How much do I pay for preventive care?
Preventive care*, such as physicals, screenings, immunizations and more, are provided at no cost when you use a Tier 1 BSWQA Network or Tier 2 Cigna National Network provider. Preventive eye exams are not included as part of our medical plans. If you or a covered dependent need routine eye care, our vision plan can help make glasses and contacts more affordable.
How much do I pay for non-preventive care?
You pay 100% of the contracted rate for non-preventive costs until your deductible is met. Once the deductible is met, you’ll pay coinsurance (a percentage of the cost) up until you reach the out-of-pocket maximum. You can always choose to utilize your HSA funds to help pay these costs or save them for later.
How much do I pay for prescription drugs?
Prescription drug costs count toward your deductible. This means you pay 100% of the contracted rate until you meet your deductible. After your deductible, you will pay coinsurance until your out-of-pocket maximum is met. Click here to learn more about our prescription drug benefits.
How much is the out-of-pocket maximum?
Your out-of-pocket maximum will vary based on how many dependents you are covering. All plans have an embedded out-of-pocket maximum so that no one in the family pays more than the individual maximum. A separate out-of-pocket maximum applies for services provided under each tier.
- Tier 1 BSWQA Network medical expenses count toward meeting the Tier 2 Cigna National Network out-of-pocket maximum, but not vice-versa
- Costs of all drugs filled at Baylor Scott & White Health pharmacies or contracted pharmacies apply to Tier 1 BSWQA Network and Tier 2 Cigna National Networ
- There is no out-of-pocket maximum for the Tier 3 Network
- Amounts paid for Tier 3 do not apply to Tier 1 BSWQA Network or Tier 2 Cigna National Network out-of-pocket maximum
- All in-network pharmacy claims are subject to the Tier 1 out-of-pocket maximum only.
Will I have out-of-pocket protection?
Yes. Once you pay your out-of-pocket maximum in Tier 1 Network BSWQA or Tier 2 Cigna National Network, the plan will pay 100% of the cost of additional eligible care expenses in that tier.
*Services will be covered at 100% when billed with a preventive diagnosis code.