How much will I pay out of my own pocket?What will I pay after I meet my deductible?Will my doctor be in-network?
Plan Options: Cigna Copay Plan, Cigna High Deductible Health Plan (HDHP), Kaiser Copay Plan, and Kaiser High Deductible Health Plan (HDHP)
The City of Thornton partners with Cigna & Kaiser Permanente to offer you a broad choice of medical plans. You may choose to enroll in 1 medical plan option. You may be confident that any plan you choose will provide 100% coverage for preventive care, and comprehensive coverage if you experience a significant medical event.
Cigna Healthcare: (800) 244-6224 | my.cigna.com | Group #3178056
Kaiser Permanente: (303) 338-3800 | kp.org | Group #00365
 |
Medical Plans |
Cigna Copay Plan
With this plan you will have access to the Cigna Local Plus Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
With this plan you will have access to the Cigna Local Plus Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with Cigna to see if your provider is in the Cigna Local Plus Network so that you can take advantage of greater discounts on care for you and your family.
| CIGNA COPAY PLAN LOCAL PLUS NETWORK |
|
|---|---|
| Annual Deductible Embedded Jan 1 — Dec 31 |
You pay up to $750 per individual $1,500 per family |
| Out-of-pocket Maximum Embedded Jan 1 — Dec 31 |
No more than $3,500 per individual $7,000 per family |
| In-Network | |
| Primary Care Visit | $20 copay per visit |
| Virtual Visit (including Mental Health & Specialist Visits) | No charge |
| Specialist Visit | $50 copay per visit |
| Preventive Care/Screening/Immunizations | No charge |
| If you have a test… | |
| Diagnostic Test (X-Ray, Bloodwork, etc.) | 10% coinsurance |
| Imaging (CT/PET scans, MRIs, etc) | $100 copay |
| If an employee needs drugs to treat an illness or condition… | |
| Generic Drugs | |
| Retail 30-day Supply Retail 90-day Supply Mail Order 90-day Supply |
$10 copay $30 copay $20 copay |
| Preferred Brand Drugs | |
| Retail 30-day Supply Retail 90-day Supply Mail Order 90-day Supply |
20% coinsurance up to $75 20% coinsurance up to $225 20% coinsurance up to $150 |
| Non-Preferred Brand Drugs | |
| Retail 30-day Supply Retail 90-day Supply Mail Order 90-day Supply |
30% coinsurance up to $125 30% coinsurance up to $375 30% coinsurance up to $250 |
| If you have outpatient surgery… | |
| Facility Fee (example: Ambulatory Surgery Center) | 10% coinsurance |
| Physician/Surgeon Fees | 10% coinsurance |
| If you need immediate medical attention… | |
| Urgent Care | $75 copay per visit |
| Emergency Room Care | $250 copay per visit |
| Emergency Medical Transportation | 10% coinsurance |
| If you have a hospital stay… | |
| Facility Fee (example: Hospital Room) | 10% coinsurance |
| Physician/Surgeon Fees | 10% coinsurance |
| If you need Mental Health, Behavioral Health, or Substance Abuse Services… | |
| Outpatient Services | $20 copay per office visit |
| Inpatient Services | 10% coinsurance |
| If you are pregnant… | |
| Office Visits | 10% coinsurance |
| Childbirth Delivery/Professional Services | 10% coinsurance |
| Childbirth Delivery/Facility Services | 10% coinsurance |
| If you need help recovering or have other special health needs… | |
| Rehabilitation Services | $20 copay per PCP visit |
| Habilitation Services | $20 copay per PCP visit |
| NOTE: Certain services may be excluded and/or limited. For a full list of excluded and other covered services, please check your plan documents for more information. | |
| Monthly Payroll Deductions for Regular Full-Time Employees For part-time and other status types please request rates from HR |
|
| COVERAGE | EMPLOYEE CONTRIBUTION |
| Employee Only | $120.04 |
| Employee + 1 Dependent | $396.62 |
| Employee + Family | $657.84 |
If you are enrolled in one of the Cigna plan options through the City, you have access to Regenexx as an in-network benefit. Regenexx is an innovative treatment for orthopedic injuries that enhances your body’s natural healing processes. To find out more about the Regenexx benefit and whether it is an option for you, contact Regenexx!
