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Compare 2022-2023 Medical Plans

Compare 2022-2023 Medical Plans

Below is a brief summary of all medical plan options. For more details, review the benefit summaries found at the bottom of the page.

Southern CA Select HMOOpen Acess Plus (OAP)1500 Copay Choice Fund w/HRA2000 Choice Fund w/HSA2500 Choice Fund w/HRA
Coinsurance percentages and copay amounts shown in the above chart represent what the member is responsible for paying.
*Benefits with an asterisk ( * ) require that the deductible be met before the Plan begins to pay.
To be eligible for the HSA, you cannot be covered through Medicare Part A or Part B or TRICARE programs. See the plan documents for full details.
1. If you use an out-of-network provider, you will be responsible for any charges above the maximum allowed amount.
In-Network OnlyIn-Network OnlyOut-of-Network1In-Network OnlyOut-of-Network1In-Network OnlyOut-of-Network1In-Network OnlyOut-of-Network1
Deductible (per plan year)
Individual / FamilyNone / None$500 / $1,000$1,000 / $2,000$1,500 / $3,000$3,000 / $6,000$2,000 / $4,000$4,000 / $8,000$2,500 / $5,000$5,000 / $10,000
Out-of-Pocket Maximum (per plan year)
Individual / Family$3,000 / $6,000$3,000 / $6,000$6,000 / $12,000$3,500 / $7,000$7,000 / $14,000$4,000 / $8,000$8,000 / $16,000$5,000 / $10,000$10,000 / $20,000
Company Contribution to Your Health Savings Account (HSA) (per plan year; prorated for new hires/newly eligible)
Individual / FamilyN/AN/A$750 / $1,500$750 / $1,500$750 / $1,500
Covered Services
Office Visits (physician/specialist)$20 PCP / $40 Specialist$20 PCP / $40 Specialist30%*$25 PCP / $50 Specialist40%*20%* / 20%*40%*20%*40%*
Virtual Visits$20 copay$20 copayNot covered$25 copayNot covered20%*Not covered20%*Not covered
Routine Preventive CareNo chargeNo charge30%* through age 16, Not covered age 17+No charge40%*No charge40%*No charge40%*
Outpatient Diagnostic (lab/X-ray)No charge / No charge10%*30%*$25 copay20%*20%*40%*20%*40%*
Complex ImagingNo charge10%*30%*$25 copay20%*20%*40%*20%*40%*
Chiropractic$15 copay$20 PCP / $40 Specialist30%*$25 PCP / $50 Specialist40%*20%*40%*20%*40%*
AmbulanceNo charge10%*20%*20%*20%*40%*20%*40%*
Emergency Room$150 copay100 copay, 100% after deductible20%*20%*20%*40%*20%*40%*
Urgent Care Facility$75 copay10%*30%*20%*40%*20%*40%*20%*40%*
Inpatient Hospital Stay$250 copay10%*30%*20%*40%*20%*40%*20%*40%*
Outpatient Surgery$125 copay10%*30%*20%*40%*20%*40%*20%*40%*
Prescription Drugs(Generic / Brand / Non-Formulary)
Retail Pharmacy (30-day supply)$10 / $30 / $50$10 / $20 / $35Not covered$10 / $30 / $50Not covered$10 / $30 / $50Not covered$10 / $30 / $50Not covered
Mail Order (90-day supply)$25 / $75 / $125$30 / $60 / $105Not covered$25 / $75 / $125Not covered$25 / $75 / $125Not covered$25 / $75 / $125Not covered

