PTMA offers three comprehensive medical plan options from Cigna Healthcare designed to fit your health and financial needs. The differences between these plans comes down to how you share costs, your level of provider flexibility, and how each plan handles out-of-network care.
Whether you prefer a lower premium with a higher deductible, the simplicity of in-network care, or the freedom to see providers nationwide, Cigna has an option that works for you and your family. All plans include nationwide coverage, preventive care at no cost, and access to Cigna’s broad network of quality providers and wellness programs.
The plans available to you are:
With a High-Deductible Health Plan (HDHP) you get low monthly premiums and the ability to save for future healthcare expenses tax-free through a Health Savings Account (HSA).
The Smart Saver Plan puts you in control of your healthcare spending while still covering preventive care at no cost. It’s a great option if you want to build long-term savings.
This plan offers predictable costs and simplicity—just use doctors and hospitals in the Cigna network, and you’re covered. There’s no need to select a primary care provider or get referrals, but out-of-network care isn’t covered (except in emergencies).
The Essential Plan is ideal for those who want quality coverage and easy access to trusted in-network providers.
Have the freedom to choose any doctor or specialist—no referrals required. You’ll pay less when you stay within the Cigna network but still have coverage if you go out of network.
The Choice Plan offers flexibility and convenience for those who value choice and nationwide access to care.
Choosing the right medical plan is an important decision. The chart below makes it easier to compare your options side by side—showing key differences in coverage, costs, and how each plan works when you receive care. If you are looking for a provider, visit Where to Get Care.
*After CYD: The cost share you are responsible for after your calendar year deductible is met.
| In-Network Benefits | Smart Saver (HDHP) Plan | Essential (OAPIN) Plan | Choice (OAP) Plan |
|---|---|---|---|
| Deductible (per Member) | $3,400 | $3,000 | $1,000 |
| Deductible (Family Max) | $6,400 | $6,000 | $3,000 |
| Out-of-Pocket Maximum (per Member) | $3,400 | $6,000 | $3,000 |
| Out-of-Pocket Maximum (Family Max) | $6,400 | $12,000 | $9,000 |
| In-Network Benefits | Smart Saver (HDHP) Plan | Essential (OAPIN) Plan | Choice (OAP) Plan |
|---|---|---|---|
| MD Live Virtual Urgent Care | $0 | $0 | $0 |
| MD Live Virtual Specialty | $0 | $0 | $0 |
| MD Live Virtual Behavioral Health | $0 | $0 | $0 |
| Preventive Care | $0 | $0 | $0 |
| Primary Care Physican | $0 After CYD | $35 copay | $25 copay |
| Specialist | $0 After CYD | $75 copay | $50 copay |
| In-Network Benefits | Smart Saver (HDHP) Plan | Essential (OAPIN) Plan | Choice (OAP) Plan |
|---|---|---|---|
| Convenience Care Clinic | $0 After CYD | $35 copay | $25 copay |
| Urgent Care | $0 After CYD | $50 copay | $50 copay |
| Emergency Room | $0 After CYD | 30% Coinsurance After CYD | $500 copay |
| In-Network Benefits | Smart Saver (HDHP) Plan | Essential (OAPIN) Plan | Choice (OAP) Plan |
|---|---|---|---|
| Laboratory (Bloodwork) | $0 After CYD | $0 copay | $0 copay |
| Radiology (X-Ray) | $0 After CYD | $0 copay | $0 copay |
| Advanced Radiology (MRI, CAT, PET) | $0 After CYD | $300 copay | $200 copay |
| In-Network Benefits | Smart Saver (HDHP) Plan | Essential (OAPIN) Plan | Choice (OAP) Plan |
|---|---|---|---|
| Inpatient Hospital Stays | $0 After CYD | 30% Coinsurance After CYD | 20% Coinsurance After CYD |
| Outpatient Procedures - Facility | $0 After CYD | 30% Coinsurance After CYD | $500 copay |
| Outpatient Procedures - Physician/Surgeon Fees | $0 After CYD | 30% Coinsurance After CYD | $0 copay |
Your prescription drug coverage is included with your medical plan and helps make medications more affordable. Coverage is based on a formulary, or list of covered drugs, organized into cost tiers. Understanding how your plan covers prescriptions can help you and your provider choose the most effective and affordable options. For those who take maintenance medications for chronic conditions, using mail order delivery is a convenient way to receive a 90-day supply at a lower cost.
| In-Network Benefits | Smart Saver (HDHP) Plan | Essential (OAPIN) Plan | Choice (OAP) Plan |
|---|---|---|---|
| Tier 1 - Generic | $0 After CYD | $5 copay | $5 copay |
| Tier 2 - Preferred Brand | $0 After CYD | $50 copay | $40 copay |
| Tier 3 - Non-Preferred Brand | $0 After CYD | $95 copay | $90 copay |
| Tier 4 - Specialty | $0 After CYD | $400 copay | $350 copay |
| Mail Order Pharmacy (90-day supply) | $0 After CYD | 2.5x Retail | 2.5x Retail |
Cigna provides a variety of tools and resources to help you get the most from your health plan. From understanding your coverage to finding in-network providers and managing claims, Cigna’s member services make it easier to stay informed and in control of your healthcare.
You can access your personalized account anytime at myCigna.com or through the myCigna mobile app.
Cigna no longer automatically mails physical ID cards to members.
Instead, you have 24/7 access to your digital ID card through myCigna.com or the myCigna mobile app.
Your digital ID card is always up to date and easy to share with your provider or pharmacy—no printing or waiting for the mail. You can view, download, or email your card instantly whenever you need it.
If you prefer a physical card, you can request one at any time through your myCigna account.