Cigna High-Deductible Open Access / Health Savings Account Plan

Your medical benefits are provided by Cigna and include coverage for both in-network and out-of-network providers.

Premiums are calculated on 24 pay periods and deducted from the first two paychecks of each month.

Coverage Tier	Total Monthly Premium	Modera’s Monthly Contribution	Employee Monthly Premium	Employee Payroll Deduction per Pay Period
Employee	$1,318.07	$1,318.07	$0.00	$0.00
Employee + Spouse	$2,793.02	$2,055.55	$737.48	$368.74
Employee + Child(ren)	$2,215.19	$1,766.63	$448.56	$224.28
Family	$3,585.56	$2,451.82	$1,133.75	$566.87

Employee

Employee + Spouse

Employee + Child(ren)

Family

Service	In-Network Benefits
Annual Deductible	$2,500 per individual / $3,300 individual with family / $5,000 per family
Coinsurance (plan pays)	90%
Out of Pocket Maximum*	$5,000 per individual / $10,000 per family
Preventive Care	Covered at 100%
Office Visit	Deductible and coinsurance
Emergency Room	Deductible and coinsurance
Inpatient Hospital	Deductible and coinsurance
Outpatient Surgery	Deductible and coinsurance

Annual Deductible

In-Network Benefits: $2,500 per individual / $3,300 individual with family / $5,000 per family

Coinsurance (plan pays)

Out of Pocket Maximum*

Preventive Care

Office Visit

Emergency Room

Inpatient Hospital

Outpatient Surgery

	In-Network Benefits
Prescription Drugs	Subject to deductible, then copay: Tier 1: $15 / Tier 2: $30 / Tier 3: $50 / Mail Order: 3x retail (a prescription filled by mail costs three times what you would pay at a regular retail pharmacy)

Prescription Drugs

In-Network Benefits: Subject to deductible, then copay: Tier 1: $15 / Tier 2: $30 / Tier 3: $50 / Mail Order: 3x retail (a prescription filled by mail costs three times what you would pay at a regular retail pharmacy)

This plan pairs with a Health Savings Account, and Modera contributes to that account on your behalf. As an added benefit, Modera will contribute the difference between the employee-only PPO Plan and High-Deductible Plan premium (currently $206.69) to your account each month.
The High-Deductible / HSA Plan may be a fit if you want Modera’s contribution to an HSA that you own and keep, cover dependents and want a lower premium, or want to save tax-free for future healthcare expenses, including in retirement.
The family deductible and out-of-pocket maximum are higher on the High-Deductible / HSA Plan.