Point of Service

For care coordinated by a Primary Care Physician (PCP), benefits are payable at the more cost-effective, in-network level, generally 100% after the applicable co-pay. Otherwise, benefits are payable out-of-network after satisfaction of the annual deductible. This plan is administered by Cigna.

Benefit Details


Cost

In-Network Benefits

Out-of-Network Benefits
PCP Office Visit and
Convenience Care Clinic
$20 / $15
20% after deductible / N/A
Specialist Office Visit
$35
20% after deductible
Deductible
$0
$1,500 per individual
$4,500 per family
Coinsurance
0%
20%
Out-of-Pocket Maximum
$4,000 per individual
$8,000 per family
$5,000 per individual
$15,000 per family