Page 8 - 2022 Clari Open Enrollment Benefits Guide

Comparing Your Medical Plan Options

KAISER (CA) KAISER (OR) CIGNA
Group #: 606205 Group #: 606205 Group #: 00623765

HMO HMO PPO 700 PPO 250 HDHP

Provider Choice You must use a Kaiser You must use a Kaiser You can go to any provider you like; however, you will benefit from negotiated rates and
Network provider, except Network provider, except higher benefit levels when you use a Cigna Open Access Plus Network provider. Some
in case of emergency in case of emergency services are not covered out-of-network.
HSA Eligible No No No No Yes
Annual Deductible No deductible No deductible $700 / $1400 $250 / $500 $2,000 / $4,000
Individual / Family
Annual Out-of-Pocket Maximum $1,500 / $3,000 $2,000 / $4,000 $4,000 / $8,000 $2,500 / $5,000 $4,000 / $8,000
Individual / Family
Preventive Care Covered at 100% Covered at 100% Covered at 100% Covered at 100% Covered at 100%
Office Visits $20 / $35, no deductible $20 / $30, no deductible $30 / $30, no deductible $25 / $25, no deductible 20%
Primary / Specialist
Virtual Visits Covered at 100% Covered at 100% $30, no deductible $25, no deductible 20%

Other Medical Expenses You pay a set copay for You pay a set copay for You pay a set copay or You pay a set copay or In general, you pay 20%
most services most services coinsurance for most coinsurance for most of the negotiated rate,
services services after deductible
Emergency Room $100 copay, waived if $150 copay, waived if 20%, no deductible 10%, no deductible
admitted admitted
Benefits listed above reflect in-network benefits only. Some services require prior authorization before care is received.
Chiropractic care benefits may use a secondary network for benefits to apply and may only cover a set number of visits. Please refer to the carrier documents for details on
benefits, limitations, exclusions, restrictions and allowances.

Healthcare on Your Schedule
Virtual Visits are a convenient way to access medical care for non-emergency situations that still need immediate attention. Download
the Cigna or Kaiser app to connect with a doctor in minutes.

• Cigna Members: Register on mycigna.com and download the MDLive app.
• Kaiser Members: Schedule a video visit with your Primary Care Provider (PCP) via the Kaiser app.

6 We've Got You Covered Your Health Your Tax-Savings Accounts Your Safety Net Your Family Your Well-being Your "Me" Time Your Contacts