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 Open Access Plus HSA

Benefit Highlights

In-Network

Deductible (Individual/Family)
$3,300/$6,600

Out-of-Pocket Max (Individual/Family)
$6,000/$11,000

Preventive Care
Covered in full

Primary Care Visit
No charge after deductible

Urgent Care
No charge after deductible

Emergency Room
No charge after deductible

Retail Rx (Up to 30-Day Supply)

Generic
$5 copay after deductible

Preferred Brand
$15 copay after deductible

Non-Preferred Brand
$30 copay after deductible

Specialty
$40 copay preferred after deductible

$60 copay non-preferred after deductible

Mail-Order Rx (Up to 90-Day Supply)

Generic
$13 copay after deductible

Preferred Brand
$38 copay after deductible

Non-Preferred Brand
$75 copay after deductible

Out-of-Network

Deductible (Individual/Family)
$8,000/$16,000

Out-of-Pocket Max (Individual/Family)
$16,000/$31,000

Preventive Care
30% after deductible

Primary Care Visit
30% after deductible

Urgent Care
30% after deductible

Emergency Room
No charge 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

Cigna Open Access Plus

Benefit Highlights

In-Network

Deductible (Individual/Family)
$250/$750

Out-of-Pocket Max (Individual/Family)
$3,500/$6,000

Preventive Care
Covered in full

Primary Care Visit
$20 copay

Urgent Care
$20 copay

Emergency Room
20% after $150 copay (copay waived if admitted)

Retail Rx (Up to 30-Day Supply)

Generic
$10 copay

Preferred Brand
$25 copay

Non-Preferred Brand
$45 copay

Specialty
$40 copay preferred

$60 copay non-preferred

Mail-Order Rx (Up to 90-Day Supply)

Generic
$25 copay

Preferred Brand
$63 copay

Non-Preferred Brand
$113 copay

Out-of-Network

Deductible (Individual/Family)
$250/$750

Out-of-Pocket Max (Individual/Family)
$7,500/$14,000

Preventive Care
40% after deductible

Primary Care Visit
40% after deductible

Urgent Care
40% after deductible

Emergency Room
20% after $150 copay (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

Hometown Health HDHP (Nevada Employees)

Benefit Highlights

In-Network

Deductible (Individual/Family)
$3,400/$6,800

Out-of-Pocket Max (Individual/Family)
$3,400/$6,800

Preventive Care
Covered in full

Primary Care Visit
No charge after deductible

Urgent Care
No charge after deductible

Emergency Room
No charge after deductible

Retail Rx (Up to 30-Day Supply)

Generic
No charge after deductible

Preferred Brand
No charge after deductible

Non-Preferred Brand
No charge after deductible

Specialty
No charge after deductible

Mail-Order Rx (Up to 90-Day Supply)

Generic
No charge after deductible

Preferred Brand
No charge after deductible

Non-Preferred Brand
No charge after deductible

Out-of-Network

Deductible (Individual/Family)
$6,800/$13,600

Out-of-Pocket Max (Individual/Family)
$6,800/$13,600

Preventive Care
30% after deductible

Primary Care Visit
30% after deductible

Urgent Care
No charge after deductible

Emergency Room
No charge 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

Hometown Health PPO (Nevada Employees)

Benefit Highlights

In-Network

Deductible (Individual/Family)
$500/$1,000

Out-of-Pocket Max (Individual/Family)
$2,000/$4,000

Preventive Care
Covered in full

Primary Care Visit
$15 copay

Urgent Care
$15 copay

Emergency Room
$100 copay (copay waived if admitted)

Retail Rx (Up to 30-Day Supply)

Generic
$10 copay

Preferred Brand
$30 copay

Non-Preferred Brand
$60 copay

Specialty
30% coinsurance

Mail-Order Rx (Up to 90-Day Supply)

Generic
$20 copay

Preferred Brand
$60 copay

Non-Preferred Brand
$120 copay

Out-of-Network

Deductible (Individual/Family)
$2,000/$4,000

Out-of-Pocket Max (Individual/Family)
$4,000/$8,000

Preventive Care
30% after deductible

Primary Care Visit
30% after deductible

Urgent Care
30% after deductible

Emergency Room
$100 copay (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

Kaiser HSA-Qualified (California Employees)

Benefit Highlights

In-Network

Deductible (Individual/Family)
$1,700/$3,400

Out-of-Pocket Max (Individual/Family)
$3,400/$6,800

Preventive Care
Covered in full

Primary Care Visit
10% after deductible

Urgent Care
10% after deductible

Emergency Room
10% after deductible

Retail Rx (Up to 30-Day Supply)

