For care coordinated by a Primary Care Physician (PCP), benefits are payable at the more cost-effective, in-network level, generally 100% after the applicable co-pay. Otherwise, benefits are payable out-of-network after satisfaction of the annual deductible. This plan is administered by Cigna.
Benefit Details
PCP Office Visit and
Convenience Care Clinic
| $20
| 20% after deductible / N/A
|
Specialist Office Visit
| $35
| 20% after deductible
|
Deductible
| $0
| $1,500 per individual
$4,500 per family
|
Coinsurance
| 0%
| 20%
|
Out-of-Pocket Maximum
| $4,000 per individual
$8,000 per family
| $5,000 per individual
$15,000 per family
|