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 Missouri Health Coop.
Tier 2 Health Link First Health
Medical Deductible
Employee Only
Family
$0
$2,000
$4,000
$5,000
$10,000
Coinsurance
0%
10%
30%
Medical & Rx Combined Out-of-Pocket Maximum
$8,000
$20,000
Preventive Care
100% Covered
30%*
Office Visits
Primary Services
Specialist Services
Chiropractic Services
$20 Copay
$35 Copay
Not Available
$45 Copay
$75 Copay
$60 Copay
Hospital Services
10%*
Emergency Services
Emergency Room
Emergency Medical Transportation
$150 Copay
$150 Copay, then 10%*
$300 Copay, then 10%*
Urgent Care Services
Mental Health/Chemical Dependency
Inpatient
Outpatient
* Coinsurance After Deductible
Premier Access Premium (Copay 2) Plan
Calendar Year Medical Deductible
$1,500
$3,000
$3,500
$7,000
$9,000
$18,000
Cigna PPO Plan
Bothwell
Cigna PPO Network
Out-of-Network
Embedded Deductible
Individual Coverage
Individual under Family Coverage
Family Coverage
$2,500
Embedded Out-of-Pocket Maximum
$7,500
$15,000
$30,000
Preventive Care Services
No Charge
50%*
Primary Office Visit
Specialist Office Visit
Chiropractic Visit
$30 Copay
$150 Copay, then 20%*
Complex Imaging: MRI/CT/PET Scans
20%*
Inpatient Hospital Care
Facility Fee
Physician Fee
Outpatient Procedures
Emergency Room Services
Office Visit
$50 Copay
* Coinsurance after deductible
Note: Please refer to your Summary Plan Description for actual coverage, limitation, and exclusion provisions.
Cigna HSA Plan
Emergency Room Services**
Emergency Medical Transportation**
** Covered as in-network in true-emergency
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