Compare Plans

Compare Plans

Your healthcare coverage is important to us. Age, family status, medical conditions, hobbies, lifestyle and a myriad of other factors will help you determine if you need a lot or a very little amount of health coverage. This summary will help you understand your plan and its coverage.

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Summary of Medical Benefits

Premier Access Standard (Copay 1) Plan

Tier 1 Bothwell

Tier 1 Health Cooperative of Missouri

Tier 2 Health Link & Freedom Select

Calendar Year Deductible

Individual

Family

 

$2,000

$4,000

 

$2,000

$4,000

 

$5,000

$10,000

Out-of-Pocket Maximum

Employee Only

Family

 

$4,000

$8,000

 

$4,000

$8,000

 

$10,000

$20,000

Preventive Care

No Charge

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$20 Copay

$35 Copay

Not Available

 

$45 Copay

$75 Copay

$60 Copay

 

30%*

30%*

30%*

Hospital Services

No Charge

10%*

30%*

Emergency Services

Emergency Room

Emergency Medical Transportation

 

$150 Copay

Not Available

 

$150 Copay, then 10%*

10%*

 

$300 Copay, then 10%*

30%*

Urgent Care Services

Not Available

$150 Copay, then 10%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Available

$20 Copay

 

10%*

$20 Copay

 

30%*

30%*

* Coinsurance After Deductible

Note: Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions.

 

 

 

 

 

 

Premier Access Premium (Copay 2) Plan

Tier 1 Bothwell

Tier 1 Health Cooperative of Missouri

Tier 2 Health Link & Freedom Select

Calendar Year Deductible

Individual

Family

 

$1,500

$3,000

 

$1,500

$3,000

 

$5,000

$10,000

Out-of-Pocket Maximum

Individual

Family

 

$3,500

$7,000

 

$3,500

$7,000

 

$7,000

$14,000

Preventive Care

No Charge

No Charge

30%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

No Charge

No Charge

Not Available

 

$45 Copay

$75 Copay

$60 Copay

 

30%*

30%*

30%*

Hospital Services

No Charge

10%*

30%*

Emergency Services

Emergency Room

Emergency Medical Transportation

 

$75 Copay

Not Available

 

$150 Copay, then 10%*

10%*

 

$300 Copay, then 30%*

30%*

Urgent Care Services

Not Available

$150 Copay, then 10%*

30%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Available

No Charge

 

10%*

No Charge

 

30%*

30%*

* Coinsurance After Deductible

Note: Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions.

 

 

 

 

 

 

Cigna PPO Plan

Bothwell

Cigna PPO Network

Out-of-Network

Calendar Year Deductible

Individual

Individual under Family

Family

 

$1,500

$1,500

$3,000

 

$2,500

$2,500

$5,000

 

$5,000

$5,000

$10,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$7,500

$7,500

$15,000

 

$7,500

$7,500

$15,000

 

$15,000

$15,000

$30,000

Preventive Care Services

No Charge

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

$30 Copay

$60 Copay

Not Available

 

$45 Copay

$75 Copay

$60 Copay

 

50%*

50%*

50%*

Urgent Care Services

Not Available

$150 Copay, then 20%*

50%*

Complex Imaging: MRI/CT/PET Scans

10%*

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

10%*

10%*

 

20%*

20%*

 

50%*

50%*

Emergency Room Services

Emergency Medical Transportation

$75 Copay

Not Available

$150 Copay, then 20%*

20%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

Not Available

$30 Copay

 

20%*

$50 Copay

 

50%*

50%*

* Coinsurance after deductible

Note: Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions.

 

 

 

 

 

 

Cigna HSA Plan

Cigna PPO Network

Out-of-Network

Calendar Year Deductible

Individual

Individual under Family

Family

 

$5,000

$5,000

$10,000

 

$7,500

$7,500

$15,000

Out-of-Pocket Maximum

Individual

Individual under Family

Family

 

$7,500

$7,500

$15,000

 

$15,000

$15,000

$30,000

Preventive Care Services

No Charge

50%*

Office Visits

Primary Office Visit

Specialist Office Visit

Chiropractic Visit

 

20%*

20%*

20%*

 

50%*

50%*

50%*

Urgent Care Services

20%*

50%*

Complex Imaging: MRI/CT/PET Scans

20%*

50%*

Inpatient Hospital Care

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Outpatient Procedures

Facility Fee

Physician Fee

 

20%*

20%*

 

50%*

50%*

Emergency Room Services**

Emergency Medical Transportation**

20%*

20%*

50%*

50%*

Mental Health/Chemical Dependency

Inpatient

Office Visit

 

20%*

20%*

 

50%*

50%*

* Coinsurance after deductible

 

 

** Covered as in-network in true-emergency

Note: Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions.

 

 

 

 

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