2025 Benefits Guide- updated 10-20 - Flipbook - Page 7
Prescription
CIGNA
High Deductible Plan
Prescription Drug 30
Day Supply- Retail
Prescription Drug 90
Day Supply
CIGNA
Healthy Engagement Plan
In Network
Out Of Network
In Network
Out Of Network
Preventative Generic
$0.00
N/A
Preventative Generic
$0.00
N/A
Other Generic
Deductible, then 30%
N/A
Other Generic
$5.00
N/A
Preferred
Deductible, then 30%
N/A
Preferred
20% to $50 max
N/A
Non-Preferred
Deductible, then 30%
N/A
Non-Preferred
25% to $75 max
N/A
Preventative Generic
100%
N/A
Preventative Generic
$100%
N/A
Other Generic
Deductible, then 30%
N/A
Other Generic
$10.00
N/A
Preferred
Deductible, then 30%
N/A
Preferred
20% to $50 max
N/A
Non-Preferred
Deductible, then 30%
N/A
Non-Preferred
25% to $75 max
N/A
