Medical Benefits
HCSS offers 3 Medical plans through Cigna using the Open Access Plus network.
HSA OAP (HDHP)
This is a brief description of the plan, please refer to the medical summary of benefits for more information.
Plan Details
- Carrier
- Cigna
- Plan Type
- HDHP
- Network
- Open Access Plus
- Out-of-Network Coverage
- Yes
- HSA Eligible
- Yes
Your Premiums
Semi-Monthly payroll deductions
| Coverage Tier | < 3 years of Tenure | > 3 years of Tenure |
|---|---|---|
| Employee Only | $0.00 | $0.00 |
| Employee + Spouse/Domestic Partner | $309.37 | $309.37 |
| Employee + Child/Children | $251.19 | $0.00 |
| Employee + Family | $532.62 | $317.31 |
Employee Only
- < 3 years of Tenure
- $0.00
- > 3 years of Tenure
- $0.00
Employee + Spouse/Domestic Partner
- < 3 years of Tenure
- $309.37
- > 3 years of Tenure
- $309.37
Employee + Child/Children
- < 3 years of Tenure
- $251.19
- > 3 years of Tenure
- $0.00
Employee + Family
- < 3 years of Tenure
- $532.62
- > 3 years of Tenure
- $317.31
Coverage Details
| Benefit | In-Network | Out-of-Network |
|---|---|---|
| Calendar Year - Deductible (Individual) | $1,700 | $4,000 |
| Calendar Year - Deductible (Family) | $3,400 | $8,000 |
| Out-of-Pocket Maximum (Individual) *Deductible, Coinsurance, & Copays | $4,000 | $8,000 |
| Out-of-Pocket Family (Individual) *Deductible, Coinsurance, & Copays | $8,000 | $16,000 |
| Preventative Care | 100% | N/A |
| Telehealth MDLive | 80% AD | N/A |
| Coinsurance | 80% | 60% |
| Office Visits - Primary / Specialist | 80% AD | 60% AD |
| Labs & X-Rays | 80% AD | 60% AD |
| In-Patient & Outpatient Hospital Facility | 90% AD | 90% AD |
| Emergency Room | 80% AD | 80% AD |
| Urgent Care | 80% AD | 60% AD |
Calendar Year - Deductible (Individual)
- In-Network
- $1,700
- Out-of-Network
- $4,000
Calendar Year - Deductible (Family)
- In-Network
- $3,400
- Out-of-Network
- $8,000
Out-of-Pocket Maximum (Individual) *Deductible, Coinsurance, & Copays
- In-Network
- $4,000
- Out-of-Network
- $8,000
Out-of-Pocket Family (Individual) *Deductible, Coinsurance, & Copays
- In-Network
- $8,000
- Out-of-Network
- $16,000
Preventative Care
- In-Network
- 100%
- Out-of-Network
- N/A
Telehealth MDLive
- In-Network
- 80% AD
- Out-of-Network
- N/A
Coinsurance
- In-Network
- 80%
- Out-of-Network
- 60%
Office Visits - Primary / Specialist
- In-Network
- 80% AD
- Out-of-Network
- 60% AD
Labs & X-Rays
- In-Network
- 80% AD
- Out-of-Network
- 60% AD
In-Patient & Outpatient Hospital Facility
- In-Network
- 90% AD
- Out-of-Network
- 90% AD
Emergency Room
- In-Network
- 80% AD
- Out-of-Network
- 80% AD
Urgent Care
- In-Network
- 80% AD
- Out-of-Network
- 60% AD
Pharmacy Benefits
| Prescription | In-Network | Out-of-Network |
|---|---|---|
| Pharmacy Benefit Copays - Retails: Generic / Preferred Brand / Non-Preferred Brand | $10 / $25 / $50 | $10 / $25 / $50 |
| Pharmacy Benefit Copays - Mail Order: Generic / Preferred Brand / Non-Preferred Brand | $25 / $63 / $125 (90 day supply) | $25 / $63 / $125 (90 day supply) |
| Medical Specialty Drugs Outpatient / Physicians Office / Home Setting | 90% AD | N/A |
Pharmacy Benefit Copays - Retails: Generic / Preferred Brand / Non-Preferred Brand
- In-Network
- $10 / $25 / $50
- Out-of-Network
- $10 / $25 / $50
Pharmacy Benefit Copays - Mail Order: Generic / Preferred Brand / Non-Preferred Brand
- In-Network
- $25 / $63 / $125 (90 day supply)
- Out-of-Network
- $25 / $63 / $125 (90 day supply)
Medical Specialty Drugs Outpatient / Physicians Office / Home Setting
- In-Network
- 90% AD
- Out-of-Network
- N/A