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.
The Cigna HMO 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.
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.
The Cigna Choice Fund PPO (CDHP PPO) with HSA plan pairs a Consumer Driven 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.
| Plan Features | Cigna HMO (CA Only) | Cigna Open Access Plus PPO | Cigna Choice Fund PPO (CDHP PPO) 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 | $750 / $2,250 | $3,000 / $4,5004 | $4,500 / $7,5004 |
| Annual Out-of-Pocket Maximum2 Individual/Family | $2,500 / $5,000 | $3,000 / $6,000 | $9,000 / $18,000 | $4,000 / $8,0004 | $8,000 / $16,0004 |
| Preventive Care | No charge | No charge | 40%3 | No charge | 40%3 |
| Telehealth | $20 copay | $25 copay | Not covered | 20%3 | Not covered |
| Primary Care Visit | $20 copay | $25 copay | 40%3 | 20%3 | 40%3 |
| Specialist Visit | $30 copay | $40 copay | 40%3 | 20%3 | 40%3 |
| Urgent Care | $30 copay | $25 copay | 20%3 | ||
| Emergency Room | $125 copay (waived if admitted) | $150 copay (waived if admitted) | 20%3 | ||
| Outpatient Hospital Service | $100 copay | $125 copay, then 20%3 | $250 copay, then 40%3 | 20%3 | 40%3 |
| Inpatient Hospital Services | $250 copay/day (5 days max) | $250 copay, then 20%3 | $500 copay, then 40%3 | 20%3 | 40%3 |
| Outpatient Mental Health | $20 copay | $25 copay | 40%3 | 20%3 | 40%3 |
| Inpatient Mental Health | $250 copay/day (5 days max) | $250 copay, then 20%3 | $500 copay, then 40%3 | 20%3 | 40%3 |
| Therapy – Speech, Physical, Occupational | $20 PCP or $30 Specialist copay | $25 PCP or $40 Specialist copay | 40%3 | 20%3 | 40%3 |
| Acupuncture (20 visits)5 | $20 PCP or $30 Specialist copay | $25 PCP or $40 Specialist copay | 40%3 | 20%3 | 40%3 |
| Plan Features | Cigna HMO (CA Only) | Cigna Open Access Plus PPO | Cigna Choice Fund PPO (CDHP PPO) 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: | |
| Prescription Drugs: Retail (up to 30-day supply) | |||||
| Generic | $10 | $10 | Not covered | $103 | Not covered |
| Brand Formulary | $20 | $30 | $303 | ||
| Non-Formulary | $40 | $50 | $503 | ||
| Specialty | $100 | $100 | 20%, up to $100 | ||
| Prescription Drugs: Mail Order (up to 90-day supply) | |||||
| Generic | $20 | $20 | Not covered | $203 | Not covered |
| Brand Formulary | $40 | $60 | $603 | ||
| Non-Formulary | $80 | $100 | $1003 | ||
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.
2Includes deductibles, copays, prescription copays, and coinsurance.
3After the deductible is satisfied. Deductible does not apply to generic preventive prescriptions on the Cigna Choice Fund PPO with HSA plan.
4An individual enrolled in family coverage will not be subject to more than the individual coverage deductible and/or out-of-pocket maximum in a calendar year.
5Treatment must be medically necessary and pre-authorization with Cigna is required.
Review the benefits guide and benefit summaries for detailed plan information.