What you need to know
Nothing is more important than the health and wellness of our Solstice Employees. We offer a high-deductible health plan (HDHP) with the choice of two national medical plan networks.* Because of the importance of preventive care, in-network preventive care is covered at 100% with no deductible. You must meet an annual deductible before the plan begins to help cover the cost of all other care. The plan allows for out-of-network care, but you save money when you use in-network doctors and facilities. To help protect you in the case of a serious medical situation, the plan has an annual out-of-pocket maximum.
* Other networks and medical plan options are available, in some locations. Visit the Solstice Benefits Center to see your options.
Solstice HDHP at a glance
The table below shows what the medical plan covers. The coverage in the HDHP is the same whether you choose Cigna, Horizon Blue Cross Blue Shield, or Kaiser Permanente (only available in some locations).
| In-Network1 | Out-of-Network1 | |
|---|---|---|
| Annual deductible (Single / Family) | $1,700 / $3,4002 | $3,000 / $6,0002 |
| Preventive care | 100% with no deductible | Not covered |
| Office visits3 | 80% after deductible4 | 50% of allowable amount5 after deductible |
| Hospital stay | 80% after deductible | 50% of allowable amount5 after deductible |
| Emergency room | 80% after deductible | 80% of allowable amount5 after deductible |
| Prescription drugs6 | 80% after deductible | 50% of allowable amount5 after deductible |
| All other covered services | 80% after deductible | 50% of allowable amount5 after deductible |
| Annual out-of-pocket maximum7 (Single / Family) | If annualized base pay is $50,000 or less: $2,900 / $5,800 If annualized base pay is more than $50,000: $4,400 / $8,800 | $8,000 / $16,000 |
| Dependent coverage | Up to age 26 | Up to age 26 |
- Out-of-network expenses do not apply to the in-network deductible or in-network out-of-pocket maximum. Similarly, in-network expenses do not apply to the out-of-network deductible or out-of-network out-of-pocket maximum.
- If you are covering one or more dependents, the family deductible must be met before coinsurance begins.
- Office visits include both primary and specialty care. They also include mental health and substance abuse outpatient visits.
- For Cigna Staff participants, in-network primary care office visits outside the Cigna Staff model are covered at 70% after deductible.
- 110% of Medicare RBRVS.
- After the deductible is met, you pay the coinsurance, subject to a $200 maximum per prescription for retail and $400 maximum for a 90-day supply for mail order.
- The out-of-pocket maximum includes the annual deductible.
How the medical plan works
You pay nothing for preventive care.
In-network preventive care is covered at 100%, which includes some generic prescription drugs. You do not have to meet the deductible first.
Having annual physicals and getting the suggested screenings and vaccinations helps you maintain good health and identify potential health issues as soon as possible.
For all other services, you must meet your annual deductible before the plan helps cover the cost of your care.
This includes doctor visits, hospital stays, and prescription drugs.
If you are eligible and enroll, you can use your health savings account to help pay your out-of-pocket costs, including your deductible.
Once you meet your deductible, you and the plan share the cost of services through coinsurance.
You pay less when you visit in-network providers, because they provide services at lower negotiated rates, and the percentage of the coverage is greater.
After you reach the out-of-pocket maximum, the plan pays 100% of the cost of services for the rest of the year.
The annual deductible and the amount you pay out-of-pocket for coinsurance all count toward your out-of-pocket maximum.
Amounts appear in the chart above. For additional details, including which expenses count toward the out-of-pocket maximum, review the Summary Plan Description (SPD).
Networks
Each year during Annual Enrollment, you have the opportunity to choose the provider network you prefer for the following year.
It’s important to check regularly whether your doctor is in-network, because it can change throughout the year.
- Cigna
- Horizon Blue Cross Blue Shield
- Kaiser Permanente (only in some locations)
Cigna and Horizon participants who are looking for a new doctor are strongly encouraged to compare the cost and quality of providers across the country. It’s easy to do on Castlight. Note: You will need to register if you haven’t already.
There’s an app for that. Many of our benefits partners have mobile apps.
