LM_SW_Benefits Guide 2024

Medical Benefits

“NEW” ADDITIONAL MEDICAL PLAN OFFERING!

CIGNA MEMBER TOOLS

OPEN ACCESS PLUS IN-NETWORK ONLY (OAP-IN) PLAN

Register for www.myCIGNA.com and click the link to view your personalized medical plan information

BENEFIT

IN-NETWORK Individual: $4,000 Family: $8,000 Individual: $7,000 Family: $14,000

Annual Deductible

Out-of-Pocket Maximum (includes deductibles, copays, and coinsurance)

• Print an I.D. card • Search for claims • Access easy-to-use cost and quality comparison tools for medical and prescription pricing • Enjoy discounts on a variety of health and wellness products and services • Find a provider in the

Lifetime Maximum

Unlimited

Preventive Care Adult Preventive Care Adult Annual Physical Exam Well-Child Care

100% 100% 100%

Outpatient Care Primary Care Physician Office Visits Specialist Office Visits Outpatient Facility Surgery Outpatient Lab & X-Ray Initial visit and all subsequent visits

$50 copay $75 copay 70% after deductible 70% after deductible 70% after deductible

CIGNA Open Access Plus Network or call 800.CIGNA24 (800.244.6224)

Hospital Care

$350 copay if not admitted; Hospital Care deductible applies if admitted

Emergency Care At hospital emergency room

PRICE ASSURE (POWERED BY GOODRX) Cigna’s partnership with GoodRx may allow members to receive the lowest prescription cost when filling eligible generic non specialty prescriptions at participating pharmacies. The price you pay will count towards your deductible and out-of-pocket maximum.

Urgent Care

$75 copay

Mental Health Inpatient Outpatient

70% after deductible $75 copay

Prescription Drugs Deductible

$150/$300; waived for generic

Retail Pharmacy (30-day supply) Generic/Preferred/Non-Preferred Mail Order (90-day supply) Generic/Preferred/Non-Preferred

$25/$75/$100

$50/$150/$200

Cigna’s OAP family plans deductible is structured so that no one family member can contribute more than the single amount toward the family deductible.

Texas legislation requires insured medical plans to extend the right for an employee to choose not to pay for coverage of elective abortions if such coverage is contrary to moral, ethical, or religious beliefs. The plan offered includes the coverage of elective abortions. You have the right to choose a health plan with or without coverage for elective abortions. Rates for enrollees that choose to decline a plan providing elective abortion coverage will be slightly lower than the rates offered to enrollees that choose a plan that covers elective abortion.

Log into www.workforcenow.adp.com and click on Resources – Company Information – Tools/Resources – 2024 Benefit Documents for details. In the event of a discrepancy, the carrier Plan Document shall prevail.

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QUESTIONS? Call BenefitsVIP ® at 866.286.5354