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’ll pay fixed copays for doctor visits and nearly all prescriptions without having to meet your deductible. The amount you pay depends on the physicians and pharmacies you use. If you chose a provider in the Tier 3 network, you’ll first have to meet your deductible before coinsurance kicks in.
How much do I pay for prescription drugs?
There is no deductible for prescription drugs. You pay copays or coinsurance from day one. Prescription costs do count towards your out-of-pocket maximum. 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 Network
- 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
- Limited drug distribution filled at contracted pharmacies are subject to the Tier 1 out-of-pocket maximum
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.