Register for an educational webinar (held weekly): regenexxbenefits.com/webinar?mailer
Call: (866) 932-7511
Visit: regenexxbenefits.com/thorntonco
Cigna High Deductible Health Plan (HDHP)
With this plan you will have access to the Cigna Local Plus Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
With this plan you will have access to the Cigna Local Plus Network. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with Cigna to see if your provider is in the Cigna Local Plus Network so that you can take advantage of greater discounts on care for you and your family.
| CIGNA HIGH DEDUCTIBLE HEALTH PLAN (HDHP) LOCAL PLUS NETWORK |
|
|---|---|
| Annual Deductible Embedded Jan 1 — Dec 31 |
You pay up to $1,650 per individual $3,300 per family |
| Out-of-pocket Maximum Embedded Jan 1 — Dec 31 |
No more than $3,500 per individual $7,000 per family |
| In-Network | |
| Primary Care Visit | 20% coinsurance |
| Virtual Visit (including Mental Health & Specialist Visits) | No charge |
| Specialist Visit | 20% coinsurance |
| Preventive Care/Screening/Immunizations | No charge |
| If you have a test… | |
| Diagnostic Test (X-Ray, Bloodwork, etc.) | 20% coinsurance |
| Imaging (CT/PET scans, MRIs, etc) | 20% coinsurance |
| If an employee needs drugs to treat an illness or condition… | |
| Generic Drugs | |
| Retail 30-day Supply Retail 90-day Supply Mail Order 90-day Supply |
20% coinsurance 20% coinsurance 20% coinsurance |
| Preferred Brand Drugs | |
| Retail 30-day Supply Retail 90-day Supply Mail Order 90-day Supply |
30% coinsurance 30% coinsurance 30% coinsurance |
| Non-Preferred Brand Drugs | |
| Retail 30-day Supply Retail 90-day Supply Mail Order 90-day Supply |
40% coinsurance 40% coinsurance 40% coinsurance |
| If you have outpatient surgery… | |
| Facility Fee (example: Ambulatory Surgery Center) | 20% coinsurance |
| Physician/Surgeon Fees | 20% coinsurance |
| If you need immediate medical attention… | |
| Urgent Care | 20% coinsurance |
| Emergency Room Care | 20% coinsurance |
| Emergency Medical Transportation | 20% coinsurance |
| If you have a hospital stay… | |
| Facility Fee (example: Hospital Room) | 20% coinsurance |
| Physician/Surgeon Fees | 20% coinsurance |
| If you need Mental Health, Behavioral Health, or Substance Abuse Services… | |
| Outpatient Services | 20% coinsurance |
| Inpatient Services | 20% coinsurance |
| If you are pregnant… | |
| Office Visits | 20% coinsurance |
| Childbirth Delivery/Professional Services | 20% coinsurance |
| Childbirth Delivery/Facility Services | 20% coinsurance |
| If you need help recovering or have other special health needs… | |
| Rehabilitation Services | 20% coinsurance |
| Habilitation Services | 20% coinsurance |
| NOTE: Certain services may be excluded and/or limited. For a full list of excluded and other covered services, please check your plan documents for more information. | |
How the Health Reimbursement Account (HRA) works:
|
|
| Cigna Healthcare: High Deductible Health Plan with HRA |
|
| SINGLE COVERAGE | |
| Deductible: $1,650 | You pay for services (with a $1,000 HRA contribution from the City and your own funds) until your deductible is met. |
| Coinsurance: 80/20 | Cigna pays 80% of eligible medical claims; you cover the remaining 20% until you hit your out-of-pocket maximum of $3,500. |
| Out-of-Pocket Maximum: $3,500 |
Cigna pays eligible medical claims at 100% after the out-of-pocket maximum of $3,500 is met. |
| FAMILY COVERAGE | |
| Deductible: $3,300 | You pay for services (with a $2,000 HRA contribution from the City and your own funds) until your deductible is met. |
| Coinsurance: 80/20 | Cigna pays 80% of eligible medical claims; you cover the remaining 20% until you hit your out-of-pocket maximum of $7,000. |
| Out-of-Pocket Maximum: $7,000 | Cigna pays eligible medical claims at 100% after the out-of-pocket maximum of $7,000 is met. |
| Monthly Payroll Deductions for Regular Full-Time Employees For part-time and other status types please request rates from HR |
|
| COVERAGE | EMPLOYEE CONTRIBUTION |
| Employee Only | $92.88 |
| Employee + 1 Dependent | $306.10 |
| Employee + Family | $507.32 |
If you are enrolled in one of the Cigna plan options through the City, you have access to Regenexx as an in-network benefit. Regenexx is an innovative treatment for orthopedic injuries that enhances your body’s natural healing processes. To find out more about the Regenexx benefit and whether it is an option for you, contact Regenexx!
