UNDERSTANDING YOUR BENEFITS
Aquafinity health plans are built on choice, offering you the opportunity to make decisions about what will best meet your and your family’s health and financial needs. Aquafinity medical plan options are administered by Cigna and Kaiser Permanente (Available in CA only) and are designed to help you maintain your health through preventive care services, access to an extensive network of providers, and affordable prescription medication.
You can choose from three flexible plan options:
- Cigna OAP BASE Plan $2500 (In-Network Only)
- Cigna OAP Buy-Up Plan $1500 (In-Network Only)
- Cigna OAP Full $500 (PPO)
- Kaiser Permanente HMO (Available in CA Only)
You must log into the enrollment site, EASE, and make your benefit elections; be sure to review and finalize benefit elections in the system.
https://aquafinity.ease.com
HEALTH MAINTENANCE ORGANIZATION (HMO)
Kaiser HMO is a type of health insurance plan that limits coverage to doctors, hospitals, and pharmacies that participate in the Kaiser Permanente HMO network only. There is no coverage if you go to out-of-network providers, except for emergency services. A Kaiser HMO requires you to live or work in its service area to be eligible for coverage with Kaiser.
CIGNA PPO PLAN
The Cigna Open Access Plus PPO plans are a National PPO Network within and out-of-network benefits. Plans have a deductible to meet first for certain services with coinsurance. Physicians services and prescriptions have copays.
Definitions:
A fixed amount you pay for a covered health service, usually when you receive the service. The amount can vary by the type of covered health care service.
The amount you owe for health care services your plan covers before your health insurance or plan begins to pay. The deductible may not apply to all services.
Once the deductible is met, you and the plan share any further health care costs until you meet your out-of-pocket maximum. This is your share of the costs of a covered health care service, calculated as a percent for the service.
The medical plan limits the total amount you pay each year for medical care. Once you meet your out-of-pocket maximum, the plan pays 100% of your eligible expenses for the remainder of the calendar year.
Plan Benefits | Kaiser HMO |
|---|---|
| IN-NETWORK ONLY (Available in CA ONLY) |
|
| Annual Deductible | $2,000 individual $4,000 family |
| Out-of-Pocket Maximums | $4,500 individual $9,000 family |
| Preventive Care | No charge |
| Primary Office Visit | $20 copay (ded waived) |
| Specialist Office Visit | $40 copay (ded waived) |
| Virtual Care | No charge |
| Urgent Care | $35 copay (ded waived) |
| Inpatient Hospital Stays | 20% coinsurance after deductible |
| Outpatient Surgery | 20% coinsurance after deductible |
| Emergency Room (waived if admitted) | 20% coinsurance after deductible |
| Prescription Drugs- 30 day supply | |
| Generic | $10 copay |
| Preferred Brand | $30 copay |
| Brand Specialty | 20% coinsurance up to $250 |
Plan Benefits | Cigna Healthcare | Cigna Healthcare | Cigna Healthcare |
|
|---|---|---|---|---|
| IN-NETWORK ONLY | IN-NETWORK ONLY | IN-NETWORK | OUT-OF-NETWORK | |
| Annual Deductible (Individual / Family) | $2,500 / $5,000 | $1,500/ $3,000 | $500 / $1,000 | $1,000 / $2,000 |
| Out-of-Pocket Maximums (Individual / Family) | $6,700/ $13,400 | $5,000 / $10,000 | $8,350 / $16,700 | $8,800 / $17,600 |
| Preventive Care | No charge | No charge | No charge | covered 50%* |
| Primary/Specialist Office | $40/$80 copay | $20/$50 copay | $35/ $70 copay | covered 50%* |
| Urgent Care | $85 copay | $55 copay | $50 copay | covered 50%* |
| Inpatient Hospital Stays | 20% coinsurance* | 20% coinsurance* | 20% coinsurance* | covered 50%* |
| Outpatient Surgery | 20% coinsurance* | 20% coinsurance* | 20% coinsurance* | covered 50%* |
| Emergency Room waived if admitted | 20% coinsurance* | $200/visit | 20% after deductible * | |
| Virtual Care Visits | No charge | No charge | No charge | Not covered |
| Prescription Drug (30 day supply) | ||||
| Generic | $15 copay | $10 copay | $10 copay | Not Covered |
| Preferred Brand Name | $100 copay | $30 copay | $35 copay | Not Covered |
| Non- Preferred Brand | $200 copay | $50 copay | $75 copay | Not Covered |
| Specialty Drugs | $300 copay | $150 copay | 30% coinsurance up to $250 max copay | Not Covered |