Benefit Program Plan Options
Medical Plan Overview
Ōnin Medical Benefits Plan Options
Basic Plan
This is a cost effective option that satisfies essential coverage for employees.
PPACA Plan
This affordable plan provides comprehensive health benefits and solutions.
Cigna PPO
Traditional PPO Plan
Ōnin will be providing three (3) medical plan options this year.
These plans are designed to offer a full range of different coverage options to our team so everyone can find one that best matches their needs.
Basic Plan
The Basic Plan meets the basic healthcare needs for the employee as well as satisfies the Minimum Essential Coverage mandate of the Patient Protection and Affordable Care Act for the employee. When the employee purchases the Basic Plan, the Affordable Care Act requirement for the employee’s individual insurance coverage mandate has been met. It should be noted that both the PPACA Plan and The Cigna PPO plan also fulfill this requirement, but the Basic Plan is designed to fulfill it in the most cost effective way possible.
PPACA Plan
The PPCA Plan is a health benefit plan that provides a comprehensive health coverage solution. The PPACA Plan provides these benefits on a level that most closely resembles a “Gold” Plan on the health exchanges, but it does so at a price point that is still affordable.
Cigna PPO
Cigna PPO – The Cigna PPO plan is a traditional preferred provider organization health benefit plan offering through the Cigna Network.
All employees will, by default, be positively enrolled into the PPACA Plan; this is being done to comply with the Affordable Care Act requirement. To change the selection, all that needs to be done is to sign into the employee benefit portal that will be provided by WH Administrators. PARTICIPATION IS COMPLETELY OPTIONAL. Employees do not need to purchase coverage; they can dis-enroll from the PPACA plan quickly and easily through the WH Administrator portal (there will also be a telephone based option to use as well).
Based on the employee selections in the portal during open enrollment, deductions for the plan selected by the employee will be done on a pretax basis, one month prior to coverage start date. The first deduction for the first month of coverage will be taken out in December.
There will be full training scheduled in the near future and support is available for both managers and employees to ensure enrollment runs smoothly.
Plan Details
| PPACA COMPLIANCE PLAN | BASIC PLAN | |
|---|---|---|
| Calender Year Deductible | $3,000 | No Deductible Plan is limited to Outpatient Services |
| Coinsurance Percentage | 80% | 80% |
| Out of Pocket Maximum | $6,500 per person | N/A |
| Base Accident Benefit | $300 | $300 |
| Base Well Care Benefit Including Immunizations | Unlimited, no co-pay or deductible | Unlimited, no co-pay or deductible |
| Primary Care Visits | 5 visits per year paid at 80%, additional visits subject to deductible and coinsurance | 6 visits per year paid at 80% additional visits are Not Coverd |
| Inpatient Hospital | 80% after Deductible | Not Covered |
| Surgery | 80% after Deductible | Not Covered |
| Physical, Speech and Occupational Therapy and Other Special Office Visits | 5 visits per calendar year, 100% after $40 copay; additional visits subject to deductible and coinsurance | Not Covered |
| Prescription Drugs | Retail: Tier 1 (Generics) 45% with $15 min Tier 2 (Formulary) 45% with $70 min Tier 3 (Formulary Non Preferred) 45% with $100 min Mail: |
Retail: Tier 1 (generics) $10 Tier 2 (Formulary) Not Covered Tier 3 (Formulary Non Preferred) Not Covered |
Cigna PPO Network Plan Details
| In Network | Out of Network | |
|---|---|---|
| Calender Year Deductible | $1,200/ Individual $3,600/ Family |
$2,400/Individual $7,200/ Family |
| Coinsurance Percentage | 80% | 60% |
| Out of Pocket Maximum | $6,000/Individual $12,000/ Family |
$12,000/Individual $24,000/ Family |
| Base Accident Benefit | $300 | $300 |
| Base Well Care Benefit Including Immunizations | Unlimited, no co-pay or deductible | 60% |
| Primary Care Visits | $20 | 60% |
| Inpatient Hospital | 80% | 60% |
| Surgery | 80% | 60% |
| Physical, Speech and Occupational Therapy and Other Special Office Visits | $40 copay | 60% |
| Prescription Drugs | Retail: Tier 1 (Generics) 25% with $10 min Tier 2 (Formulary) 25% with $40 min Tier 3 (formulary Non Preferred) 25% with $60 min Mail: |
Retail: Tier 1 (generics) 25% with $10 min Tier 2 (Formulary) 25% with $40 min Tier 3 (formulary Non Preferred) 25% with $60 min Mail: |
Reimbursement: Based off of Cigna Healthcare Network www.cigna.com
The Ōnin Group Corporate Office is located at:
1 Perimeter Park S, Suite 450 N Brimingham, AL 35243.
Phone: 866-581-6646