Wellness Employee Contributions (effective 7.1.2022) Direct Link

Employees earning less than $50,000/yearEmployee Contributions Per Pay Period (26)
CIGNA 1500 CHOICE FUND WITH HRA
Employee $72.22
Employee + Spouse$195.40
Employee + Child(ren)$182.34
Employee + Family$284.26
CIGNA 2500 CHOICE FUND WITH HRA
Employee $45.25
Employee + Spouse$160.41
Employee + Child(ren)$133.34
Employee + Family$206.14
CIGNA 2000 CHOICE FUND WITH HSA
Employee $60.58
Employee + Spouse$172.69
Employee + Child(ren)$159.12
Employee + Family$246.75
CIGNA SOUTHERN CA SELECT HMO
Employee $58.31
Employee + Spouse$179.64
Employee + Child(ren)$166.48
Employee + Family$269.17
CIGNA OPEN ACCESS PLUS PPO
Employee $80.22
Employee + Spouse$220.19
Employee + Child(ren)$201.19
Employee + Family$350.59
Employees earning between $50,000 - $99,999/yearEmployee Contributions Per Pay Period (26)
CIGNA 1500 CHOICE FUND WITH HRA
Employee $76.02
Employee + Spouse$205.68
Employee + Child(ren)$191.94
Employee + Family$299.22
CIGNA 2500 CHOICE FUND WITH HRA
Employee $47.64
Employee + Spouse$168.85
Employee + Child(ren)$140.36
Employee + Family$216.99
CIGNA 2000 CHOICE FUND WITH HSA
Employee $63.76
Employee + Spouse$181.79
Employee + Child(ren)$167.49
Employee + Family$259.74
CIGNA SOUTHERN CA SELECT HMO
Employee $61.38
Employee + Spouse$189.09
Employee + Child(ren)$175.24
Employee + Family$283.34
CIGNA OPEN ACCESS PLUS PPO
Employee $84.02
Employee + Spouse$230.47
Employee + Child(ren)$210.78
Employee + Family$365.55
Employees earning $100,000 or more/yearEmployee Contributions Per Pay Period (26)
CIGNA 1500 CHOICE FUND WITH HRA
Employee $83.63
Employee + Spouse$226.26
Employee + Child(ren)$211.13
Employee + Family$329.14
CIGNA 2500 CHOICE FUND WITH HRA
Employee $52.40
Employee + Spouse$185.74
Employee + Child(ren)$154.40
Employee + Family$238.68
CIGNA 2000 CHOICE FUND WITH HSA
Employee $70.14
Employee + Spouse$199.96
Employee + Child(ren)$184.24
Employee + Family$285.71
CIGNA SOUTHERN CA SELECT HMO
Employee $67.52
Employee + Spouse$208.00
Employee + Child(ren)$192.77
Employee + Family$311.68
CIGNA OPEN ACCESS PLUS PPO
Employee $91.62
Employee + Spouse$251.04
Employee + Child(ren)$229.98
Employee + Family$395.47

Non-Wellness Employee Contributions (effective 7.1.2022) Direct Link

Employees earning less than $50,000/yearEmployee Contributions Per Pay Period (26)
CIGNA 1500 CHOICE FUND WITH HRA
Employee$97.22
Employee + Spouse$220.40
Employee + Child(ren)$207.34
Employee + Family$309.26
CIGNA 2500 CHOICE FUND WITH HRA
Employee$70.26
Employee + Spouse$185.41
Employee + Child(ren)$158.34
Employee + Family$231.14
CIGNA 2000 CHOICE FUND WITH HSA
Employee$85.58
Employee + Spouse$197.70
Employee + Child(ren)$184.12
Employee + Family$271.75
CIGNA SOUTHERN CA SELECT HMO
Employee$83.31
Employee + Spouse$204.64
Employee + Child(ren)$191.48
Employee + Family$294.17
CIGNA OPEN ACCESS PLUS
Employee $105.22
Employee + Spouse$245.19
Employee + Child(ren)$226.19
Employee + Family$375.59
Employees earning between $50,000 - $99,999/yearEmployee Contributions Per Pay Period (26)
CIGNA 1500 CHOICE FUND WITH HRA
Employee $101.03
Employee + Spouse$230.69
Employee + Child(ren)$216.94
Employee + Family$324.22
CIGNA 2500 CHOICE FUND WITH HRA
Employee$72.64
Employee + Spouse$193.86
Employee + Child(ren)$165.36
Employee + Family$241.99
CIGNA 2000 CHOICE FUND WITH HSA
Employee $88.76
Employee + Spouse$206.79
Employee + Child(ren)$192.49
Employee + Family$284.74
CIGNA SOUTHERN CA SELECT HMO
Employee $86.39
Employee + Spouse$214.09
Employee + Child(ren)$200.24
Employee + Family$308.34
CIGNA OPEN ACCESS PLUS PPO
Employee $109.02
Employee + Spouse$255.47
Employee + Child(ren)$235.79
Employee + Family$390.55
Employees earning $100,000 or more/year Employee Contributions Per Pay Period (26)
CIGNA 1500 CHOICE FUND WITH HRA
Employee $108.63
Employee + Spouse$251.26
Employee + Child(ren)$236.13
Employee + Family$354.14
CIGNA 2500 CHOICE FUND WITH HRA
Employee $77.40
Employee + Spouse$210.74
Employee + Child(ren)$179.40
Employee + Family$263.69
CIGNA 2000 CHOICE FUND WITH HSA
Employee $95.14
Employee + Spouse$224.96
Employee + Child(ren)$209.24
Employee + Family$310.71
CIGNA SOUTHERN CA SELECT HMO
Employee $92.52
Employee + Spouse$233.00
Employee + Child(ren)$217.77
Employee + Family$336.68
CIGNA OPEN ACCESS PLUS PPO
Employee $116.62
Employee + Spouse$276.04
Employee + Child(ren)$254.98
Employee + Family$420.47