Medical Benefits
HCSS offers 3 Medical plans through Cigna using the Open Access Plus network.
OAP Plus (PPO)
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
- PPO
- Network
- Open Access Plus
- Out-of-Network Coverage
- Yes
- HSA Eligible
- No
Your Premiums
Semi-Monthly payroll deductions
| Coverage Tier | Premium Plan |
|---|---|
| Employee Only | $88.68 |
| Employee + Spouse/Domestic Partner | $310.63 |
| Employee + Child/Children | $258.07 |
| Employee + Family | $564.68 |
Employee Only
- Premium Plan
- $88.68
Employee + Spouse/Domestic Partner
- Premium Plan
- $310.63
Employee + Child/Children
- Premium Plan
- $258.07
Employee + Family
- Premium Plan
- $564.68
Coverage Details
| Benefit | In-Network | Out-of-Network |
|---|---|---|
| Calendar Year - Deductible (Individual) | $500 | $1,000 |
| Calendar Year - Deductible (Family) | $1,000 | $2,000 |
| Out-of-Pocket Maximum (Individual) *Deductible, Coinsurance, & Copays | $3,000 | $6,000 |
| Out-of-Pocket Family (Individual) *Deductible, Coinsurance, & Copays | $6,000 | $12,000 |
| Preventative Care | 100% | N/A |
| Telehealth MDLive | Variable | N/A |
| Coinsurance | 90% | 70% |
| Office Visits - Primary / Specialist | $25 / $50 | 70% AD |
| Labs & X-Rays | 100% | N/A |
| In-Patient & Outpatient Hospital Facility | 90% AD | 70% AD |
| Emergency Room | $250 | $250 |
| Urgent Care | $50 | 70% AD |
Calendar Year - Deductible (Individual)
- In-Network
- $500
- Out-of-Network
- $1,000
Calendar Year - Deductible (Family)
- In-Network
- $1,000
- Out-of-Network
- $2,000
Out-of-Pocket Maximum (Individual) *Deductible, Coinsurance, & Copays
- In-Network
- $3,000
- Out-of-Network
- $6,000
Out-of-Pocket Family (Individual) *Deductible, Coinsurance, & Copays
- In-Network
- $6,000
- Out-of-Network
- $12,000
Preventative Care
- In-Network
- 100%
- Out-of-Network
- N/A
Telehealth MDLive
- In-Network
- Variable
- Out-of-Network
- N/A
Coinsurance
- In-Network
- 90%
- Out-of-Network
- 70%
Office Visits - Primary / Specialist
- In-Network
- $25 / $50
- Out-of-Network
- 70% AD
Labs & X-Rays
- In-Network
- 100%
- Out-of-Network
- N/A
In-Patient & Outpatient Hospital Facility
- In-Network
- 90% AD
- Out-of-Network
- 70% AD
Emergency Room
- In-Network
- $250
- Out-of-Network
- $250
Urgent Care
- In-Network
- $50
- Out-of-Network
- 70% 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