Medical

When deciding which medical plan is right for you and your family, it is important to consider the total cost of coverage. This includes what you pay in premiums and what you pay for services out of your pocket.

Learn more about your three medical plan options by clicking on each plan below.

CA Network Plan – CA Only

The Cigna CA Network Plan is available only to residents of California. It provides coverage through in-network doctors from which you will select a primary care physician (PCP) who refers you to specialists if you need them. You will not have access to out-of-network physicians if you are enrolled in this plan. If you decide to seek treatment from an out-of-network doctor, you will be responsible for the full cost of treatment.

Open Access Plus (PPO)

The Cigna Open Access Plus PPO plan offers the flexibility to choose an in-network or out-of-network provider each time you need care. Keep in mind, you will save money when you visit in-network providers. Office visits, specialist visits, and urgent care visits are subject to a copay with some limitations.

Choice Fund HDHP with HSA

The Cigna Choice Fund HDHP with HSA plan pairs a High Deductible Health Plan with a Health Savings Account. With this plan, you are responsible for most expenses up to the calendar year deductible. After you meet the calendar year deductible, you will share a percentage of the expenses known as coinsurance. The out-of-pocket maximum limits the total amount you could be responsible for in a given year. You can use a Health Savings Account to help pay for eligible medical, dental, and vision expenses with pre-tax funds for you, your spouse, and your children. Acadia also contributes to your HSA.

Medical Plan Summary

Plan Features	Cigna CA Network Plan (CA Only)	Cigna Open Access Plus (PPO)		Cigna Choice Fund HDHP with HSA
	In-Network Only	In-Network	Out-of-Network¹	In-Network	Out-of-Network¹
	You pay:	You pay:	You pay:	You pay:	You pay:
Annual Deductible Individual/Family	None	$500 / $1,500	$1,200 / $2,400	$3,000 / $4,500²	$4,500 / $7,500²
Annual Out-of-Pocket Maximum³ Individual/Family	$2,500 / $5,000	$3,000 / $6,000	$9,000 / $18,000	$4,000 / $8,000²	$8,000 / $16,000²
Preventive Care	No charge	No charge	40%⁴	No charge	40%⁴
Telehealth	No charge	No charge	Not covered	No charge (MDLive only)	Not covered
Primary Care Visit	$20 copay	$25 copay	40%⁴	20%⁴	40%⁴
Specialist Visit	$30 copay	$40 copay	40%⁴	20%⁴	40%⁴
Urgent Care	$30 copay	$25 copay		20%⁴
Emergency Room (copay waived if admitted)	$125 copay	$150 copay + 20%		20%⁴
Outpatient Hospital Service	$100 copay	$125 copay + 20%⁴	$250 copay + 40%⁴	20%⁴	40%⁴
Inpatient Hospital Services	$250 copay/day (5 days max)	$250 copay + 20%⁴	$500 copay + 40%⁴	20%⁴	40%⁴
Outpatient Mental Health	$20 copay	$25 copay	40%⁴	20%⁴	40%⁴
Inpatient Mental Health	$250 copay/day (5 days max)	$250 copay + 20%⁴	$500 copay + 40%⁴	20%⁴	40%⁴
Therapy (Speech, Physical, Occupational)	$20 PCP or $30 Specialist copay	$25 PCP or $40 Specialist copay	40%⁴	20%⁴	40%⁴
Acupuncture (20 visits)⁵	$20 PCP or $30 Specialist copay	$25 PCP or $40 Specialist copay	40%⁴	20%⁴	40%⁴
Prescription Drugs: Retail (up to 30-day supply)
Generic	$10	$10	Not covered	$10⁴	Not covered
Brand Formulary	$20	$30		$30⁴
Non-Formulary	$40	$50		$50⁴
Specialty	$100	20%, up to $175		20%, up to $175
Prescription Drugs: Mail Order (up to 90-day supply)
Generic	$20	$20	Not covered	$20⁴	Not covered
Brand Formulary	$40	$60		$60⁴
Non-Formulary	$80	20%, up to $175		20%, up to $175⁴

¹Members may be responsible for the difference between the covered charges and the billed charges (‘Balance Billed’ amount) in addition to any deductible and coinsurance. ²An individual enrolled in family coverage will not be subject to more than the individual coverage deductible of $3,400 and/or out-of-pocket maximum in a calendar year. ³Includes deductibles, copays, prescription copays, and coinsurance. ⁴After the deductible is satisfied. Deductible does not apply to generic preventive prescriptions on the Cigna Choice Fund HDHP with HSA plan. ⁵Treatment must be medically necessary and pre-authorization with Cigna is required.

Review the benefits guide and benefit summaries for detailed plan information.

Cigna Transparency in Coverage Info
This link leads to the machine-readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.