Medical

Point of Service Medical Plan - Two Plan Options

The Harris County medical plans are offered through Cigna and afford you the opportunity to choose any doctor or other health care provider. Whether you utilize in-network or out-of-network benefits depends on where and with whom you receive your care. Neither plan requires a PCP selection or referrals for specialist visits.

Employees are given the opportunity each January to choose between the Base Plan OR Base Plus Plan. These plans consist of a point-of-enrollment option for employees with a “Base” level of benefits at no cost for employee only coverage. In addition, the County will pay 50% of the incremental cost of dependent coverage. The “Base” plan offers a high level of affordable access to basic health and preventative services as well as protection to pay for high cost hospital and surgical expenses while containing premium cost increases for both the County and employees. While many routine services on the “Base” plan only require a copayment; some inpatient and outpatient services are subject to an annual deductible and coinsurance when utilizing a provider in-network and/or out-of-network.

The second option provided to employees is a “Plus” plan that allows employees to pay a higher contribution to receive a higher level of benefits. The County will pay 50% of the incremental cost of dependent coverage. The “Plus” plan has no deductibles or coinsurance when utilizing in-network providers, though out-of-network providers will be subject to deductibles on both the “Base” and “Plus” plans.

Both plans contain the same prescription drug benefit, which will encourage cost effective utilization of these benefits and provides potential savings to both employees and the County.

Cigna Open Access Plus Plan Highlights

Benefit	Base Plan / HAMP In-Network	Base Plan / HAMP Out-of-Network	Plus Plan / HAMP In-Network	Plus Plan / HAMP Out-of-Network
Annual Deductible	BASE: $600/$1,800 HAMP: $300/$900	$1,000 Individual $3,000 Family	None	$1,000 Individual $3,000 Family
Maximum Out-of-Pocket-includes deductible, coinsurance, medical, and Rx copays (Per Individual / Family Per Calendar Year)	BASE: $7,350/$14,700 HAMP: $7,150/$13,700	$10,000 Individual $30,000 Family	PLUS: $6,350/$12,700 HAMP: $6,150/$11,700	$10,000 Individual $30,000 Family
Lifetime Maximum Benefit	Unlimited except where otherwise indicated	Unlimited except where otherwise indicated	Unlimited except where otherwise indicated	Unlimited except where otherwise indicated
Primary Care Physician Visit	BASE: $30 copay HAMP: $25 copay CCN: $20 copay	50% after deductible	PLUS: $25 copay HAMP: $20 copay CCN: $15 copay	50% after deductible
Specialist Office Visit Participating CCN Providers Non CCN Participating Providers	BASE: $40 copay HAMP: $35 copay BASE: $50 copay HAMP: $45 copay	50% after deductible	PLUS: $30 copay HAMP: $25 copay PLUS: $40 copay HAMP: $35 copay	50% after deductible
Preventive Care	100% coverage	50% after deductible	100% coverage	50% after deductible
Allergy Services (includes testing, serum and injections)	100% after $40 copay 150 doses per calendar year	50% after deductible 150 doses per calendar year	100% after $40 copay 150 doses per calendar year	50% after deductible 150 doses per calendar year
Maternity Care (coverage includes voluntary sterilization)	Payable as any other covered expense	Payable as any other covered expense	Payable as any other covered expense	Payable as any other covered expense
Diagnostic Laboratory & Radiology Services	100% coverage	50% after deductible	100% coverage	50% after deductible
Complex Imaging / High Tech Radiology	90% after deductible 100% Coverage at eviCore Facilities	50% after deductiible	$100 copay 100% Coverage at eviCore Facilities	50% after deductiible
Rehabilitation, Speech, Occupational and Physical Therapy	100% after a $25 copay, up to 60 visits per calendar year*	50% after deductible, up to 60 visits per calendar year	100% after a $20 copay, up to 60 visits per calendar year*	50% after deductible, up to 60 visits per calendar year
Convenience Care Clinic	BASE: $30 copay HAMP: $25 copay	50% after deductible	PLUS: $25 copay HAMP: $20 copay	50% after deductible
Urgent Care Facility	100% after a $50 copay	50% after deductible	100% after a $50 copay	50% after deductible
Emergency Room	$300 copay; waived if confined, 80% after deductible if admitted	$300 copay; waived if confined, 50% after deductible if admitted	$300 copay; waived if confined	$300 copay; waived if confined, 50% after deductible if admitted
Outpatient Surgery	80% after deductible	50% after deductible	PLUS: 100% after $400 copay HAMP: 100% after $200 copay	50% after deductible
Inpatient Services	80% after deductible	50% after deductible	PLUS: $600 copay HAMP: $300 copay	50% after deductible
Home Health Care 100 visits per calendar year	90% after deductible	50% after deductible	100% coverage	50% after deductible
Mental Health Outpatient Visits	BASE: $40 copay HAMP: $35 copay	50% after deductible	PLUS: $30 copay HAMP: $25 copay	50% after deductible
Mental Health Inpatient Services	80% after deductible	50% after deductible	PLUS: $600 copay HAMP: $300 copay	50% after deductible
Chemical Dependency Outpatient Visits	BASE: $40 copay HAMP: $35 copay	50% after deductible	PLUS: $30 copay HAMP: $25 copay	50% after deductible
Chemical Dependency Inpatient Services	80% after deductible	50% after deductible	PLUS: $600 copay HAMP: $300 copay	50% after deductible

* Maximums are a combined limit for in-network and out-of-network services.

Prescription Benefit in-network for all plans

CIGNA Rx 90 NETWORK or MAIL ORDER (61-90 days supply)

Prescription Type	% You Pay	Minimum Copay	Maximum Copay
Tier 1 - Generics	25%	$10	$100
Tier 2 - Preferred Brands	30%	$50	$300
Tier 3 - Non-Preferred Brands	35%	$100	$500

Retail (30 day supply)

Prescription Type	% You Pay	Minimum Copay	Maximum Copay
Tier 1 - Generics	25%	$5	$50
Tier 2 - Preferred Brands	30%	$25	$150
Tier 3 - Non-Preferred Brands	35%	$50	$250
Tier 4 - Specialty Medications	30%	$75	$350

Point of Service Medical Plan - Two Plan Options

Cigna Open Access Plus Plan Highlights

Prescription Benefit in-network for all plans

CIGNA Rx 90 NETWORK or MAIL ORDER (61-90 days supply)

Retail (30 day supply)

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