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US Mainland—Medical Plan Details

This plan is only available to U.S. mainland employees.

Cigna Open Access Plus Cigna Open Access Plus Cigna Open Access Plus
Base—$2,000 PPO Choice—$1,000 PPO HDHP 1—$3,000 HDHP
In-Network Out-of-Network In-Network Out-of-Network In-Network Out-of-Network
Calendar Year Deductible
Embedded Embedded Embedded
Individual $2,000 $4,000 $1,000 $3,000 $3,000 $6,000
Family $4,000 $12,000 $2,000 $6,000 $6,000 $12,000
Out-of-Pocket Maximum (includes deductible)
Individual $6,350 $16,000 $3,000 $9,000 $5,000 $10,000
Family $12,700 $48,000 $6,000 $18,000 $10,000 $20,000
Physician Oice Visits
Preventive Care Covered at Deductible; Covered at Deductible; Covered at 100% Deductible; 40%
100% 50% 100% 30% coinsurance
coinsurance coinsurance
Primary Care Visit $35 copay Deductible; $25 copay Deductible; Deductible; 20% Deductible; 40%
50% 30% coinsurance coinsurance
coinsurance coinsurance
Specialist Visit $50 copay Deductible; $40 copay Deductible; Deductible; 20% Deductible; 40%
50% 30% coinsurance coinsurance
coinsurance coinsurance
Telemedicine $35 copay Not covered $25 copay Not covered $55 copay Not covered
that applies to
deductible; 20%
coinsurance
Urgent Care $75 copay Deductible; $75 copay Deductible; Deductible; 20% Deductible; 40%
50% 30% coinsurance coinsurance
coinsurance coinsurance
Hospital Services
Inpatient Deductible; Deductible; Deductible; Deductible; Deductible; 20% Deductible; 40%
30% 50% 20% 40% coinsurance coinsurance
coinsurance coinsurance coinsurance coinsurance
Outpatient Deductible; Deductible; Deductible; Deductible; Deductible; 20% Deductible; 40%
30% 50% 20% 40% coinsurance coinsurance
coinsurance coinsurance coinsurance coinsurance
Emergency Room $250 copay $250 copay $250 copay $250 copay Deductible; 20% Deductible; 40%
coinsurance coinsurance

10 2020 Benefits Guide