Medical
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers. The key difference between the plans is the amount of money you’ll pay each pay period and when you need 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.
Cigna Select HMO (Southern CA Only)
Plan Information
Plan Name: Cigna Select HMO (CA Only)
Policy Number: 3344704
Effective Date: 01/01/2025
Provider Network: Select Network
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$500/$1,000
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
No charge*
Primary Care Visit
$20 copay*
Specialist Visit
$40 copay*
Urgent Care
$50 copay*
Emergency Room (copay waived if admitted)
$150 copay*
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
$100 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Specialty
$100 copay (up to a 30-day supply)
* Deductible does not apply
Contact Information
Cigna Full HMO
Plan Information
Plan Name: Cigna Full HMO – All States Other than California
Policy Number: 3344704
Effective Date: 01/01/2025
Provider Network: Full HMO Network
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network Only
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$4,000/$8,000
Preventive Care
No charge
Primary Care Visit
$30 copay
Specialist Visit
$45 copay
Urgent Care
$60 copay (CA)
$50 copay (Outside CA)
Emergency Room (copay waived if admitted)
$200 copay (CA)
$100 copay (Outside CA)
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
$100 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Specialty
$200 copay
Plan Documents
2025 Cigna Full HMO Summary of Benefits & Coverage (AZ Only)
2025 Cigna Full HMO Summary of Benefits & Coverage (CA Only)
2025 Cigna Full HMO Summary of Benefits & Coverage (FL Only)
2025 Cigna Full HMO Summary of Benefits & Coverage (GA Only)
2025 Cigna Full HMO Summary of Benefits & Coverage (IL Only)
2025 Cigna Full HMO Summary of Benefits & Coverage (IN Only)
2025 Cigna Full HMO Summary of Benefits & Coverage (MO Only)
2025 Cigna Full HMO Summary of Benefits & Coverage (NC Only)
2025 Cigna Full HMO Summary of Benefits & Coverage (NJ Only)
2025 Cigna Full HMO Summary of Benefits & Coverage (SC Only)
2025 Cigna Full HMO Summary of Benefits & Coverage (TN Only)
2025 Cigna Full HMO Summary of Benefits & Coverage (TX Only)
Contact Information
Cigna Open Access Plus (OAP) PPO
Plan Information
Plan Name: Cigna Open Access Plus (OAP) PPO
Policy Number: 3344704
Effective Date: 01/01/2025
Provider Network: PPO
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$750/$1,500
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
No charge
Primary Care Visit
$20 copay*
Specialist Visit
$40 copay*
Urgent Care
$50 copay*
Emergency Room (copay waived if admitted)
$250 copay + 20%*
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
$250 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$30 copay
Preferred Brand
$90 copay
Non-Preferred Brand
$150 copay
Specialty
$250 copay (up to a 30-day supply)
* Deductible does not apply
Out-of-Network
Deductible (Individual/Family)
$1,500/$3,000
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
40% after deductible
Primary Care Visit
40% after deductible
Specialist Visit
40% after deductible
Urgent Care
40% after deductible
Emergency Room (copay waived if admitted)
$250 copay + 20%*
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
Specialty
Not covered
Contact Information
Cigna Open Access Plus (OAP) HDHP
Plan Information
Plan Name: Cigna Open Access Plus (OAP) HDHP
Policy Number: 3344704
Effective Date: 01/01/2025
Provider Network: Cigna Open Access Plus OAP
In-Network Benefit Highlights
Deductible (Individual/Family)
$XX/$XX
Out-of-Pocket Max (Individual/Family)
$XX/$XX
Preventive Care
$XX
Primary Care Visit
$XX
Specialist Visit
$XX
Urgent Care
$XX
Emergency Room
$XX
Benefit Highlights
In-Network
Deductible (Individual/Family)
$3,500/$7,000
Out-of-Pocket Max (Individual/Family)
$6,555/$13,100
Preventive Care
No charge
Primary Care Visit
10% after deductible
Specialist Visit
10% after deductible
Urgent Care
10% after deductible
Emergency Room (copay waived if admitted)
10% after deductible
Retail Rx (Up to 30-Day Supply)
Generic
$10 copay
Preferred Brand
$30 copay
Non-Preferred Brand
$50 copay
Specialty
$250 copay
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20 copay
Preferred Brand
$60 copay
Non-Preferred Brand
$100 copay
Specialty
$250 copay (up to a 30-day supply)
Out-of-Network
Deductible (Individual/Family)
$10,000/$20,000
Out-of-Pocket Max (Individual/Family)
$13,100/$26,200
Preventive Care
30% after deductible
Primary Care Visit
30% after deductible
Specialist Visit
30% after deductible
Urgent Care
30% after deductible
Emergency Room (copay waived if admitted)
10% 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
Specialty
Not covered