Medical – Foundation for the Carolinas

Medical Plan Comparison

The Foundation offers two (2) health plan options including medical and prescription drug benefits. The medical portion of the plan is administered by Cigna.

Both plans are supported by a national network of medical providers and allow you to seek the care of any physician or facility without the need to choose a primary care physician (PCP) or seek referrals. You can choose a plan that best suits you and your family’s needs.

Below is a side-by-side comparison of the Medical Plan options.

	CIGNA HDHP			CIGNA PPO
	In-Network Benefits	Out-of-Network Benefits	In-Network Benefits	Out-of-Network Benefits
Annual Deductible
Individual	$3,500	$7,000	$3,500	$7,000
Family	$7,000	$14,000	$7,000	$14,000
Coinsurance (Member)	20%	50%	30%	50%
Maximum Out-of-Pocket
Individual	$7,000	$14,000	$5,500	$11,000
Family	$14,000	$28,000	$11,000	$22,000
Physician Office Visit
Primary Care	20% after deductible	50% after deductible	$25 copay	50% after deductible
Specialty Care	20% after deductible	50% after deductible	$50 copay	50% after deductible
Preventive Care
Adult Periodic Exams	100%	50% after deductible	100%	50% after deductible
Well-Child Care	100%	50% after deductible	100%	50% after deductible
Diagnostic Services
X-ray and Lab Tests	20% after deductible	50% after deductible	30% after deductible	50% after deductible
Complex Radiology	20% after deductible	50% after deductible	30% after deductible	50% after deductible
Urgent Care Facility	20% after deductible	50% after deductible	$50 copay	50% after deductible
Emergency Room Facility Charges	20% after deductible	80% after deductible	$300 copay	$300 copay
Inpatient Facility Charges	20% after deductible	50% after deductible	30% after deductible	50% after deductible
Outpatient Facility and Surgical Charges	20% after deductible	50% after deductible	30% after deductible	50% after deductible
Mental Health
Inpatient	20% after deductible	50% after deductible	30% after deductible	50% after deductible
Outpatient	20% after deductible	50% after deductible	$10 copay	50% after deductible
Substance Abuse
Inpatient	20% after deductible	50% after deductible	30% after deductible	50% after deductible
Outpatient	20% after deductible	50% after deductible	30% after deductible	50% after deductible
Other Services
Chiropractic	20% after deductible	50% after deductible	$50 copay	50% after deductible
Retail Pharmacy (30 Day Supply)
Generic (Tier 1)	20% after deductible	80% after deductible	$10 copay	N/A
Preferred (Tier 2)	20% after deductible	80% after deductible	$50 copay	N/A
Non-Preferred (Tier 3)	20% after deductible	80% after deductible	$100 copay	N/A
Preferred Specialty (Tier 4)	20% after deductible	80% after deductible	$100 copay	N/A
Mail Order Pharmacy (90 Day Supply)
Generic (Tier 1)	20% after deductible	N/A	$30 copay	N/A
Preferred (Tier 2)	20% after deductible	N/A	$150 copay	N/A
Non-Preferred (Tier 3)	20% after deductible	N/A	$300 copay	N/A
Preferred Specialty (Tier 4)	No home delivery	N/A	No home delivery	N/A

Decision Support by Cigna

Choosing the right health plan is one of the most important decisions you will make all year. That’s why Cigna created a complimentary benefits education website specific to your company.

It’s designed to make the pre-enrollment experience easier. You and your family members can learn about the benefits being offered through Cigna.

Highlights include:

Easy-to-understand details on the plans offered through Cigna.
Explanations of plan components and comprehensive plan summary documents.
Benefits education videos and information, including a video library and glossary of terms.
Telephone support from Cigna’s live open enrollment support team.
Cigna Dental and Cigna Vision plan details.

www.benefitseducationcigna.com