You have the freedom to choose doctors both in and out-of-network and may see a specialist without a referral. In-network and out-of-network benefits are subject to the applicable annual deductible and coinsurance. Office visits are generally paid at 100% after the applicable co-pay. No referrals required. Administered by Cigna.
Cost | In-Network Benefits | Out-of-Network Benefits |
PCP Office Visit and Convenience Care Clinic | $20 / $15 | 20% after deductible / N/A |
Specialist Office Visit | $35 | 30% after deductible |
Deductible | $250 per individual $750 per family | $1,500 per individual $4,500 per family |
Coinsurance | 10% | 20% |
Out-of-Pocket Maximum | $4,000 per individual $8,000 per family | $5,000 per individual $15,000 per family |