Choosing Your Health Plan
What you need to know
The Fund offers two health plans that provide different levels of protection from health care expenses. Before enrolling in a health plan, it’s important to understand what each plan covers—how they differ and how they are the same. If you are eligible for coverage, you also have the option to cover dependents. However, you pay the full cost of that dependent coverage.
Eligibility
Visit the Eligibility page.
Plan tier comparison chart
As an active employee, once you are eligible, the following benefits are available to support the overall health of you and your family:
No matter which health tier you choose, you get protection from health care expenses.
Both tiers:
- Use the same nationwide Cigna network
- Cover the same medical services, although the amount you pay out of your pocket may be different, as shown in the table below
- Include vision coverage and prescription drug coverage
- Cost you $300 per quarter (unless you choose to buy up or buy down to another tier)
- Give you the option to purchase dependent medical coverage. NOTE: You pay the full cost of dependent coverage out of your pocket.
- Give you the option to purchase dependent dental coverage. NOTE: You pay the full cost of dental coverage out of your pocket.
- Cost less when you use a provider who is in-network
For individuals who live in the New York or Maryland-Virginia-Washington, DC metropolitan areas, or in California, an HMO medical plan option is also available.
The other differences between the tiers have to do with how you and the Fund share the cost when you receive health care services and fill prescriptions. View a brief summary below. View the complete Summaries of Benefits.
Medical and Hospital Care
Tier 1
In-Network
Deductible
(calendar year – CY)
Coinsurance
Coinsurance Limit
(what you could pay in a CY)
You Pay
Per Office Visit 1
Emergency Room Copay
Preventive Care
Tier 1
Out-of-Network
Deductible
(calendar year – CY)
Coinsurance
Coinsurance Limit
(what you could pay in a CY)
You Pay
Per Office Visit 1
Emergency Room Copay
Preventive Care
Tier 2
In-Network
Deductible
(calendar year – CY)
Coinsurance
Coinsurance Limit
(what you could pay in a CY)
You Pay
Per Office Visit 1
Emergency Room Copay
Preventive Care
Tier 2
Out-of-Network
Deductible
(calendar year – CY)
Coinsurance
Coinsurance Limit
(what you could pay in a CY)
You Pay
Per Office Visit 1
Emergency Room Copay
Preventive Care
Prescription Drugs (In-Network)2
Tier 1
Retail Pharmacy (30-Day Supply)
Generics
Preferred Brand
Non-Preferred Brand
Specialty Brand
Tier 1
Mail or Retail
(90-Day Supply)
Generics
Preferred Brand
Non-Preferred Brand
Specialty Brand
Tier 2
Retail Pharmacy
(30-Day Supply)
Generics
Preferred Brand
Non-Preferred Brand
Specialty Brand
Tier 2
Mail or Retail
(90-Day Supply)
Generics
Preferred Brand
Non-Preferred Brand
Specialty Brand
In New York, Maryland, Virgina, Washington, D.C., and metropolitan areas of California, HMOs with no deductibles are also available, which you may want to consider.
1 Where flat copays are shown for medical benefits, they are in lieu of the deductible and coinsurance.
2 A separate $100 / $200 annual deductible applies to all drugs other than generics, and there is a separate coinsurance maximum of $4,000 per individual and $8,000 per family. Generics are generally the lowest-cost drugs, but occasionally the brand-name version can be lower in cost than the generic, in which case your out-of-pocket cost may be similar to that for a generic. Preferred drugs generally have the same outcomes as non-preferred but are less expensive. Non-preferred drugs are higher-cost name brands.
Things to consider
As an active employee, once you are eligible, the following benefits are available to support the overall health of you and your family:
There are many things to consider when choosing your health plan. Use the content below to help you evaluate your CIGNA options. Learn about the HMOs.
You Have the Following Choices
If you worked 11-14 weeks
Your Subtitle Goes Here
Choice 1: Use 11 of your weeks to purchase the Tier 2 Plan.
- You will pay $300 per quarter for coverage.
- If applicable, weeks that you do not use can be applied to your next available Accumulation Period, but ONLY if they fall within that period. Learn about unused weeks below.
Choice 2: Buy up to the Tier 1 Plan.
- You will pay $300 plus an additional $285 for a total of $585 per quarter for coverage.
- In this plan, you pay less out of pocket when you receive health care services.
If you worked 15 Weeks
Your Subtitle Goes Here
Choice 1: Use 15 of your weeks to purchase the Tier 1 Plan.
- You will pay $300 per quarter for coverage.
- If applicable, weeks that you do not use can be applied to your next available Accumulation Period, but ONLY if they fall within that period. Learn about unused weeks below.
Choice 2: Bank weeks above 11 and choose the Tier 2 Plan.
- You will pay $300 per quarter for coverage.
- You will pay more out of pocket in this plan when you receive health insurance.
- Weeks that you do not use can be applied to your next available Accumulation Period, but ONLY if they fall within that period. Learn about unused weeks below.
There are no buy up/down options if you qualify for Tier 1 coverage, but you can choose Tier 2 in order to use fewer weeks (11 weeks instead of 15) and then have the balance applied to your next Accumulation Period ONLY if they fall within that period.
Unused weeks: Understanding Accumulation Periods
If you choose not to enroll in a health plan as soon as you are eligible, or if you choose to enroll in a plan that does not use all your weeks, it’s important to remember that any unused weeks must be used within an applicable Accumulation Period.
Each Accumulation Period looks at the number of weeks you worked in 12 consecutive months (January to December, April to March, July to June, etc.). Once a week is earned, it must be used to enroll in coverage within 12 months; otherwise, it will fall outside all applicable Accumulation Periods. And remember that there is a two-month waiting period between the end of the applicable Accumulation Period and the beginning of your Benefit Period.