Medical Benefits
HCSS offers 3 Medical plans through Cigna using the Open Access Plus network.
OAP IN (In-Network)
This is a brief description of the plan, please refer to the medical summary of benefits for more information.
Plan Details
- Carrier
- Cigna
- Network
- Open Access Plus
- Out-of-Network Coverage
- No
- HSA Eligible
- No
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 | $269.47 | $269.47 |
| Employee + Child/Children | $218.58 | $0.00 |
| Employee + Family | $496.84 | $278.77 |
Employee Only
- < 3 years of Tenure
- $0.00
- > 3 years of Tenure
- $0.00
Employee + Spouse/Domestic Partner
- < 3 years of Tenure
- $269.47
- > 3 years of Tenure
- $269.47
Employee + Child/Children
- < 3 years of Tenure
- $218.58
- > 3 years of Tenure
- $0.00
Employee + Family
- < 3 years of Tenure
- $496.84
- > 3 years of Tenure
- $278.77
Coverage Details
| Benefit | In-Network | Out-of-Network |
|---|---|---|
| Calendar Year - Deductible (Individual) | $2,000 | N/A |
| Calendar Year - Deductible (Family) | $4,000 | N/A |
| Out-of-Pocket Maximum (Individual) *Deductible, Coinsurance, & Copays | $4,000 | N/A |
| Out-of-Pocket Family (Individual) *Deductible, Coinsurance, & Copays | $8,000 | N/A |
| Preventative Care | 100% | N/A |
| Telehealth MDLive | Variable | N/A |
| Coinsurance | 80% | N/A |
| Office Visits - Primary / Specialist | $25 / $50 | N/A |
| Labs & X-Rays | 100% | N/A |
| In-Patient & Outpatient Hospital Facility | 90% AD | N/A |
| Emergency Room | $300 | N/A |
| Urgent Care | $50 | N/A |
Calendar Year - Deductible (Individual)
- In-Network
- $2,000
- Out-of-Network
- N/A
Calendar Year - Deductible (Family)
- In-Network
- $4,000
- Out-of-Network
- N/A
Out-of-Pocket Maximum (Individual) *Deductible, Coinsurance, & Copays
- In-Network
- $4,000
- Out-of-Network
- N/A
Out-of-Pocket Family (Individual) *Deductible, Coinsurance, & Copays
- In-Network
- $8,000
- Out-of-Network
- N/A
Preventative Care
- In-Network
- 100%
- Out-of-Network
- N/A
Telehealth MDLive
- In-Network
- Variable
- Out-of-Network
- N/A
Coinsurance
- In-Network
- 80%
- Out-of-Network
- N/A
Office Visits - Primary / Specialist
- In-Network
- $25 / $50
- Out-of-Network
- N/A
Labs & X-Rays
- In-Network
- 100%
- Out-of-Network
- N/A
In-Patient & Outpatient Hospital Facility
- In-Network
- 90% AD
- Out-of-Network
- N/A
Emergency Room
- In-Network
- $300
- Out-of-Network
- N/A
Urgent Care
- In-Network
- $50
- Out-of-Network
- N/A
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