2021 Retiree Benefits

Open Enrollment: October 19 – November 6, 2020

Retired Employee Medical Plans

Cigna Healthcare Highlights

Cigna healthcare plans continue to be offered to eligible retirees, and dependents who are under age 65, or dependents over age 65 and not Medicare eligible.

OAP High

This plan offers a higher level of coverage with a lower out-of-pocket expense when receiving services, while having access to nationwide providers in exchange for a higher premium.

  • No Primary Care Physician selection required
  • No referral for Specialists
  • Nationwide Provider Network
  • Low Deductible – deductible must be satisfied for services subject to co-insurance
  • Lower Primary Care Physician co-payment
  • Lower Urgent Care co-payment
  • $0 co-payment for Telemedicine
  • $0 co-payment for Generic Seven Drug Classes (both retail & 90-day supply)

OAP Standard

This plan offers individuals needing less access to care a lower premium option, with access to nationwide providers in exchange for a higher out-of-pocket expense when receiving services.  

  • No Primary Care Physician selection required
  • No referral for Specialists
  • Co-payments for Primary and Specialist visits
  • Co-payments for Urgent visits
  • Nationwide Provider Network
  • Low Deductible – deductible must be satisfied for services subject to co-insurance
  • $0 co-payment for Telemedicine
  • $0 co-payment for Generic Seven Drug Classes (both retail & 90-day supply)

 

SureFit Plan

This plan offers a lower out-of-pocket expense when receiving services, a lower premium, and a narrow strong network of providers. You must reside in the tri-county area (Miami-Dade, Broward and Palm Beach Counties).

  • Selection of Primary Care Physician required
  • Referrals needed for Specialists
  • Narrow network with a minimum disruption in comparison to the OAP Plans
  • Co-payments for Primary and Specialist visits
  • Low co-payments for Urgent visits
  • A significant lower deductible – deductible must be satisfied for services subject to co-insurance
  • A significant lower Maximum Out of Pocket – The amount that you must pay before the plan covers 100% of all the services subject to co-insurance
  • $0 co-payment for Telemedicine
  • $0 co-payment for Generic Seven Drug Classes (both retail & 90-day supply)

Healthcare Plan Comparison

OAP High OAP Standard SureFit
Coverage In-Network Out-of-Network In-Network Out-of-Network In-Network Only
Medical Network Basis OAP Network OAP Network SureFit Network TriCounty 1
PCP Coordination of Medical Care No No Yes
Medical Benefits
Deductible (Individual/Family) $500/$1,000 $1,000/$2,000 $750/$1,500 $1,500/$3,000 $150/$250
Out of Pocket Max (Ind/Fam)(incl ded. & copay & Rx) $3,000/$6,000 $6,000/$12,000 $4,000/$8,000 $8,000/$16,000 $1,500/$3,000
Coinsurance 30% 50% 30% 50% 30%
Telemedicine $0 N/A $0 N/A $0
Primary Care Physician OV $25/ $0 M-DCPS Clinic 50% AD $30/ $0 M-DCPS Clinic 50% AD $20/ $0 M-DCPS Clinic
Tier 1 Specialist $50 50% AD $50 50% AD $50
Non-Tier 1 Specialist $70 50% AD $75 50% AD N.A.
Outpatient BH (1st 3 visits at $0) $25 50% AD $30 50% AD $20
Physical Therapy $35 $55 $35
Speech & Occupational Therapies $55 ST, OT 50% AD $60 ST, OT 50% AD $20 PCP/ $50 SCP
Pulmonary Cardiac Therapy (40 days per year) $55 50% AD $70 50% AD $45
Chiropractic Care (30 days per year) $60 50% AD $70 50% AD $45
Convenience Care Centers $10 50% AD $15 50% AD $10
Urgent Care $40 $40 $40 $40 $40
Imaging 30% AD, or $100 at non-hospital based 50% AD 30% AD, or $100 at non-hospital based 50% AD 30% AD, or $100 at non-hospital based
Inpatient Hospital 30% AD 50% AD 30% AD 50% AD 30% AD
Outpatient Hospital and Major Diagnostics 30% AD or $150 at affiliated Non-hospital 50% AD 30% AD or $150 at affiliated Non-hospital 50% AD 30% AD or $100 at affiliated Non-hospital
Emergency Room $350/$200 preferred facilities $350 $400/$200 preferred facilities $400 $300/$150 preferred facilities
Other - Hearing Aides $65 visit/ 30% AD for devices Not covered $70 visit/ 30% AD for devices Not covered $50 visit/ 30% AD for devices
Other - Bariatric Surgery 30% AD Not covered Not covered Not covered Not covered
Prescription Drug Benefits (50% Retail only out-of-network benefit)
Prescription Drug Deductible (Ind/Fam) N/A N/A N/A
Formulary Same as OAP Standard and SureFit Same as OAP High and SureFit Same as OAP plans
Other - Insulin Copay Waiver Yes Yes Yes
Retail Drug Network (no coverage for maintenance meds after 3rd fill)
Generic Seven Drug Classes2 $0 50% $0 50% $0
Generic $20 – no coverage for maintenance meds after 3rd fill $20 – no coverage for maintenance meds after 3rd fill $15 – no coverage for maintenance meds after 3rd fill
GENERIC ADD & ADHD $15 $15 $15
Preferred Brand (Including Specialty Drugs) $55 – no coverage for maintenance meds after 3rd fill $65 – no coverage for maintenance meds after 3rd fill $40 – no coverage for maintenance meds after 3rd fill
Non-Preferred Brand (Including Specialty Drugs) $150 – no coverage for maintenance meds after 3rd fill $175 – no coverage for maintenance meds after 3rd fill $125 – no coverage for maintenance meds after 3rd fill
Mail Order Prescription (90 day supply) N/A N/A
Generic Seven Drug Classes2 $0 $0 $0
Generic $40 $40 $30
Generic ADD & ADHD $30 $30 $15
Preferred Brand (Including Specialty Drugs) $140 $160 $80
Non-Preferred Brand (Including Specialty Drugs) $375 $435 $315
1 Broward, Dade and Palm Beach Counties, FL
2 90-Day supply on Seven Drug Classes related to the following conditions: Asthma, Blood Pressure, Blood Thinner, Cholesterol, Diabetes, Osteoporosis, Prenatal Vitamins
AD = after deductible, OV = office visit

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