Health/Dental/Vision

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 Only

Office Visit Copay: $40
Urgent Care Facility Copay: $50
Annual Deductible: $500/$1,200 for all services not requiring a copayment and are hospital based
Out of Pocket Maximum: $3,350/$6,700
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: 80% reimbursement
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.