It’s that time of year again.
I have two different plan options to choose from. Either my wife’s work, or my work. We are expecting our child to be born in February, so for that, we are looking at the PPO plans only.
The Cigna Medical seems like a better plan. However, I’ve not heard great reviews with Cigna — this is in Colorado by the way. Currently, my wife and I are on BCBS of Texas, and we’ve had a great experience so far. She is about 6 months into her pregnancy, and we’ve paid <$200 with doing every test offered and ultrasounds. So we are happy with staying on the same plan. However, babies are expensive, so if there’s substantial savings from one plan to the next, I would like to do that.
Plan 1
Copay PPO Plan
Employee and Spouse $175.70/Bi-Weekly — Employee and Family $203.49/Bi-Weekly
Cigna Medical
In Network
Out-of-Network
Calendar Year Deductible
$1,250/$2,500
$2,500/$5,000
Deductible Basis
Each covered individual is subject to individual deductible limit
Each covered individual is subject to individual deductible limit
Coinsurance split
80/20
60/40
Calendar Year OOPM
$4,500/$9,000
$10,000/$20,000
OOPM Basis
Each covered individual is subject to individual deductible limit
Each covered individual is subject to individual deductible limit
Physician Office Visit
$25/50
40% Coinsurance
Preventive Visit
100% Covered
40% Coinsurance
Inpatient Hospital
20% Coinsurance
40% Coinsurance
Emergency Room
20% Coinsurance
20% Coinsurance
Urgent Care
20% Coinsurance
40% Coinsurance
Ambulance
20% Coinsurance
20% Coinsurance
X-Ray
20% Coinsurance
40% Coinsurance
Laboratory
20% Coinsurance
40% Coinsurance
Maternity
20% Coinsurance
40% Coinsurance
Outpatient Physical Therapy
$25 Copay
40% Coinsurance
Speech, Hearing, and Occupational Therapy
$25 Copay
40% Coinsurance
Durable Medical Equipment
20% Coinsurance
40% Coinsurance
Home Health Care
20% Coinsurance
40% Coinsurance
Hospice
20% Coinsurance
40% Coinsurance
Skilled Nursing
20% Coinsurance
40% Coinsurance
Hearing aids (testing/fitting)
20% Coinsurance
40% Coinsurance
Chiropractic Care (20 days)
$25 Copay
40% Coinsurance
Mental Health/Substance (inpatient)
20% Coinsurance
40% Coinsurance
Mental Health/Substance (outpatient)
$25 Copay
40% Coinsurance
Fertility Coverage
Cost share, subject to place of service & treatment administered. $50,000 lifetime max
Cost share, subject to place of service & treatment administered. $50,000 lifetime max
Prescription Drugs
—
—
Generic Brand/Tier 1
$15 Copay
Not Covered
Formulary Brand/Tier 2
$45 Copay
Not Covered
Non-Formulary Brand/Tier 3
$60 Copay
Not Covered
Mail Order (90 Days Supply)
$37/$113/$150 Copay
Not Covered
Preventive Maintenance Medication
$0
Not Covered
Plan 2
Standard PPO
Employee and Spouse $84.92/Bi-weekly — Employee and Family $112.62/Bi-Weekly
BCBS of Texas
In Network
Out-of-Network
Deductible Individual
$1,250
$1,250
Deductible Family
$2,500
$2,500
OOPM Individual
$4,250
$8,500
OOPM Family
$8,500
$17,000
Coinsurance
20% In Network after deductible
50% Out of Network after deductible
Primary care visit to treat an injury or illness
20% In Network
50% Out of Network
Specialist Visit
20% In Network
50% Out of Network
Outpatient X-Ray
20% In Network after deductible
50% Out of Network after deductible
Outpatient Lab and Pathology
20% In Network after deductible
50% Out of Network after deductible
Outpatient Surgery
20% In Network after deductible
50% Out of Network after deductible
Inpatient Hospital Care
20% In Network after deductible
50% Out of Network after deductible
Emergency Room Services
$200 plus 20% after deductible
— Unsure if this applies to out-of-network, the plan does not specify —
Preventive Care/ Screening/ Immunization
100% covered In Network
50% Out of Network after deductible
Prescription Deductible
$50.00
—
Prescription OOPM
$2,750 Employee Only, $5,500 All other coverage levels
Generic Drugs
$15 copay (Retail 30 day supply) 25% (Minimum $65; Maximum $200) (Mail order 90 day supply)
Preferred Brand Drugs
25% – (Minimum $25; Maximum $100) (Retail 30 day supply) 45% (Minimum $115; Maximum $250) (Mail order 90 day supply)
Nonpreferred Brand Drugs
45% (Minimum $45; Maximum $100) (Retail 30 day supply) 45% (Minimum $115; Maximum $250) (Mail order 90 day supply)
Specialty Drugs
30% of total cost (Coinsurance waived if enrolled in PrudentRx)
