Page 5 - Success Academy | 21-22 Benefits Summary
P. 5

 Medical Plans
Copay Value Plan
The Copay Value Plan is an Exclusive Provider Organization (EPO Plan) that allows you to choose your providers from within Cigna’s Open Access Plus network.
For in-network providers, there are three types of payments
for medical services with this plan: your copay at the doctor’s office, your deductible, and your coinsurance. The most common copays are $30 per visit for a primary care doctor and $50 for
a specialist and urgent care. The deductible is the amount that you’ll need to pay for inpatient hospitalization and outpatient professional services before splitting the cost with Success, $1,500 (Employee Only) / $3,000 (Employee + Dependents). After you satisfy your annual deductible, Success will cover 80% of your medical costs and you’ll be responsible for the remaining 20% until you reach your annual maximum of $3,000 (Employee Only) / $6,000 (Employee + Dependents).
Visit for a listing of network providers in the Cigna OAP Network.
Lowest cost per paycheck.
Comprehensive medical coverage.
Set prescription costs: up to $15 for generic, $40 for preferred, and $80 for nonpreferred.
no future value from unspent HSA funds. Employees are unable to set aside pre-tax contributions toward an HSA account, and are ineligible for quarterly HSA contributions from SA.
Deductible:Mustmeetdeductibleof$1,500 (Employee Only) or $3,000 (Employee + Dependents) before coinsurance begins for inpatient hospitalization and outpatient professional services.

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