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​Medical Plan


Point of Service Medical Plan - Two Plan Options

The Harris County medical plans are offered through Cigna and afford you the opportunity to choose any doctor or other health care provider. Whether you utilize in-network or out-of-network benefits depends on where and with whom you receive your care. Neither plan requires a PCP selection or referrals for specialist visits.

 

Employees are given the opportunity each January to choose between the Base Plan OR Base Plus Plan. These plans consist of a point-of-enrollment option for employees with a “Base” level of benefits at no cost for employee only coverage. In addition, the County will pay 50% of the incremental cost of dependent coverage. The “Base” plan offers a high level of affordable access to basic health and preventative services as well as protection to pay for high cost hospital and surgical expenses while containing premium cost increases for both the County and employees. While many routine services on the “Base” plan only require a copayment; some inpatient and outpatient services are subject to an annual deductible and coinsurance when utilizing a provider in-network and/or out-of-network.

The second option provided to employees is a “Plus” plan that allows employees to pay a higher contribution to receive a higher level of benefits. The County will pay 50% of the incremental cost of dependent coverage. The “Plus” plan has no deductibles or coinsurance when utilizing in-network providers, though out-of-network providers will be subject to deductibles on both the “Base” and “Plus” plans.

Both plans contain the same prescription drug benefit, which will encourage cost effective utilization of these benefits and provides potential savings to both employees and the County.

  
Base Plan / HAMP In-Network
Base Plan / HAMP Out-of-Network
Plus Plan / HAMP In-Network
Plus Plan / HAMP Out-of-Network
Annual Deductible

  BASE: $600/$1,800

HAMP: $300/$900

$1,000 Individual

$3,000 Family

​None

$1,000 Individual

$3,000 Family

Maximum Out-of-Pocket-includes deductible, coinsurance, medical, and Rx copays (Per Individual / Family Per Calendar Year)

  BASE: $7,350/$14,700

HAMP: $7,150/$13,700

$10,000 Individual

$30,000 Family

  PLUS: $6,350/$12,700

HAMP: $6,150/$11,700


$10,000 Individual

$30,000 Family

Lifetime Maximum Benefit
Unlimited except where otherwise indicated
Unlimited except where otherwise indicated
Unlimited except where otherwise indicated
Unlimited except where otherwise indicated
Primary Care Physician Visit

  BASE: $30 copay

HAMP: $25 copay

   CCN: $20 copay

50% after deductible

  PLUS: $25 copay

HAMP: $20 copay

   CCN: $15 copay

50% after deductible
Specialist Office Visit Participating CCN Providers Non CCN Participating Providers

  BASE: $40 copay

HAMP: $35 copay

 

  BASE: $50 copay

HAMP: $45 copay

50% after deductible

  PLUS: $30 copay

HAMP: $25 copay

 

  PLUS: $40 copay

HAMP: $35 copay

50% after deductible
Preventive Care
100% coverage
50% after deductible
100% coverage
50% after deductible
Allergy Services (includes testing, serum and injections)

100% after $40 copay

150 doses per calendar year

50% after deductible
 
150 doses per calendar year
100% after $40 copay
 
150 doses per calendar year
50% after deductible
 
150 doses per calendar year
Maternity Care (coverage includes voluntary sterilization)
Payable as any other covered expense
Payable as any other covered expense
Payable as any other covered expense
Payable as any other covered expense
Diagnostic Laboratory & Radiology Services
100% coverage
50% after deductible

​100% coverage

50% after deductible
Complex Imaging / High Tech Radiology

90% after deductible

100% Coverage at eviCore Facilities

50% after deductiible

$100 copay

100% Coverage at eviCore Facilities

50% after deductiible
Rehabilitation, Speech, Occupational and Physical Therapy
100% after a $25 copay, up to 60 visits per calendar year*
50% after deductible, up to 60 visits per calendar year
100% after a $20 copay, up to 60 visits per calendar year*
50% after deductible, up to 60 visits per calendar year
Convenience Care Clinic

  BASE: $30 copay

HAMP: $25 copay

50% after deductible

  PLUS: $25 copay

HAMP: $20 copay

50% after deductible
Urgent Care Facility
100% after a $50 copay
50% after deductible
100% after a $50 copay
50% after deductible
Emergency Room
$300 copay; waived if confined, 80% after deductible if admitted
$300 copay; waived if confined, 50% after deductible if admitted
$300 copay; waived if confined
$300 copay; waived if confined, 50% after deductible if admitted
Outpatient Surgery
80% after deductible
50% after deductible

PLUS: 100% after $400 copay

HAMP: 100% after $200 copay

50% after deductible
Inpatient Services
80% after deductible
50% after deductible

  PLUS: $600 copay

HAMP: $300 copay

50% after deductible
Home Health Care 100 visits per calendar year
90% after deductible
50% after deductible
100% coverage
50% after deductible
Mental Health Outpatient Visits

  BASE: $40 copay

HAMP: $35 copay

50% after deductible

  PLUS: $30 copay

HAMP: $25 copay

50% after deductible
Mental Health Inpatient Services
80% after deductible
50% after deductible

  PLUS: $600 copay

HAMP: $300 copay

50% after deductible
Chemical Dependency Outpatient Visits

  BASE: $40 copay

HAMP: $35 copay

50% after deductible

  PLUS: $30 copay

HAMP: $25 copay

50% after deductible
Chemical Dependency Inpatient Services
80% after deductible
50% after deductible

  PLUS: $600 copay

HAMP: $300 copay

50% after deductible

* Maximums are a combined limit for in-network and out-of-network services.

 

Prescription Benefit in-network for all plans

  
  
  
  
Tier 1 - Generics25%$10$100
Tier 2 - Preferred Brands30%$50$300
Tier 3 - Non-Preferred Brands35%$100$500
  
  
  
  
Tier 1 - Generics25%$5$50
Tier 2 - Preferred Brands30%$25$150
Tier 3 - Non-Preferred Brands35%$50$250
Tier 4 - Specialty Medications30%$75$350
  
  
  
  
  
(888) 806-5042Medical
1
  
(713) 274-5500Medical
2
  
(866) 474-7475Medical
3

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