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Cigna Medical and Prescription Drug Plans

Coverage to Build a Foundation of Good Health

At Smithers, we understand the importance of good health as the foundation for a productive life at home and at work. That is why we offer you the choice of three medical plans administered by Cigna to fit your needs and budget. If you participate in our Wellness Program and elect one of the HRA plan options you will receive money from Smithers to help meet your plan deductible and fund your health care expenses. Refer to the wellness webpage for more information.

Our Cigna plans utilizes the Open Access Plus network which offers you the flexibility to select the provider or facility of your choice. Keep in mind if you choose an in-network provider, your Cigna benefits will be paid at the highest level.

Definitions for the Medical Plans

Preventive Care: The plan pays 100% for in-network preventive care.

Annual Deductible: For non-preventive care there is an annual deductible that must be met. The annual deductible is per person up to the Family deductible.

Coinsurance: Your percentage share of the costs of a healthcare service, for example 20%. You start paying coinsurance after you’ve paid your plan’s deductible.

Copay: A fixed dollar amount, $25 for example, you pay for a covered health care service like an office visit. The copay lets you know ahead of time exactly how much you will owe. Note, if you have any lab testing, X-ray or diagnostic testing done at a providers office these are not covered by the copay and are subject to the plan deductible and coinsurance.

Out-of-Pocket Maximum: This is the most that you will have to pay for covered services in a plan year. All medical and prescription drug deductibles, copayments and coinsurance apply toward the out-of-pocket maximum. Once you meet the out-of-pocket maximum then the plan pays 100% of your eligible expenses, including the cost of all office visits and prescription drugs, for the remainder of the year.

Cost per pay: The pre-tax dollar amount removed from each bi-weekly pay.

Cigna

YOU HAVE A CHOICE OF THREE MEDICAL PLANS

In-network benefits are reflected. Refer to the benefit summaries for your out-of-network benefit.

Cigna Medical Plan Base Plan with HRA
OAP Network
Mid Plan with HRA
OAP Network
Buy Up Plan PPO
OAP Network
Calendar Year Deductible:
Single / Family
$5,000 / $10,000 $3,500 / $7,000 $1,500/ $3,000
Coinsurance 20% after deductible 20% after deductible 20% after deductible
Maximum Out of Pocket Limit:
Single /Family (Includes the deductible)
$8,000 / $16,000 $7,000 / $14,000 $6,000 / $12,000
Primary Care Office Visit $30 copay $30 copay $15 copay
 Specialist Office Visit $60 copay $60 copay $45 copay
Preventive Care Visit $0 copay $0 copay $0 copay
Virtual Visit $30 copay $30 copay $15 copay
Complex X-Ray and Lab
CT, PET, MRI, MRA etc.
20% after deductible 20% after deductible $500 copay
Urgent Care Centers $100 Copay $100 Copay $100 Copay
Emergency Medical Care
Copay waived if admitted
$300 copay + 20% coinsurance $300 copay + 20% coinsurance $300 copay + 20% coinsurance
In-Patient Hospital Services 20% after deductible 20% after deductible 20% after deductible
Out-Patient Hospital Services 20% after deductible 20% after deductible 20% after deductible
Prescription Drugs:
Retail (30 day supply) Tier 1 – $25 / Tier 2 – $70 / Tier 3 – $125 / Tier 4 Copay for retail of 25% to $250 Maximum
Mail Order (90 day supply) Tier 1 – $63 / Tier 2 – $175 / Tier 3 – $313