Register for an educational webinar (held weekly): regenexxbenefits.com/webinar?mailer
Call: (866) 932-7511
Visit: regenexxbenefits.com/thorntonco
Kaiser Permanente Copay Plan
Kaiser Permanente is a self-contained medical plan that provides convenient access to services within their network of healthcare providers and facilities. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Kaiser Permanente is a self-contained medical plan that provides convenient access to services within their network of healthcare providers and facilities. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with Kaiser Permanente to see if your provider is in the Kaiser Permanente Network so that you can take advantage of greater discounts on care for you and your family.
| KAISER COPAY PLAN KAISER PERMANENTE NETWORK |
|
|---|---|
| Annual Deductible Embedded Jan 1 — Dec 31 |
You pay up to $750 per individual $1,500 per family |
| Out-of-pocket Maximum Embedded Jan 1 — Dec 31 |
No more than $3,500 per individual $7,000 per family |
| In-Network | |
| Primary Care Visit | $20 copay per visit |
| Virtual Visit (including Mental Health & Specialist Visits) | No charge |
| Specialist Visit | $50 copay per visit |
| Preventive Care/Screening/Immunizations | No charge |
| If you have a test… | |
| Diagnostic Test (X-Ray, Bloodwork, etc.) | X-Ray: 10% coinsurance Labs: No charge |
| Imaging (CT/PET scans, MRIs, etc) | $100 copay |
| If an employee needs drugs to treat an illness or condition… | |
| Generic Drugs | |
| Retail 30-day Supply Mail Order 90-day Supply |
$10 copay $20 copay |
| Preferred Brand Drugs | |
| Retail 30-day Supply Mail Order 90-day Supply |
20% coinsurance 20% coinsurance |
| Non-Preferred Brand Drugs | |
| Retail 30-day Supply Mail Order 90-day Supply |
20% coinsurance 20% coinsurance |
| Specialty Drugs | |
| Retail 30-day Supply | 20% coinsurance up to $250 |
| If you have outpatient surgery… | |
| Facility Fee | Ambulatory Surgery Center: $500 copay Outpatient Hospital: 10% coinsurance |
| Physician/Surgeon Fees | Ambulatory Surgery Center: No charge Outpatient Hospital: 10% coinsurance |
| If you need immediate medical attention… | |
| Urgent Care | $75 copay per visit |
| Emergency Room Care | $250 copay per visit |
| Emergency Medical Transportation | 10% coinsurance up to $500 |
| If you have a hospital stay… | |
| Facility Fee (example: Hospital Room) | 10% coinsurance |
| Physician/Surgeon Fees | 10% coinsurance |
| If you need Mental Health, Behavioral Health, or Substance Abuse Services… | |
| Outpatient Services | $20 copay per office visit |
| Inpatient Services | 10% coinsurance |
| If you are pregnant… | |
| Office Visits | 10% coinsurance |
| Childbirth Delivery/Professional Services | 10% coinsurance |
| Childbirth Delivery/Facility Services | 10% coinsurance |
| If you need help recovering or have other special health needs… | |
| Rehabilitation Services | Inpatient: 10% coinsurance Outpatient: $20 copay per visit |
| Habilitation Services | $20 copay per visit |
| NOTE: Certain services may be excluded and/or limited. For a full list of excluded and other covered services, please check your plan documents for more information. | |
| Monthly Payroll Deductions for Regular Full-Time Employees For part-time and other status types please request rates from HR |
|
| COVERAGE | EMPLOYEE CONTRIBUTION |
| Employee Only | $97.34 |
| Employee + 1 Dependent | $317.54 |
| Employee + Family | $518.94 |
Register for your Kaiser member account and use the below resources for help with:
- Scheduling
- Mental Health resources
- Finding providers/facilities
- Plan questions
- Pharmacy Services
- Health & Fitness resources
Call: (866) 932-7511
Visit: kp.org/allthatisyou
Kaiser Permanente High Deductible Health Plan (HDHP)
Kaiser Permanente is a self-contained medical plan that provides convenient access to services within their network of healthcare providers and facilities. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Kaiser Permanente is a self-contained medical plan that provides convenient access to services within their network of healthcare providers and facilities. An important thing to know about this plan is that both the family deductible and family out-of-pocket maximum are embedded. This means that on a family plan each covered member must meet their individual deductible — up to the maximum family deductible — and each covered member has an individual out-of-pocket maximum — up to the family out-of-pocket maximum.
