Page 6 - MyPoint EE Guide

BENEFITS

Medical Insurance

Considering which plan to Cigna Select HMO Cigna Full HMO
choose? Plan Name HMO
The plan design is the same with both Network Name So. Cal. Select HMO HMO
options. The difference is the network
of Providers you have access to. Plan Differences
Employee Premiums $ $$
The Select Network includes, Mercy
Physicians Medical Group, Rady Out of Pocket Costs $ $
Children's, Scripps Green, Scripps Employee Cost Sharing Contribution, Copay Contribution, Copay
Memorial Hospital, Scripps Clinic
Medical Group, Scripps Coastal Health Benefits
Medical Center, Scripps Physicians
Lifetime Maximum Unlimited Unlimited
Medical Group.
Deductible (Annual)
The Full Network includes the same as - Individual $0 $0
Select, but with additional Providers - Family $0 $0
including Sharp, Tri-City, UCSD.
Out-of-Pocket Maximum
- Individual $3,000 $3,000

- Family $6,000 $6,000

Office Visit Copay
- Preventive Care No Charge No Charge
Virtual Visits - Primary Care Physician $25 Copay $25 Copay
- Specialist Office Visit $25 Copay $25 Copay
When you don’t feel well, or your - Urgent Care $35 Copay $35 Copay
child is sick, the last thing you want
- Virtual Visits $25 Copay $25 Copay
to do is leave the comfort of home
- Chiropractic (20 days) $25 Copay $25 Copay
to sit in a waiting room. Now you
don’t have to. Hospitalization
- Inpatient $500 Copay $500 Copay
MDLIVE will allow you see and talk - Outpatient $250 Copay $250 Copay
to a doctor from your mobile
device or computer without an Lab and X-Ray
appointment. Most visits take - Diagnostic $0 Copay $0 Copay
- Complex $50 Copay $50 Copay
about 10-15 minutes and doctors
can send a prescription to your Emergency Services $100 Copay $100 Copay
local pharmacy, if needed. Use this
service for minor issues such as Pharmacy Benefits
colds, fever, flu, allergies, soar
Pharmacy Deductible $0 $0
throats, headache, stomach ache
and more. This service is part of Retail Pharmacy (30 Days)
your health benefits offered - Generic Formulary $15 Copay $15 Copay
through Cigna. - Brand Name Formulary $35 Copay $35 Copay
- Non-Formulary $50 Copay $50 Copay
Cigna Mail Order Pharmacy
Quickly and easily make video visits
- Generic Formulary $30 Copay $30 Copay
online or via the mobile app. You - Brand Name Formulary $70 Copay $70 Copay
must be registered on Cigna’s
- Non-Formulary $100 Copay $100 Copay
website to take advantage of this
service.
www.cigna.com

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