We are pleased to provide a choice of three medical plans: two Health Maintenance Organization (HMO) plans and one Preferred Provider Organization (PPO) plan administered by Cigna and Kaiser Permanente.
HMOs center on the relationship between you and your Primary Care Physician (PCP). When you enroll you must choose a PCP who will be responsible for directing your care within a larger group of healthcare professionals (a medical group). If necessary, your PCP will refer you to any specialist within your medical group as well as take the appropriate steps to pre-authorize any facility-based care (excluding emergencies) and you will only be responsible to pay your deductible / co-payment amount.
PPOs give you the freedom to visit any licensed professional without a referral from your personal doctor. When you choose to visit a doctor within the Cigna PPO network, you will benefit from lower coinsurance amounts and significant savings by receiving the contracted discounted rates after any applicable deductibles. If you choose a non-contracted doctor you will pay more for your health care.
In the following pages of this brochure you will find a brief overview that will summarize the benefits for the following plans:
Medical Plans:
Ancillary Plans:
- Cigna DHMO plan
- Cigna DPPO plan
- EyeMed Vision plan
- Mutual of Omaha Basic & Voluntary Life plans
- Mutual of Omaha Voluntary Short Term Disability plan
- Mutual of Omaha Long Term Disability plan
- Mutual of Omaha Employee Assistance Plan (EAP)
- Mutual of Omaha Travel Insurance
- Voluntary Pet Insurance plans
These summaries are intended to highlight the most common procedures to assist employees in choosing the type of plan most suitable to their needs. They are not intended to be relied upon to fully determine coverage. Unless stated otherwise, the amounts shown are based on what you would pay. Any one plan may not cover all health care expenses. Please refer to your Certificate of Coverage for a complete listing of services, limitations, exclusions and a description of all terms and conditions of coverage. If these summaries/descriptions conflict in any way with the policies issued, the policies will prevail.
MEDICAL
Choosing a medical plan is an important decision to make because of its direct impact to you and your family’s health care services. The benefit comparison chart below highlights the differences between the medical plans offered. You may want to review the Summary Plan Description for specific coverage information. The plan that is best for your depends on you and your family’s individual needs.
 HMO Plan Group #: So. CA - 605516 Phone #: 800-464-4000 |
 CA HMO Plan D Group #: 3337191 Phone #: 800-244-6224 |
|
|---|---|---|
| Kaiser Facility | Cigna Healthcare of California, Inc. - So.CA HMO Network | |
| Lifetime Maximum | Unlimited | Unlimited |
Annual Deductible
|
None None |
$250 $500 |
Office Visit Co-pay
|
$35 $50 |
$30 $50 |
| In-Patient Hospitalization Co-pay | $500/Day | $250/Day (Max 5 Days/Admit) |
| Emergency Room Co-pay (waived if admitted) Urgent Care |
$150 $35 |
$125 $30 |
| Routine Physical Exam Co-pay (Age Schedule applies) |
$0 | $0 |
| Outpatient Surgery Co-pay | $250/Procedure | $100 |
| Lab, X-Ray and Diagnostic Co-pay | $10 | $0 |
| Well Baby Care Co-pay (Age Schedule applies) |
$0 | $0 |
Prescription Drugs Co-pay
|
(30 day supply) $15 $35 Same as Preferred Brand Drugs |
(30 day supply) $10 $20 $40 |
Mail Order Prescription Drugs
|
(100 day supply) $30 $70 Same as Preferred Brand Drugs |
(90 day supply) $20 $40 $80 |
Annual Out-Of-Pocket Maximum
|
$3,000 $6,000 |
$2,500 $5,000 |
HMOs center on the relationship between you and your Primary Care Physician (PCP). When you enroll you must choose a PCP who will be responsible for directing your care within a larger group of healthcare professionals (a medical group). If necessary, your PCP will refer you to any specialist within your medical group as well as take the appropriate steps to pre-authorize any facility-based care (excluding emergencies) and you will only be responsible to pay your deductible / co-payment amount.
Remember, PPOs give you the freedom to visit any licensed professional without a referral from your personal doctor. When you choose to visit a doctor within the Cigna PPO network, you will benefit from lower co-insurance amounts and significant savings by receiving the contracted discounted rates after any applicable deductibles. If you choose a noncontracted doctor you will pay more for your health care.
Open Access Plus (OAP) PPO Plan Custom Group #: 3337191 Phone #: 800-244-6224 |
||
|---|---|---|
| In-Network | Out-of-Network | |
| Lifetime Maximum | Unlimited | Unlimited |
Annual Deductible
|
$250 $500 |
$500 $1,000 |
Office Visit Co-pay
|
$20 $40 |
50% 50% |
| In-Patient Hospitalization Co-pay | 90% | 50% After $500/Admit Co-pay |
| Emergency Room Co-pay (waived if admitted) Urgent Care |
$150 $75 |
$150 $75 |
| Routine Physical Exam Co-pay (Age Schedule applies) |
$0 | Not Covered |
| Outpatient Surgery Co-pay | 90% | 50% After $250 Co-pay |
| Lab, X-Ray and Diagnostic Co-pay | 90% | 50% |
| Well Baby Care Co-pay (Age Schedule applies) |
$0 | 50% |
Prescription Drugs Co-pay
|
(30 day supply) $10 $20 $40 |
N/A Not Covered Not Covered Not Covered |
Mail Order Prescription Drugs
|
(90 day supply) $20 $40 $80 |
N/A Not Covered Not Covered Not Covered |
Annual Out-Of-Pocket Maximum
|
$4,000 $8,000 |
$8,000 $16,000 |
An out-of-network provider is one which has not contracted with your insurance company for reimbursement at a negotiated rate. If the doctor, hospital or health care facility you visit is part of your insurance company’s network, you’ll get your health care at lower prices. But if you go out of your network for health care, it can become a lot more expensive. Going out-of-network could mean you’ll have to pay a larger percentage of the cost or the total cost. You may also pay a higher co-insurance percentage and have higher annual co-insurance and out-of-pocket maximums.