Generic
$10 copay after deductible

Preferred Brand
$30 copay after deductible

Non-Preferred Brand
$30 copay after deductible

Specialty
$30 copay after deductible

Mail-Order Rx (Up to 90-Day Supply)

Generic
$20 copay after deductible

Preferred Brand
$60 copay after deductible

Non-Preferred Brand
$60 copay after deductible

Kaiser HMO (California Employees)

Benefit Highlights

In-Network

Deductible (Individual/Family)
None

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

Preventive Care
Covered in full

Primary Care Visit
$20 copay

Urgent Care
$20 copay

Emergency Room
$100 per visit (copay waived if admitted)

Retail Rx (Up to 30-Day Supply)

Generic
$15 copay

Preferred Brand
$35 copay

Non-Preferred Brand
$35 copay

Specialty
$35 copay

Mail-Order Rx (Up to 90-Day Supply)

Generic
$30 copay

Preferred Brand
$70 copay

Non-Preferred Brand
$70 copay

Kaiser HMO (Hawaii Employees)

Benefit Highlights

In-Network Only

Deductible (Individual/Family)
None

Out-of-Pocket Max (Individual/Family)
$2,500/$7,500

Preventive Care
Covered in full

Primary Care Visit
$15 copay

Urgent Care
$15 copay or 20% coinsurance (if outside of Kaiser service area)

Emergency Room
$100 per visit (copay waived if admitted)

Retail Rx (Up to 30-Day Supply)

Generic
$15 copay

Preferred Brand
$50 copay

Non-Preferred Brand
$50 copay

Specialty
$200 copay

Mail-Order Rx (Up to 90-Day Supply)

Generic
$30 copay

Preferred Brand
$100 copay

Non-Preferred Brand
$100 copay

HMSA PPO (Hawaii Employees)

Benefit Highlights

In-Network

Deductible (Individual/Family)
None

Out-of-Pocket Max (Individual/Family)
$2,500/$7,500

Preventive Care
Covered in full

Primary Care Visit
10% coinsurance

Urgent Care
10% coinsurance

Emergency Room
10% coinsurance

Retail Rx (Up to 30-Day Supply)

Generic
$3 copay

Preferred Brand
$7 copay

Non-Preferred Brand
$40 copay

Specialty
$40 copay

Mail-Order Rx (Up to 90-Day Supply)

Generic
$8 copay

Preferred Brand
$17 copay

Non-Preferred Brand
$60 copay

Out-of-Network

Deductible (Individual/Family)
None

Out-of-Pocket Max (Individual/Family)
$2,500/$7,500

Preventive Care
Covered in full

Primary Care Visit
30% coinsurance

Urgent Care
30% coinsurance

Emergency Room
10% coinsurance

Retail Rx (Up to 30-Day Supply)

Generic
$3 copay + 20% coinsurance

Preferred Brand
$7 copay + 20% coinsurance

Non-Preferred Brand
$40 copay + 20% coinsurance

Specialty
$40 copay + 20% coinsurance

Mail-Order Rx (Up to 90-Day Supply)

Generic
Not covered

Preferred Brand
Not covered

Non-Preferred Brand
Not covered

HMSA CompMED (Hawaii Employees)

Benefit Highlights

In-Network

Deductible (Individual/Family)
$200/$600

Out-of-Pocket Max (Individual/Family)
$2,200/$6,600

Preventive Care
Covered in full

Primary Care Visit
$12 copay

Urgent Care
$12 copay

Emergency Room
20% after deductible

Retail Rx (Up to 30-Day Supply)

Generic
$3 copay

Preferred Brand
$7 copay

Non-Preferred Brand
$40 copay

Specialty
$40 copay

Mail-Order Rx (Up to 90-Day Supply)

Generic
$8 copay

Preferred Brand
$17 copay

Non-Preferred Brand
$60 copay

Out-of-Network

Deductible (Individual/Family)
$200/$600

Out-of-Pocket Max (Individual/Family)
$2,200/$6,600

Preventive Care
Covered in full

Primary Care Visit
$12 copay

Urgent Care
$12 copay

Emergency Room
20% after deductible

Retail Rx (Up to 30-Day Supply)

Generic
$3 copay + 20% coinsurance

Preferred Brand
$7 copay + 20% coinsurance

Non-Preferred Brand
$40 copay + 20% coinsurance

Specialty
$40 copay + 20% coinsurance

Mail-Order Rx (Up to 90-Day Supply)

Generic
Not covered

Preferred Brand
Not covered

Non-Preferred Brand
Not covered