Please check with Kaiser to see if your provider is in the Kaiser Permanente Network so that you can take advantage of greater discounts on care for you and your family.
| KAISER HIGH DEDUCTIBLE HEALTH PLAN (HDHP) KAISER PERMANENTE NETWORK |
|
|---|---|
| Annual Deductible Embedded Jan 1 — Dec 31 |
You pay up to $1,650 per individual $3,300 per family |
| Out-of-pocket Maximum Embedded Jan 1 — Dec 31 |
No more than $3,500 per individual $7,000 per family |
| In-Network | |
| Primary Care Visit | 20% coinsurance |
| Virtual Visit (including Mental Health & Specialist Visits) | Coinsurance applies until deductible is met |
| Specialist Visit | 20% coinsurance |
| Preventive Care/Screening/Immunizations | No charge |
| If you have a test… | |
| Diagnostic Test (X-Ray, Bloodwork, etc.) | 20% coinsurance |
| Imaging (CT/PET scans, MRIs, etc) | 20% coinsurance |
| If an employee needs drugs to treat an illness or condition… | |
| Generic Drugs | |
| Retail 60-day Supply Mail Order 60-day Supply |
$15 copay $15 copay |
| Preferred Brand Drugs | |
| Retail 60-day Supply Mail Order 60-day Supply |
$30 copay $30 copay |
| Non-Preferred Brand Drugs | |
| Retail 60-day Supply Mail Order 60-day Supply |
$50 copay $50 copay |
| Specialty Drugs | |
| Retail 60-day Supply | 20% coinsurance |
| If you have outpatient surgery… | |
| Facility Fee (example: Ambulatory Surgery Center) | Ambulatory Surgical Center: 10% coinsurance Outpatient Hospital: 20% coinsurance |
| Physician/Surgeon Fees | Ambulatory Surgical Center: 10% coinsurance Outpatient Hospital: 20% coinsurance |
| If you need immediate medical attention… | |
| Urgent Care | 20% coinsurance |
| Emergency Room Care | 20% coinsurance |
| Emergency Medical Transportation | 20% coinsurance |
| If you have a hospital stay… | |
| Facility Fee (example: Hospital Room) | 20% coinsurance |
| Physician/Surgeon Fees | 20% coinsurance |
| If you need Mental Health, Behavioral Health, or Substance Abuse Services… | |
| Outpatient Services | 20% coinsurance |
| Inpatient Services | 20% coinsurance |
| If you are pregnant… | |
| Office Visits | 20% coinsurance |
| Childbirth Delivery/Professional Services | 20% coinsurance |
| Childbirth Delivery/Facility Services | 20% coinsurance |
| If you need help recovering or have other special health needs… | |
| Rehabilitation Services | 20% coinsurance |
| Habilitation Services | 20% coinsurance |
| NOTE: Certain services may be excluded and/or limited. For a full list of excluded and other covered services, please check your plan documents for more information. | |
How the Health Reimbursement Account (HRA) works:
|
|
| Kaiser Permanente: High Deductible Health Plan with HRA |
|
| SINGLE COVERAGE | |
| Deductible: $1,650 | You pay for services (with a $1,000 HRA contribution from the City and your own funds) until your deductible is met. |
| Coinsurance: 80/20 | Kaiser Permanente pays 80% of eligible medical claims; you cover the remaining 20% until you hit your out-of-pocket maximum of $3,500. |
| Out-of-Pocket Maximum: $3,500 | Kaiser Permanente pays eligible medical claims at 100% after the out-of-pocket maximum of $3,500 is met. |
| FAMILY COVERAGE | |
| Deductible: $3,300 | You pay for services (with a $2,000 HRA contribution from the City and your own funds) until your deductible is met. |
| Coinsurance: 80/20 | Kaiser Permanente pays 80% of eligible medical claims; you cover the remaining 20% until you hit your out-of-pocket maximum of $7,000. |
| Out-of-Pocket Maximum: $7,000 | Kaiser Permanente pays eligible medical claims at 100% after the out-of-pocket maximum of $7,000 is met. |
| Monthly Payroll Deductions for Regular Full-Time Employees For part-time and other status types please request rates from HR |
|
| COVERAGE | EMPLOYEE CONTRIBUTION |
| Employee Only | $81.68 |
| Employee + 1 Dependent | $263.64 |
| Employee + Family | $435.94 |
Register for your Kaiser member account and use the below resources for help with:
- Scheduling
- Mental Health resources
- Finding providers/facilities
- Plan questions
- Pharmacy Services
- Health & Fitness resources
Call: (866) 932-7511
Visit: kp.org/allthatisyou
