The Cigna Select PPO plan provides a comprehensive range of benefits to cover your health care needs, including prescription drugs, immunizations, vaccines and hospital stays.
If you live in Hawaii: You are eligible to enroll in the Kaiser Hawaii HMO medical plan.
Cigna Select PPO Summary of Benefits
| Plan Feature | Cigna Select PPO In-Network |
Cigna Select PPO Out-of-Network |
|---|---|---|
|
Plan-Year Deductible |
$750 individual |
$1,500 individual1 |
|
Plan-Year |
$3,250 individual |
$6,500 individual2 |
| Coinsurance | Plan pays 80% after deductible | Plan pays 60% after deductible |
| Preventive Care | Plan pays 100% | $30 copay, then plan pays 60% |
| Office Visits (PCP/specialist) |
$30 copay, then plan pays 100% | $30 copay, then plan pays 60% |
| Inpatient Care | Plan pays 80% after deductible | Plan pays 60% after deductible |
| Outpatient Care | Plan pays 80% after deductible | Plan pays 60% after deductible |
| Emergency Room (waived if admitted) |
$250 copay | $250 copay |
1 After each eligible member meets his or her individual deductible, covered expenses for that family member will be paid based on the benefit level that are within reasonable and customary charges. Or once the family deductible is met, covered expenses for each family member will be paid based on the benefit level that are within reasonable and customary charges.
2 After each eligible member meets his or her individual out-of-pocket maximum, the plan will pay 100% of their covered expenses that are within reasonable and customary charges. Or once the family out-of-pocket maximum is met, the plan will pay 100% of each eligible member’s covered expenses that are within reasonable and customary charges.
Cigna Select PPO Paycheck Deductions
| Coverage Level | Per-Paycheck Cost |
|---|---|
| Employee Only | $69 |
| Employee + Spouse/Domestic Partner | $224 |
| Employee + Children | $172.25 |
| Employee + Family | $275.75 |
Kaiser Hawaii HMO Summary of Benefits
Hawaii state law mandates the types of medical plans that can be offered to employees residing in Hawaii. Intuit has established the Hawaii Kaiser medical plan, which also covers prescription drug benefits. Employees in Hawaii must either enroll in or waive coverage for this plan. Otherwise, they will be defaulted into employee-only coverage.
| Plan Feature | Kaiser Hawaii HMO In-Network |
Kaiser Hawaii HMO Out-of-Network |
|---|---|---|
|
Plan-Year Deductible |
$0 individual |
Not Covered |
|
Plan-Year |
$2,500 individual |
Not Covered |
| Coinsurance | N/A | Not Covered |
| Preventive Care | No Charge | Not Covered |
| Office Visits (PCP/specialist) |
$20 copay | Not Covered |
| Inpatient Care | Plan pays 90% | Not Covered |
| Outpatient Care | Plan pays 90% | Not Covered |
| Emergency Room | $100 copay | Limited initial visit only. Must notify KP within 48 hours if admitted to a non-plan provider |
1 After each eligible member meets his or her individual out-of-pocket maximum, the plan will pay 100% of their covered expenses. Or once the family out-of-pocket maximum is met, the plan will pay 100% of each eligible member’s covered expenses.
Kaiser Hawaii HMO Prescription Benefits
| Kaiser Hawaii HMO | |
|---|---|
| Annual Out-of-Pocket Maximum | Prescription amounts count toward medical plan out-of-pocket maximum |
| Retail (per 30-day supply) | |
| Preferred Generic | $10 copay |
| Preferred Brand | $35 copay |
| Non-preferred Brand | $35 copay |
| Mail Order (per 90-day supply) | |
| Preferred Generic | $20 copay |
| Preferred Brand | $70 copay |
| Non-preferred Brand | $70 copay |
Kaiser Hawaii HMO Paycheck Deductions
| Coverage Level | Per-Paycheck Cost |
|---|---|
| Employee Only | $12.75 |
| Employee + Spouse/Domestic Partner | $127.58 |
| Employee + Children | $104.62 |
| Employee + Family | $242.42 |
If you are a resident of Hawaii and you plan to waive coverage you must make the election to waive during your enrollment and you must complete the Form HC-5 Notification to Employer to waive coverage and submit to Employee Benefits.