Medical – California – Frontier Dental Labs

Which Medical Plan is Right?

Cigna

Medical coverage is provided through Cigna. The medical coverage includes a national network of physicians, specialists and hospitals. Frontier Dental Labs offers employees medical coverage through Cigna’s Open Access Plus (OAP) Network. Below is a snapshot of what is covered under the plan. To see a full, comprehensive list, please refer to the Summary of Benefits. Plan Costs are communicated separately.

We understand how confusing and overwhelming it can be to review your health plan options. And we want to help by providing the resources you need to make a decision with confidence. That’s why Cigna One Guide® service is available to you now.

Call a Cigna One Guide representative during preenrollment to get personalized, useful guidance.

Your personal guide will help you:

Easily understand the basics of health coverage
Identify the types of health plans available to you
Check if your doctors are in-network to help you avoid unnecessary costs
Get answers to any other questions you may have about the plans or provider networks available to you

The best part is, during the enrollment period, your personal guide is just a call away.

Don’t wait until the last minute to enroll.

Call 888.806.5042 to speak with a Cigna One Guide representative today.

Kaiser

Medical coverage is provided through Kaiser Permanente. The medical coverage includes a regional network of physicians, specialists and hospitals. Frontier Dental Labs offers employees medical coverage through Kaiser’s Health Maintenance Organization (HMO) plan. Below is a snapshot of what is covered under the plan. To see a full, comprehensive list, please refer to the Summary of Benefits. Plan Costs are communicated separately.

Prescription Drug - California Only

When you enroll in a medical plan, you automatically receive prescription drug benefits. Please see the chart below for an overview of the Kaiser prescription drug benefits.

Medical Plan Comparison - California Only

Kaiser	Health Maintenance Organization (HMO)			Deductible Health Maintenance Organization (DHMO)
Benefit	In-Network	Out-of-Network	In-Network	Out-of-Network
Contract Year Deductible	$0 Individual $0 Family	N/A	$1,000 Individual $2,000 Family	N/A
After Deductible Plan Pays	N/A	N/A	70%	N/A
Contract Year Out-of-Pocket Maximum (includes Rx)	$3,000 Individual $6,000 Family	N/A	$5,000 Individual $10,000 Family	N/A
Lifetime Maximum	Unlimited	N/A	Unlimited	N/A
Preventive Care for Adults & Children	100%	N/A	100%	N/A
Doctors Office Visits Primary Care Specialist Urgent Care	$30 Copay $50 Copay $30 Copay	N/A	$30 Copay $50 Copay $30 Copay	N/A
Inpatient / Outpatient Facility Charges	$500 per Admission / $200 per Procedure	N/A	30% Coinsurance after plan deductible	N/A
Emergency Room Facility Charges*	$100 per Visit	N/A	30% Coinsurance after plan deductible	N/A
Ambulance	$75 per Trip	N/A	$150 per Trip after plan deductible	N/A
Chiropractic Benefits	$15 per Visit	N/A	$15 per Visit	N/A
Independent Labs	N/A	N/A	N/A	N/A
*Out of Network Emergency Facility and Professional charges are subject to In Network Coinsurance and/or Co pay and Out of Network Benefit Year Deductible and Out of Pocket.

Prescription Plan Comparison - California Only

Benefit	HMO Plan	DHMO Plan
Prescription Deductible	N/A	$125 per Individual
Retail Pharmacy (per 30-day supply) Generic Brand / Non-preferred Specialty	$15 Copay $35 Copay 20% Coinsurance (not to exceed $250)	$15 Copay, Drug deductible does not apply $50 Copay, After drug Deductible $50 Copay, After drug Deductible
Retail and Home Delivery Pharmacy (per 100-day supply) Generic Brand / Non-preferred	$30 Copay $70 Copay	$15, Drug deductible does not apply $50 Copay, After drug Deductible