Medical Plans
When it comes to medical care, everyone has different needs. Some people rarely see the doctor, while others require more frequent medical attention. Because CHOC appreciates that your needs are special, we provide you with four medical plans that offer flexibility and choice. This way, you can pick the plan that’s right for you.
Cigna Full Network HMO Plan
Key Features
Access Cigna’s entire HMO network. You have access to all doctors and hospitals in the Cigna HMO network.
Copays for most services. You pay a copay for most medical services, instead of coinsurance.
Qualified in-network preventive care at no cost to you. You pay nothing out-of-pocket for in-network annual physicals, immunization, routine cancer screenings and more.
How it works
- For certain services, such as doctor’s office visits, you pay a copay at the time of service.
- For other services, such as inpatient hospital services, you’ll pay the full costs until you meet the annual deductible. Once the deductible is met, you and the plan share in the cost through coinsurance until you meet your out-of-pocket maximum.
- You pay a copay for prescription drugs after (with the exception of preventive drugs, which have no out-of-pocket costs when you use an in-network pharmacy).
- If you meet the out of pocket maximum, the plan pays 100% of your eligible expenses for the rest of the year.
Cigna Select Network HMO Plan
Key Features
All services provided in the Providence St. Joseph Health Network. You have access to doctors located in and around Orange County.
Least costly in premiums. Of the 4 medical plans offered under the CHOC benefit program, this plan has the lowest premiums.
Copays for most services. You pay a copay for most medical services, instead of coinsurance.
Qualified in-network preventive care at no cost to you. You pay nothing out-of-pocket for in-network annual physicals, immunization, routine cancer screenings and more.
How it works
- For certain services, such as doctor’s office visits, you pay a copay at the time of service.
- For other services, such as inpatient hospital services, you’ll pay the full costs until you meet the annual deductible. Once the deductible is met, you and the plan share in the cost through coinsurance until you meet your out-of-pocket maximum.
- You pay a copay for prescription drugs (with the exception of preventive drugs, which have no out-of-pocket costs when you use an in-network pharmacy).
- If you meet the out of pocket maximum, the plan pays 100% of your eligible expenses for the rest of the year.
Cigna PPO Plan
Key Features
Provides more choice and flexibility. Can choose to go to any doctor or hospital but will pay less if choose a provider in the Cigna network.
Qualified in-network preventive care at no cost to you. You pay nothing out-of-pocket for in-network annual physicals, immunization, routine cancer screenings and more.
How it works
- You have the freedom to choose from both in-network and out-of-network providers.
- For services, you’ll pay your initial medical care costs until you meet the annual deductible (with the exception of in-network preventive care, which has no out-of-pocket costs.)
- Once the deductible is met, you and the plan share costs through coinsurance until you meet your out-of-pocket maximum.
- You pay a copay for prescription drugs (with the exception of preventive drugs, which have no out-of-pocket costs when you use an in-network pharmacy).
- If you meet the out of pocket maximum, the plan pays 100% of your eligible expenses for the rest of the year.
Cigna High Deductible Health Plan (HDHP)
Key Features
High deductible. This plan has the highest deductible of the 4 offered plans but you have the ability to set up a tax-free Health Savings Account to help you cover costs.
Tax- Free Health Savings Account (HSA). When you enroll in this plan, you can set up and use an HSA to pay for eligible medical expenses with tax-free dollars. The money in your HSA is always yours to keep. Spend it anytime – even in retirement. CHOC also will fund $500 (for individual coverage) or $1,000 (for family coverage) into your HSA.
Provides more choice and flexibility. Can choose to go to any doctor or hospital but will pay less if choose a provider in the Cigna network.
Qualified in-network preventive care at no cost to you. You pay nothing out-of-pocket for in-network annual physicals, immunization, routine cancer screenings and more.
How it works
- You have the freedom to choose from both in-network and out-of-network providers.
- For services, you’ll pay your initial medical care costs and prescription drugs until you meet the annual deductible (with the exception of in-network preventive care, which has no out-of-pocket costs.)
- Once the deductible is met, you and the plan share costs through coinsurance until you meet your out-of-pocket maximum.
- You pay a copay for prescription drugs after you have met the annual deductible (with the exception of preventive drugs, which have no out-of-pocket costs when you use an in-network pharmacy).
- If you meet the out of pocket maximum, the plan pays 100% of your eligible expenses for the rest of the year.
