CIGNA Copay
RailWorks is pleased to offer you and your family two comprehensive medical plans through CIGNA.The plans work very differently, so please review them in detail to determine the best fit for you and your family.
CIGNA Copay
Plan Details
Carrier
Cigna
Network Name
Cigna OAP Network
Has Out Of Network Coverage
Yes
HSA Eligible
No
FSA Eligible
Yes
Covered Services
Medical Services
| In-Network | Out-of-Network | |
|---|---|---|
| Deductible (indiv./family) | $1,850 / $3,700 | $3,700 / $7,400 |
| Medical Out-of-Pocket Maximum (includes deductible & pharmacy) | Individual - Employee Only: $4,800 Individual - within a Family: $4,800 Family Maximum: $9,900 | Individual - Employee Only: $9,600 Individual - within a Family: $9,600 Family Maximum: $19,800 |
| Coinsurance | 20% after deductible | Up to 40% after deductible |
| Lifetime Max. Benefit | Unlimited | Unlimited |
| Physician Office Visit | $35 copay | 40% after deductible |
| Specialist Office Visit | $60 copay | 40% after deductible |
| Preventive Care Services | Covered 100%, deductible waived | 40% after deductible |
| Urgent Care Facility | $60 copay | $60 copay |
| Emergency Room | $250 copay | $250 copay |
| Inpatient Hospital Stay | 20% after deductible | 40% after deductible |
| Outpatient Services | 20% after deductible | 40% after deductible |
Deductible (indiv./family)
- In-Network
- $1,850 / $3,700
- Out-of-Network
- $3,700 / $7,400
Medical Out-of-Pocket Maximum (includes deductible & pharmacy)
- In-Network
- Individual - Employee Only: $4,800 Individual - within a Family: $4,800 Family Maximum: $9,900
- Out-of-Network
- Individual - Employee Only: $9,600 Individual - within a Family: $9,600 Family Maximum: $19,800
Coinsurance
- In-Network
- 20% after deductible
- Out-of-Network
- Up to 40% after deductible
Lifetime Max. Benefit
- In-Network
- Unlimited
- Out-of-Network
- Unlimited
Physician Office Visit
- In-Network
- $35 copay
- Out-of-Network
- 40% after deductible
Specialist Office Visit
- In-Network
- $60 copay
- Out-of-Network
- 40% after deductible
Preventive Care Services
- In-Network
- Covered 100%, deductible waived
- Out-of-Network
- 40% after deductible
Urgent Care Facility
- In-Network
- $60 copay
- Out-of-Network
- $60 copay
Emergency Room
- In-Network
- $250 copay
- Out-of-Network
- $250 copay
Inpatient Hospital Stay
- In-Network
- 20% after deductible
- Out-of-Network
- 40% after deductible
Outpatient Services
- In-Network
- 20% after deductible
- Out-of-Network
- 40% after deductible
Prescription Drugs
| In-Network | Out-of-Network | |
|---|---|---|
| Pharmacy Out-of-Pocket Maximum | Included in medical | Included in medical |
| Retail (30 days) - Generic | $15 copay | 30% after deductible |
| Retail (30 days) - Preferred Brand | $40 copay | 30% after deductible |
| Retail (30 days) - Non-Preferred Brand | $75 copay | 30% after deductible |
| Mail (90 days) - Generic | $37.50 copay | In-network only |
| Mail (90 days) - Preferred Brand | $100 copay | In-network only |
| Mail (90 days) - Non-Preferred Brand | $187.50 copay | In-network only |
Pharmacy Out-of-Pocket Maximum
- In-Network
- Included in medical
- Out-of-Network
- Included in medical
Retail (30 days) - Generic
- In-Network
- $15 copay
- Out-of-Network
- 30% after deductible
Retail (30 days) - Preferred Brand
- In-Network
- $40 copay
- Out-of-Network
- 30% after deductible
Retail (30 days) - Non-Preferred Brand
- In-Network
- $75 copay
- Out-of-Network
- 30% after deductible
Mail (90 days) - Generic
- In-Network
- $37.50 copay
- Out-of-Network
- In-network only
Mail (90 days) - Preferred Brand
- In-Network
- $100 copay
- Out-of-Network
- In-network only
Mail (90 days) - Non-Preferred Brand
- In-Network
- $187.50 copay
- Out-of-Network
- In-network only