Medical
Medical coverage offers healthcare protection for you and your family. You may visit any medical provider you choose, but in-network providers offer the highest level of benefits and lower out-of-pocket costs. Network providers charge members reduced, contracted fees instead of their typical fees. Providers outside the plan’s network set their own rates, so you may be responsible for the difference if a provider’s fees are above the Reasonable and Customary (R&C) limits.
Preventive Care – like physical exams, flu shots, and screenings – is always covered 100% when you use in-network providers.
High Level Information About The Stack AV Medical Plan:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay. The in-network deductible is $0. If you go Out-of-Network, there is a $2,000 individual or $5,000 family deductible.
- Out-of-pocket maximums – the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service.
- Coinsurance – For out-of-network services, once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, for out-of-network services, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Cigna Medical Plan
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$5,350/$10,700
Preventive Care
$0
Primary Care Visit
$15 copay
Specialist Visit
$15 copay
Urgent Care
$15 copay
Emergency Room
$150 (copay waived if admitted)
Retail Rx (Up to 30-Day Supply)
Generic
$5 copay
Preferred Brand
$10 copay
Non-Preferred Brand
$20 copay
Specialty (Through Accredo Specialty Pharmacy)
Through Accredo Specialty Pharmacy (877-826-7657)
Applicable copay applies
Mail-Order Rx (Up to 90-Day Supply)
Generic
$10 copay
Preferred Brand
$20 copay
Non-Preferred Brand
$40 copay
Specialty
Not covered
Out-of-Network
Deductible (Individual/Family)
$2,000/$5,000
Out-of-Pocket Max (Individual/Family)
$10,700/$21,400
Preventive Care
20% coinsurance after deductible
Primary Care Visit
20% coinsurance after deductible
Specialist Visit
20% coinsurance after deductible
Urgent Care
20% coinsurance after deductible
Emergency Room
$150 (copay waived if admitted)*
Retail Rx (Up to 30-Day Supply)
Generic
50% coinsurance*
Preferred Brand
50% coinsurance*
Non-Preferred Brand
50% coinsurance*
Specialty
Not Covered*
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not covered
Preferred Brand
Not covered
Non-Preferred Brand
Not covered
Specialty
Not covered
*Deductible does not apply
Monthly Plan Cost
Enrollment Tier |
Stack AV Cost |
Your Cost |
| Employee Only: | $1,337.13 | $0 |
| Employee and Spouse / Partner: | $2,807.99 | $0 |
| Employee and Child(ren): | $2,540.56 | $0 |
| Employee and Family: | $4,011.40 | $0 |