Page 28 - Skechers 2022 Benefits Guide

INTERNATIONAL – CIGNA MEDICAL PLAN OVERVIEW
CIGNA INTERNATIONAL MEDICAL HIGHLIGHTS***
Your Cost Share Shown Below
CIGNA INTERNATIONAL BENEFITS
Skechers’ international benefit plans for US expatriates consist of Medical, Dental, Vision, and Life Plans that are offered through Cigna International (Cigna).
Full-time expatriate employees and their eligible dependents may join the plan upon date of hire or the date of international assignment. Eligible dependents include spouses, domestic partners, and children under the age of 26. Coverage is only available for dependent children through and including age 25.
CIGNA INTERNATIONAL — MEDICAL PLAN
Under the Cigna Medical Plan, you may access care with any licensed physician of your choice.
The chart is a brief summary of the benefits and contributions of the international plans. For more detailed information, please go to the Reference Center on skechersbenefits.com (see enrollment section of this booklet for Reference Center access).
Member Services (U.S. Domestic Only): 800-441-2668 Member Services (International Collect Calls): +1-302-797-3100 Website: cignaenvoy.com
Employee
Employee + Family
Out-of-Pocket Maximum
Employee
Employee + Family
Services
Physician Office Visits
Specialist Office Visits
Preventive
Emergency Services
Hospitalization
Outpatient Services
X-ray and Laboratory Services
Mental Health and Substance Abuse
$300
$900
$3,000
$9,000
20% After Deductible
20% After Deductible
No Copay
20% After Deductible
20% After Deductible
20% After Deductible
20% After Deductible
20% After Deductible
***When in the US, use a Cigna medical provider to receive greater coverage. To find participating providers near you, please visit cignaenvoy.com or call 800-441-2668.
INTERNATIONAL BENEFIT**
(Medical, Dental, Vision, and Life Contributions)
Your Cost Share Shown Below
Employee
Employee + Spouse/ Domestic Partner
Employee + Child(ren)
Employee + Family
*Contributions include Medical, Dental, Vision, and Life **Your cost per paycheck (pre-tax). For the Cigna International Plan, your benefits become effective on the date of hire or transfer and you will be responsible for all per paycheck costs in the pay period in which your date of hire or transfer date occurs. If you become ineligible for the plan, your benefits terminate on the
$96.50 last day of the month in which you become ineligible, and you will be responsible for all per paycheck costs
$231.65 for the month. Benefits costs are NOT prorated.
$217.20
$354.50
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