Which Medical Plan is Right?
River City Construction Inc. offers two medical plans through Cigna. Below is a summary of the plans. Please refer to the Summary of Benefits and Coverage (SBC), for the full scope of coverage.
Medical Plan Comparison
Medical Plan Highlights
| | 3500 OAP Plan | 6500 HSA Plan | ||||||
|---|---|---|---|---|---|---|---|---|
| Member Responsibility | In-Network | In-Network | In-Network | Out-of-Network | ||||
|
Deductible Individual / Family |
$3,500 / $7,000 | $7,000 / $14,000 | $6,500 / $13,000 | $13,000 / $26,000 | ||||
|
Out-of-Pocket Maximum Individual / Family |
$7,500 / $15,000 | $15,000 / $30,000 | $6,500 / $13,000 | $13,000 / $26,000 | ||||
|
Coinsurance Plan Pays / You Pay |
70% / 30% | 50% / 50% | 100% / 0% | 60% / 40% | ||||
|
Preventative Care* Wellness, Mammograms, etc. |
No Charge | No Charge | No Charge | 40% AD | ||||
| Facility Visits | ||||||||
| Primary Care | No Charge | 50% AD | No Charge AD | 40% AD | ||||
| Specialists | $35 Copay + 30% AD | 50% AD | No Charge AD | 40% AD | ||||
| Emergency Room | $500 Copay | $500 Copay | No charge AD | Covered as in-network | ||||
| Urgent Care | No Charge | 50% AD | No Charge AD | 40% AD | ||||
| Inpatient Hospital | 30% AD | 50% AD | No Charge AD | 40% AD | ||||
| Outpatient Hosptial | 30% AD | 50% AD | No charge AD | 40% AD | ||||
| Telehealth | No charge | N/A | No charge AD** | N/A | ||||
| Prescriptions | ||||||||
| Tier 1 | $3 Copay | 50% AD | No charge AD | 40% AD | ||||
| Tier 2 | $75 Copay | 50% AD | No Charge AD | 40% AD | ||||
| Tier 3 | $100 Copay | 50% AD | No Charge AD | 40% AD | ||||
| Tier 4 | 20% up to $300 | 50% AD | No Charge AD | 40% AD | ||||
AD = After Deductible
* Preventative care is covered 100%, however, if additional services are needed, charges may apply. These charges are based on the codes your provider uses to bill the plan.
** Telehealth may have a different or smaller cost share for use of MD Live, Cigna’s preferred partner, through the app or member portal.
| Weekly Cost for Coverage | 3500 OAP Plan | 6500 HSA Plan |
|---|---|---|
| Employee Only | $57.00 | $50.25 |
| Employee + Spouse | $147.21 | $129.78 |
| Employee + Child(ren) | $137.41 | $121.14 |
| Family | $215.71 | $190.18 |