Page 6 - Macys 2018 AE Guide

Medical Options
This year, choose from three Cigna My Choice Plan medical options, providing more exibility to choose the medical option that works for you and your family.
CIGNA MY CHOICE PLAN MEDICAL OPTIONS
ENHANCED
MY CHOICE PLAN 1
MY CHOICE PLAN 2
NEW
MY CHOICE PLAN 3 (PPO)*
Monthly Premiums**
Colleague
$210
$109
$90
Family
$631
$328
$270
Annual In-Network Deductible
Colleague
$1,400
$3,000
$6,000
Family***
$2,800
$6,000
$12,000
Annual In-Network Out-of-Pocket Maximum
Primary care, specialist visits & prescriptions not subject to deductible
Colleague
Inpatient/Outpatient Hospital, MRI, Lab, X-ray, Emergency Room
Generic Non-Formulary
Generic
Non-Formulary
$4,300
$6,450
$7,350
You pay 10% coinsurance after deductible
30% (Max $50) 50% (Max $200)
30% (Max $100)
40% (Max $250)
50% (Max $500)
Family***
Formulary
Specialty
$8,600
You pay $0
You pay 10% coinsurance after deductible
$12,900
What You Pay for In-Network Medical Services
Preventive Care
You pay $0
You pay 20% coinsurance after deductible
You pay $0
Primary Care Of ce Visit/ Specialist Visit
You pay 10% coinsurance after deductible
You pay 20% coinsurance after deductible
$60 copay/ $120 copay
You pay 10% coinsurance after deductible
MDLIVE
What You Pay for Prescription Medications
Retail 30-Day
$42
*Copays for primary care, specialist visits, MDLIVE and pharmacy costs are not subject to the deductible but count toward your
out-of-pocket maximum.
**The amount shown is for comparison purposes only. Your actual premium may be different based on your geographical location. ***Family deductible and out-of-pocket maximum are for all coverage levels, except colleague only. Each member in the family will have an individual out-of-pocket maximum as shown.
Decrease from last year.
$42
You pay 20% coinsurance after deductible
$40
Home Delivery/Walgreens Family Pharmacy 90-Day Re ll (90 Saver Plus Program)
40% (Max $100)
$300 per 30-day ll
Formulary
Specialty
You pay 10% coinsurance after deductible
You pay 20% coinsurance after deductible
N/A
6 Macy’s, Inc.
$14,700