Entegris offers three Cigna Medical Plan choices to keep you and your family healthy—two High Deductible Health Plans (HDHPs) with a Health Savings Account (HSA) and one Preferred Provider Option (PPO).
Each plan includes:
Making the Most of Your Plan
No matter which plan you choose, keep these key tips in mind to get the best value from your medical coverage:
Resources
Access your medical plan documents on the resources page.
Review the tabs below to compare your coverage options, out-of-pocket limits, and current plan rates.
|
Medical Plan Features |
HDHP Option 1 |
HDHP Option 2 |
PPO Plan |
|
|---|---|---|---|---|
|
Entegris Annual Contribution to HSA |
$500 / $1,000 |
$500 / $1,000 |
Not applicable |
|
|
You Pay |
||||
|
Annual Deductible (Individual / Family) |
$4,000 / $8,000 |
$2,500 / $5,000 |
$1,000 / $3,000 |
|
|
Annual Out-of-Pocket Maximum |
$8,000 / $16,000 Embedded |
$5,000 / $10,000 |
$3,000 / $9,000 |
|
|
Preventive Well-Child Care |
$0 |
$0 |
$0 |
|
|
Preventive Routine Adult Exam |
$0 |
$0 |
$0 |
|
|
Physician’s Office Visits |
20%2 |
20%2 |
$25 copay/$50 copay; |
|
|
Chiropractor Office Visits |
20%2 |
20%2 |
$50 copay; |
|
|
Durable Medical Equipment |
20%2 |
20%2 |
20%2 |
|
|
Inpatient Hospital Services |
20%2 |
20%2 |
20%2 |
|
|
Outpatient Hospital Services |
20%2 |
20%2 |
20%2 |
|
|
Urgent Care |
20%2 |
20%2 |
$50 copay; |
|
|
Emergency Room |
20%2 |
20%2 |
$200 copay; |
|
|
Pharmacy |
Retail & Mail Order |
Retail & Mail Order |
Retail |
|
|
Generic |
25%2 |
25%2 |
$10 copay; |
|
|
Brand Preferred |
35%2 |
35%2 |
$30 copay; |
|
|
Brand Non-Preferred |
45%2 |
45%2 |
$60 copay; |
|
|
Specialty4 |
Brand Preferred: |
Brand Preferred: |
$150 copay; |
|
1. Out-of-Network coverage is also available. Please refer to the plan booklets for additional details
2. After deductible
3. 90-day supply of maintenance medications available at select in-network retail pharmacies
4. For all plans, specialty prescriptions are filled through ESI’s specialty pharmacy (Accredo); 30-day supply
