Health Insurance Plan

Health Maintenance Organization (HMO)

Managed Care Health Plans provide health care through a system of network Providers. Participants must select a Primary Care Physician (PCP) from a network of participating providers. All routine medical care, hospitalization, and referrals for specialized medical care must be coordinated under the direction of your primary care physician. Comprehensive medical benefits are offered at lower Out-of-Pocket cost by utilizing network Providers. There are no annual plan deductibles for medical services; however there is a $50 annual prescription deductible applicable for each plan participant. Only a co-payment applies when the medical services are coordinated through the PCP.

Indemnity Plan – Quality Care Health Plan (PPO)

The Quality Care Health Plan (QCHP) (administered by CIGNA) is a traditional indemnity health plan which offers a comprehensive range of benefits. Under this plan participants can choose any physician or hospital for medical services and any pharmacy for prescription drugs. Plan participants receive enhanced benefits resulting in lower out-of-pocket cost when utilizing:

  • Preferred Provider Organization (PPO) Hospitals for Inpatient and Outpatient Services.
  • Pharmacy network (Medco retail pharmacy network) an annual $75 deductible will be applied to each plan participant for prescription coverage.
  • Behavioral health benefits, through the Behavioral Health Plan Administrator (Magellan behavioral health network).
  • Transplant PPO Network (Notification Administrator, Intracorp).

The Plan year deductible must be satisfied prior to benefits begin, unless the Family Cap has been met. The annual deductible is based on the annual salary as of the first of each April preceding the beginning of the next Plan Year. The Plan Year Deductible also applies toward satisfying the Out-of Pocket Maximums. The coverage for Prescription Drugs and behavioral health services operates independently of medical benefits. It is not necessary to satisfy the Plan Year Deductible in order to start receiving benefits for these benefits. Information is available at: http://provider.healthcare.cigna.com/soi.htm