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You have the freedom to choose doctors both in and out-of-network and may see a specialist without a referral. In-network and out-of-network benefits are subject to the applicable annual deductible and coinsurance. Office visits are generally paid at 100% after the applicable co-pay. No referrals required. 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 30% after deductible
Deductible $250 / individual
$750 / family
$1,500 / individual
$4,500 / family
Coinsurance 10% 20%
Out-of-Pocket Maximum $4,000 / individual
$8,000 / family
$5,000 / individual
$15,000 / family


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