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Port of Seattle 2017 Medical Plans:
Comparison of Coverage

This is a summary of the benefits available under each health care plan's contract. Please see each plan's Benefits Booklet for complete detail. This summary does not include all covered items, limitations, and exclusions.

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  Kaiser Permanente (formerly Group Health) Cigna High Deductible Health Plan (HDHP) Cigna Deductible Plan
Providers You must use Group Health, Virginia Mason, or the Everett Clinic providers. You must use a Cigna Open Access Plus (OAP) network provider to receive maximum benefits. It is the member’s responsibility to ensure the chosen providers are in the Cigna OAP network. If out-of-network providers are used, coverage will be significantly less, balance billing may occur, and in some cases, services will not be covered. You must use a Cigna Open Access Plus (OAP) network provider to receive maximum benefits. It is the member’s responsibility to ensure the chosen providers are in the Cigna OAP network. If out-of-network providers are used, coverage will be significantly less, balance billing may occur, and in some cases, services will not be covered.
Alternative Providers May self-refer to an acupuncturist for up to 8 visits and naturopath for up to 3 visits per condition per calendar year—additional visits may be approved. Self-refer to nutritionist. May use acupuncturist, nutritionist, naturopath, massage therapist. May use acupuncturist, nutritionist, naturopath, massage therapist.
Deductible – paid by member and applies to all expenses None In-network: $1,400/employee only; $2,800/employee & family per calendar year. 
 
Out of network: $2,100/employee only; $4,200/employee & family per calendar year.
In-network: $400/person; $1,200 family maximum per calendar year.
 
Out-of-network: $600/person; $1,800 family per calendar year.
Coinsurance – paid by member 20% of allowable charges up to the annual out-of-pocket maximum for in-network services. In-network: 20% of allowable charges up to the annual out-of-pocket maximum.
 
Out-of-network: 40% of allowable charges up to the annual out of pocket maximum.
In-network: 20% of allowable charges up to the annual out-of-pocket maximum.
 
Out-of-network: 40% of allowable charges up to the annual out-of-pocket maximum.
Out of Pocket Maximum (Stop Loss) – including deductible, coinsurance and copays, if any. $1,500 per person ($3,000 family) per calendar year. In-network: $3,000/employee only ($6,000 employee & family) per calendar year.
 
Out-of-network: $9,000/employee only; $18,000/employee & family per calendar year.
In-network: $1,800/person ($5,400/family) per calendar year. 
 
Out-of-network: $5,400/person; $16,200/family per calendar year.
Copayment – paid by member $35 copay per outpatient visit, plus 20% coinsurance. None None
Routine Vision Exam and Hardware One exam every 12 months. $35 copay in-network. 
 
Hardware covered at 100% up to $150 per 24 months. Out of network not covered and coinsurance is waived.
Exam: One per calendar year. $30 copay in-network, up to $45 covered out-of-network. 
 
Hardware & Frames: Covered at 100% up to $200 every two calendar years in-network, up to $128 every two calendar years out-of-network.
Exam: One per calendar year. $30 copay in-network, up to $45 covered out-of-network. 
 
Hardware & Frames: Covered at 100% up to $200 every two calendar years in-network, up to $128 every two calendar years out-of-network.
Prescription Drugs – 30 day supply at participating pharmacies $15 copay for a 30-day supply of generic drugs and $30 copay for a 30-day supply of brand name drugs when prescribed by a GH or Alliance provider. Paid at 80% after deductible is met up to out-of-pocket maximum. Deductible waived for certain generic preventative medications (see list). $5 copay for generic, $35 copay for preferred brand name, and $50 copay for non-preferred brand name.
Prescription Drugs – 90-day supply by Cigna mail order or at participating pharmacies For mail order: $30 copay for a 90-day generic supply and $60 copay for 90-day preferred brand name supply. Paid at 80% after deductible is met up to out-of-pocket maximum. $10 copay for generic, $70 copay for preferred brand name, and $100 copay for non-preferred brand name.
Preventive Services See Cigna and Group Health flyers for details Paid at 100% Paid at 100% in-network. Out-of-network not covered. Paid at 100% in-network. Out-of-network not covered.
​Telemedicine ​Paid at 100% ​$38 per visit before deductible is met; then, paid at 80% when designated telemedicine provider is used. ​Paid at 100% when designated telemedicine provider is used.
X-Ray and Lab Charges Paid at 80% Paid at 80% in network, 60% out-of-network* Paid at 80% in network, 60% out-of-network*
Hospital Services (inpatient confinements) Paid at 80% Paid at 80% in network, 60% out of network* Paid at 80% in network, 60% out of network*
Hospital Services (Outpatient) $50 copay, plus 20% coinsurance Paid at 80% in network, 60% out of network* Paid at 80% in network, 60% out of network*
Emergency Room $100 copayment per visit (waived if admitted from emergency room), plus 20% coinsurance. Paid at 80% in-network and out-of-network* $75 copay (waived if admitted from the emergency room), plus 20% coinsurance in-network and out-of-network*
Mental Health Care Outpatient: $35 copay per visit, plus 20% coinsurance.
 
Inpatient: Paid at 80%.
Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network* Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network.*
Chemical Dependency Outpatient: $35 copay per visit, plus 20% coinsurance
 
Inpatient: Paid at 80%.
Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network* Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network*
Rehabilitative Care Benefit limits: 60 outpatient visits and 60 inpatient days per calendar year. 
 
Outpatient: $35 copay per visit, plus 20% coinsurance. 
 
Inpatient: Paid at 80%.
Physical, occupational, speech and massage therapy. Benefit limits: 45 outpatient visits and 30 inpatient days per calendar year. Cardiac & pulmonary rehabilitation: 36 days. 
 
Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network*
Physical, occupational, speech and massage therapy. Benefit limits: 45 outpatient visits and 30 inpatient days per calendar year. Cardiac & pulmonary rehabilitation: 36 days. 
 
Outpatient and inpatient: Paid at 80% in-network, 60% out-of-network*
Chiropractic Care / Manipulative Therapy Self-refer for up to 10 visits per year, subject to $35 copay, plus 20% coinsurance. Additional visits when approved. 12 spinal adjustments per calendar year. Paid at 80% in-network and 60% out-of-network* 12 spinal adjustments per calendar year. Paid at 80% in-network and 60% out-of-network*
Routine Hearing Exam $35 copay plus 10% coinsurance. 1 exam per calendar year. Paid at 80% in-network, 60% out-of-network* 1 exam per calendar year. Paid at 80% in-network, 60% out-of-network*
Hearing Hardware Covered up to $1,000 per year, limited to one aid per year, every 36 months. In-network and out-of-network: paid at 80% of allowable charges, up to a maximum benefit of $3,000 per enrollee in a period of three (3) consecutive calendar years. In-network and out-of-network: Deductible waived. Paid at 80% of allowable charges, up to a maximum benefit of $3,000 per enrollee in a period of three (3) consecutive calendar years.