Health/Dental/Vision
CSHL offers 2 health plans through United Healthcare
- Choice Tiered Plan – see below for details
- Choice Plus Plan – see next tab for details
In Network Benefits Only
Office Visit Tier 1 Physician Copay: $20
Office Visit Non-Designated Physician Copay: $35
Urgent Care Facility Copay: $50
Annual Deductible: $400/$800 for all services not requiring a copayment and are hospital based
Coinsurance: Laboratory and Radiology Services: 5% coinsurance for services provided at a free-standing facility (deductible does not apply); 20% coinsurance after deductible for outpatient services performed in hospital based setting; Outpatient Surgery: 5% coinsurance for services provided at a free-standing facility (deductible does not apply); 5% coinsurance after $250 co-pay per occurrence for outpatient services performed in hospital based setting
Out of Pocket Maximum: $3,500/$7,000
Inpatient Hospital Coinsurance: 5% coinsurance – deductible does not apply
Emergency Room Copay: $150
Prescription Copay (Retail – 31 Day Supply): $10/$35/$55
Prescription Copay (Mail Order – 90 day Supply): $20/$70/$110
CSHL offers 2 health plans through United Healthcare
- Choice Tiered Plan – see previous tab for details
- Choice Plus Plan – see below for details
In Network Benefits
Office Visit Copay: $40
Urgent Care Facility Copay: $50
Annual Deductible: $600/$1,300 for all services not requiring a copayment
Coinsurance: 30% after deductible is met
Out of Pocket Maximum: $3,500/$7,000
Inpatient Hospital Copay: $1,000
Emergency Room Copay: $150
Prescription Copay (Retail – 31 Day Supply): $10/$35/$55
Prescription Copay (Mail Order – 90 day Supply): $20/$70/$110
Out of Network Benefits
Annual Deductible: $1,000/$2,400
Coinsurance: 30% after deductible is met
Out of Pocket Maximum: $5,000/$10,000
Prescription Copay (Retail – 31 Day Supply): $10/$35/$55
Prescription Copay (Mail Order – 90 day Supply): $20/$70/$110
EyeMed—Vision Carrier
Provides one annual routine eye exam ($10 copay) for all benefits eligible employees. Employee can also purchase additional coverage for eyeglasses and contact lenses.
Cigna—Dental Carrier
A choice between a Dental HMO (DHMO) or Dental PPO (DPPO) plan. Both plans cover similar services however there are two primary differences.
- DPPO members can use both participating and non-participating dentists, while DHMO members can only use participating DHMO dentists and must select a Primary Dentist prior to receiving services.
- DPPO members pay coinsurance for services, up to a calendar year maximum, while DHMO members pay fees based on a schedule of services and have unlimited benefits during a calendar year.