Medical
Medical coverage provides healthcare protection for you and your family. You can visit any provider, but in-network doctors offer the highest level of benefits and lower out-of-pocket costs by charging reduced, contracted rates. Out-of-network providers set their own fees, so you may be responsible for charges above the Reasonable and Customary (R&C) limits. Preventive care—such as physical exams, flu shots, and screenings—is covered at 100% when you use in-network providers. The main differences between plan options are how much you pay per paycheck and what you pay when you receive care.
Each plan has different:
- Annual deductible amounts – the amount you pay each year for eligible in-network and out-of-network charges before the plan begins to pay.
- Out-of-pocket maximums– the most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays – A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance – Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Cigna Global Health Benefits–U.S. Citizen Global Assignees
Benefit Highlights
U.S. In-Network
Deductible (Individual/Family)
$300/$600
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
$0
Primary Care Visit
$20
Specialist Visit
$20
Emergency Room
20%*
Retail Rx (Up to 30-Day Supply)
Generic
$5
Preferred Brand
$15
Non-Preferred Brand
$30
Mail-Order Rx (Up to 90-Day Supply)
Generic
$15
Preferred Brand
$45
Non-Preferred Brand
$90
U.S. Out-of-Network
Deductible (Individual/Family)
$600/$1,200
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
$0
Primary Care Visit
$20
Specialist Visit
$20
Emergency Room
20%*
Retail Rx (Up to 30-Day Supply)
Generic
30%*
Preferred Brand
30%*
Non-Preferred Brand
30%*
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
International
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$0/$0
Preventive Care
$0
Primary Care Visit
$0
Specialist Visit
$0
Emergency Room
$0
Retail Rx (Up to 30-Day Supply)
Generic
$0
Preferred Brand
$0
Non-Preferred Brand
$0
Mail-Order Rx (Up to 90-Day Supply)
Generic
$0
Preferred Brand
$0
Non-Preferred Brand
$0
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Cigna Global Health Benefits–Non-U.S. Citizen Global Assignees
Benefit Highlights
U.S. In-Network
Deductible (Individual/Family)
$300/$600
Out-of-Pocket Max (Individual/Family)
$3,000/$6,000
Preventive Care
Not Covered
Primary Care Visit
Not Covered
Specialist Visit
Not Covered
Emergency Room
20%*
Retail Rx (Up to 30-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
U.S. Out-of-Network
Deductible (Individual/Family)
$600/$1,200
Out-of-Pocket Max (Individual/Family)
$6,000/$12,000
Preventive Care
Not Covered
Primary Care Visit
Not Covered
Specialist Visit
Not Covered
Emergency Room
20%*
Retail Rx (Up to 30-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
International
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$0/$0
Preventive Care
$0
Primary Care Visit
$0
Specialist Visit
$0
Emergency Room
$0
Retail Rx (Up to 30-Day Supply)
Generic
$0
Preferred Brand
$0
Non-Preferred Brand
$0
Mail-Order Rx (Up to 90-Day Supply)
Generic
$0
Preferred Brand
$0
Non-Preferred Brand
$0
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Aetna OA Select–Non-Union Employees and Retirees
Benefit Highlights
In-Network
Deductible (Individual/Family)
$0/$0
Out-of-Pocket Max (Individual/Family)
$5,080/$12,700
Preventive Care
$0
Primary Care Visit
$25
Specialist Visit
$35
Urgent Care
$25
Emergency Room
$150 (waived if admitted with 24 hours)
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$35
Non-Preferred Brand
$70
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$70
Non-Preferred Brand
$140
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX
Aetna POS II–Non-Union Employees and Retirees
Benefit Highlights
In-Network
Deductible (Individual/Family)
$250/$500
Out-of-Pocket Max (Individual/Family)
$5,050/$10,100
Preventive Care
$0
Primary Care Visit
$35
Specialist Visit
$45
Urgent Care
$35
Emergency Room
$150 (waived if admitted with 24 hours)
Retail Rx (Up to 30-Day Supply)
Generic
$10
Preferred Brand
$35
Non-Preferred Brand
$70
Mail-Order Rx (Up to 90-Day Supply)
Generic
$20
Preferred Brand
$70
Non-Preferred Brand
$140
Out-of-Network
Deductible (Individual/Family)
$1,500/$3,000
Out-of-Pocket Max (Individual/Family)
$9,000/$18,000
Preventive Care
$0
Primary Care Visit
70%*
Specialist Visit
70%*
Urgent Care
70%*
Emergency Room
$150 (waived if admitted with 24 hours)
Retail Rx (Up to 30-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Mail-Order Rx (Up to 90-Day Supply)
Generic
Not Covered
Preferred Brand
Not Covered
Non-Preferred Brand
Not Covered
Plan Cost
Employee Only: $XX
Employee and Spouse: $XX
Employee and Child(ren): $XX
Employee and Family: $XX