Benefit Program Plan Options

 

medical_plan

Medical Plan Overview

Ōnin Medical Benefits Plan Options

Basic Plan

Cost Effective Option
That Satisfies Employee
Essential Coverage

PPACA Plan

Affordable Solution
That Provides
Comprehensive Health
Benefits

Cigna PPO

Traditional PPO Plan

Ōnin will be providing three (3) medical plan options this year.
These plans are designed to offer a full range of different coverage options to our team so everyone can find one that best matches their needs.

medical careBasic Plan

The Basic Plan meets the basic healthcare needs for the employee as well as satisfies the Minimum Essential Coverage mandate of the Patient Protection and Affordable Care Act for the employee. When the employee purchases the Basic Plan, the Affordable Care Act requirement for the employee’s individual insurance coverage mandate has been met. It should be noted that both the PPACA Plan and The Cigna PPO plan also fulfill this requirement, but the Basic Plan is designed to fulfill it in the most cost effective way possible.

ppacaPPACA Plan

The PPCA Plan is a health benefit plan that provides a comprehensive health coverage solution. The PPACA Plan provides these benefits on a level that most closely resembles a “Gold” Plan on the health exchanges, but it does so at a price point that is still affordable.

Cigna PPO

Cigna PPO – The Cigna PPO plan is a traditional preferred provider organization health benefit plan offering through the Cigna Network.

All employees will, by default, be positively enrolled into the PPACA Plan; this is being done to comply with the Affordable Care Act requirement. To change the selection, all that needs to be done is to sign into the employee benefit portal that will be provided by WH Administrators. PARTICIPATION IS COMPLETELY OPTIONAL. Employees do not need to purchase coverage; they can dis-enroll from the PPACA plan quickly and easily through the WH Administrator portal (there will also be a telephone based option to use as well).

Based on the employee selections in the portal during open enrollment, deductions for the plan selected by the employee will be done on a pretax basis, one month prior to coverage start date. The first deduction for the first month of coverage will be taken out in December.

There will be full training scheduled in the near future and support is available for both managers and employees to ensure enrollment runs smoothly.

Plan Details

PPACA COMPLIANCE PLAN BASIC PLAN
Calender year Deductible $3,000 No Deductible Plan is limited to Outpatient Services
Coinsurance Percentage 80% 80%
Out of Pocket maximum $6,500 per person N/A
Base Accident Benefit $300 $300
Base well Care benefit Including Immunizations Unlimited, no co-pay or deductible Unlimited, no co-pay or deductible
Primary Care Visits 5 visits per year paid at 80%, additional visits subject to deductible and coinsurance 6 visits per year paid at 80% additional visits are Not Coverd
Inpatient Hospital 80% after Deductible Not Covered
Surgery 80% after Deductible Not Covered
Physical, Speech and Occupational Therapy and other Special Office Visits 5 visits per calendar year, 100% after $40 copay; additional visits subject to deductible and coinsurance Not Covered
Prescription Drugs Retail:
Tier 1 (generics) 45% with $15 min
Tier 2 (Formulary) 45% with $70 min
Tier 3 (formulary Non Preferred) 45% with $100 min
Tier 1(Generics) 45% with $30 min
Tier 2 (Formulart) 45% with $140 min
Tier 3 (Formulary Non Preferred) 45% with $200 minTier4 (Speciality Drugs) 50%100% generic birth control
Retail:
Tier 1 (generics) $10Tier 2 (Formulary) Not CoveredTier 3 (Formulary Non Preferred) Not Covered

Cigna PPO Network Plan Details

In Network Out of Network
Calender year Deductible $1,200/ Indivividual
$3,600/ Family
$2,400/ Indivividual
$7,200/ Family
Coinsurance Percentage 80% 60%
Out of Pocket maximum $6,000/ Indivividual
$12,000/ Family
$12,000/ Indivividual
$24,000/ Family
Base Accident Benefit $300 $300
Base well Care benefit Including Immunizations Unlimited, no co-pay or deductible 60%
Primary Care Visits $20 60%
Inpatient Hospital 80% 60%
Surgery 80% 60%
Physical, Speech and Occupational Therapy and other Special Office Visits $40 copay 60%
Prescription Drugs Retail:
Tier 1 (generics) 25% with $10 min
Tier 2 (Formulary) 25% with $40 min
Tier 3 (formulary Non Preferred) 25% with $60 min
Tier 1(Generics) 25% with $20 min
Tier 2 (Formulart) 25% with $80min
Tier 3 (Formulary Non Preferred) 25% with $120minTier4 (Speciality Drugs) 50%100% generic birth control
Retail:
Tier 1 (generics) 25% with $10 min
Tier 2 (Formulary) 25% with $40 min
Tier 3 (formulary Non Preferred) 25% with $60 min
Tier 1(Generics) 25% with $20 min
Tier 2 (Formulart) 25% with $80min
Tier 3 (Formulary Non Preferred) 25% with $120minTier4 (Speciality Drugs) 50%100% generic birth control
Reimbursement: Based off of Cigna Healthcare Network www.cigna.com
The Ōnin Group Corporate Office is located at:
1 Perimeter Park S, Suite 450 N Brimingham, AL 35243.
Phone: 866-581-6646