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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 / individual
$4,500 / family
Coinsurance 0%     20%
 Out-of-Pocket Maximum $4,000 / individual
$8,000 / family
$5,000 / individual
$15,000 / family


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