Page Comparison

Versions Compared

Key

This line was added.
This line was removed.
Formatting was changed.

Comparative Features	HDHP/HSA Option

OAP/PPO Option

In-Network	Out-of-Network

In-NetworkOut-of-Network

Deductible

Individual

$2,000

N/A (In- and out-of-network Deductible

cross-accumulate

$750$950

Family

$4,000

$2,250$2,850

Out-of-Pocket (OOP) Maximum

Individual

$3,425

N/A (In- and out-of-network Deductible

cross-accumulate

$2,750$10,750

Family

$6,850

$8,250$32,250

	Includes the deductible
SPU HSA Funding to offset Deductible for Individual	Up to $1,008 ($84 per month of participation)

Not available

Not available

SPU HSA Funding to offset Deductible for Family

Up to $2,016 ($168 per month of participation)

Not available

Not available


Coinsurance - You pay:

10%40%

	10%	40%
Office Visit	No copay; You pay 10% AFTER Deductible

No copay; You pay 40% AFTER Deductible

$25 copay; deductible waived, no coinsurance

No copay; You pay 40% AFTER Deductible

Preventive Care –

Routine Physicals (Adult exams)
Routine Well-Child Exams
Routine Mammograms
Routine DRE/Prostate Antigen Test/Exam for males
Routine Colorectal Cancer Screening

Covered 100%; deductible waived

Diagnostic mammograms covered under Diagnostic Lab/Xray

Covered 100%; deductible waived

Diagnostic mammograms covered the same as routine mammograms

In-Network Diagnostic Lab/Xray Outpatient

No copay; You pay 10% AFTER Deductible

No copay; You pay 40% AFTER Deductible

No copay; You pay 10% AFTER Deductible

No copay; You pay 40% AFTER Deductible

Urgent Care Provider (both In and Out-of-Network)

No copay; You pay 10% AFTER Deductible

Deductible applies after $25 copay; then plan pays 100%

Emergency Room (both In and Out-of-Network)

No copay; You pay 10% AFTER Deductible

Deductible applies after $100 copay (waived if admitted); then plan pays 90%


Ambulance (both In and Out-of-Network)	No copay; You pay 10% AFTER Deductible

No copay; You pay 10% AFTER Deductible

Hospital - Inpatient (both In and Out-of-Network)

No copay; You pay 10% AFTER Deductible

No copay; You pay 10% AFTER Deductible

Prescription Drugs

In-Network - Pharmacy – Retail

10% (generic) /20% (preferred brand)/30% (non-preferred brand) AFTER Deductible

Full cost of prescriptions accumulate towards the deductible
Specific Generic Preventive drugs covered at 100% with deductible waived
Other Brand-Name Preventive drugs require you pay 20% or 30% with deductible waived

Not covered

$10 (generic) /$25 (preferred brand) /$45 (non-preferred brand)

Co-pays count toward out-of-pocket maximum
Deductible does not apply
$5 copay for Specific Generic Preventive drugs

Not covered

Pharmacy – Cigna Mail Order Drug (90 day supply)

10% (generic) /20% (preferred brand) /30% non-preferred brand) AFTER Deductible

Full cost of prescriptions accumulate towards the deductible
Specific Generic Preventive drugs covered at 100%, deductible waived
Other Brand-Name Preventive drugs require you pay 20% or 30% with deductible waived
Shop pharmacies for lowest price

Not covered

$20 (generic) /$50 (preferred brand) /$90 (non-preferred brand)

Deductible does not apply

Co-pays count toward out-of-pocket maximum

$10 copay for Specific Generic Preventive drugs

Not covered