A
Family: N/A
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Coinsurance
In-Network:
0%
Non-Network:
N/A
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Doctor's Office
In-Network:
$20 copay
Non-Network:
N/A
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Specialist's Office
In-Network:
$40 copay
Non-Network:
N/A
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Retail Prescription Drugs
30-day supply
In-Network:
Generic: $10 copay
Preferred Brand: $30 copay
Non-Preferred Brand: $50 copay
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Retail Prescription Drugs
90-day supply
In-Network:
Generic: $25 copay
Preferred Brand: $75 copay
Non-Preferred Brand: $125 copay
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Mail Order Prescription Drugs
90-day supply
In-Network:
Generic: $25 copay
Preferred Brand: $75 copay
Non-Preferred Brand: $125 copay
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Bi-Weekly Employee Contributions (Effective 7/1/2020)
Wellness
EE Only: $57.19
EE + Spouse: $176.17
EE + Child(ren): $163.27
EE + Family: $263.98
Non-Wellness
EE Only: $82.19
EE + Spouse: $201.17
EE + Child(ren): $188.27
EE + Family: $288.98
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