Medical Benefits

Your employer offers medical insurance to protect the health of you and your family. It covers medical expenses such as visits to the doctor’s office, emergency care, and prescription drugs. It’s important to have a medical plan that meets your needs and the needs of your family.

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please www.cigna.com.

Plans	PPO $2,000 OAP	HSA $5,000 OAP	PPO $4,000 Local Plus	HSA $5,000 Local Plus
Cigna Network	National Open Access Plus	National Open Access Plus	Local Plus	Local Plus
HSA Eligible?	NO	YES and Employer Contribution	NO	YES and Employer Contribution
Deductible (Individual/Family)	$2,000 / $4,000	$5,000 / $10,000	$4,000 / $8,000	$5,000 / $10,000
Member Coinsurance	20%	0%	20%	0%
Out-of-Pocket Max (Individual/Family)	$4,500/$9,000	$5,000 / $10,000	$6,750 / $13,500	$5,000 / $10,000
Routine Preventive Care	No Cost	No Cost	No Cost	No Cost
Primary Care Office Visit	$40 Copay	Deductible	$40 Copay	Deductible
Specialist Visit	$40 Copay	Deductible	$80 Copay	Deductible
Inpatient/Outpatient Services	Deductible then 20%	Deductible	Deductible then 20%	Deductible
MRI, MRA, CT and PET Scans, etc.	Deductible then 20%	Deductible	Deductible then 20%	Deductible
Urgent Care	$40 Copay	Deductible	$80 Copay	Deductible
Emergency Room	$300 Copay, then Deductible then 20%	Deductible	$350 Copay, then Deductible then 20%	Deductible
Prescriptions
Retail	$15 / $35 / $75	Deductible	$15 / $35 / $75	Deductible
Mail Order	$38 / $88 / $188	Deductible	$38 / $88 / $188	Deductible


*HSA plan participants are responsible for paying 100% of medical costs until the plan’s deductible is met. Once the deductible is met, all subsequent expenses will be covered in full by Blue Cross.


*Participants in an HSA plan will receive a $50 per month contribution from DCA into a Health Savings Account (HSA).*

Full-Time Employee Rates Per Pay Period (26)	PPO $2,000 OAP	HSA $5,000 OAP	PPO $4,000 Local Plus	HSA $5,000 Local Plus
Employee Only	$129.30	$52.24	$60.86	$47.55
Employee + Spouse	$368.68	$288.20	$277.38	$264.63
Employee + Child(ren)	$341.67	$255.72	$258.03	$241.09
Family	$642.71	$562.99	$498.41	$471.36


This is a brief outline of your benefits, showing in-network benefits only.
Dependents are covered until the end of the calendar year in which they turn age 26.
Employees who are or reach the age of 65 may continue to be enrolled in benefits. See “Miller Milestones” on page 23 of your brochure for more information.

Downloads

CignaOne Guide

Know Before You Go

MyCigna Customer Flyer

Cigna Virtual Care

Wellness

Preventive - Get Health Screenings Flyer

Health Information Line Customer Flyer

MyCigna Find a Doctor Open Enrollment Customer Flyer

Omada Flyer

Keep in mind that your out-of-pocket costs will be lower if you receive care from an in-network doctor and facility. To find an in-network doctor, please www.cigna.com.

Plans	PPO $2,000 OAP	HSA $5,000 OAP	PPO $4,000 OAP
Cigna Network	National Open Access Plus	National Open Access Plus	National Open Access Plus
HSA Eligible?	NO	YES and Employer Contribution	NO
Deductible (Individual/Family)	$2,000 / $4,000	$5,000 / $10,000	$4,000 / $8,000
Member Coinsurance (Your Share)	20%	0%	20%
Out-of-Pocket Max (Individual/Family)	$4,500 / $9,000	$5,000 / $10,000	$6,750 / $13,500
Routine Preventive Care	No Cost	No Cost	No Cost
Primary Care Office Visit	$40 Copay	Deductible	$40 Copay
Specialist Visit	$40 Copay	Deductible	$80 Copay
Inpatient/Outpatient Services	Deductible then 20%	Deductible	Deductible then 20%
MRI, MRA, CT and PET Scans, etc.	Deductible then 20%	Deductible	Deductible then 20%
Urgent Care	$40 Copay	Deductible	$80 Copay
Emergency Room	$300 Copay, then Deductible then 20%	Deductible	$350 Copay, then Deductible then 20%
Prescriptions
Retail	$15 / $35 / $75	Deductible	$15 / $35 / $75
Mail Order	$38 / $88 / $188	Deductible	$38 / $88 / $188


*HSA plan participants are responsible for paying 100% of medical costs until the plan’s deductible is met. Once the deductible is met, all subsequent expenses will be covered in full by Blue Cross.


Participants in an HSA plan will receive a $50 per month contribution from DCA into a Health Savings Account (HSA).

Full-Time Employee Rates Per Pay Period (26)	PPO $2,000 OAP	HSA $5,000 OAP	PPO $4,000 OAP
Employee Only	$129.30	$52.24	$88.77
Employee + Spouse	$368.68	$288.20	$307.86
Employee + Child(ren)	$341.67	$255.72	$267.51
Family	$642.71	$562.99	$566.09


This is a brief outline of your benefits, showing in-network benefits only.
Dependents are covered until the end of the calendar year in which they turn age 26.
Employees who are or reach the age of 65 may continue to be enrolled in benefits. See “Miller Milestones” on page 23 of your brochure for more information.