Coca-Cola will continue to offer you and your family the options of the Gold and Silver Plans.
Premiums
The charts below reflect the premiums for the Gold Plan and the Silver Plan.
| Gold Plan | ||
|---|---|---|
| Tier | Monthly | Weekly |
| Employee Only | $151.67 | $35.00 |
| Employee + 1 | $433.33 | $100.00 |
| Family | $498.33 | $115.00 |
| Silver Plan | ||
|---|---|---|
| Tier | Monthly | Weekly |
| Employee Only | $108.33 | $25.00 |
| Employee + 1 | $260.00 | $60.00 |
| Family | $325.00 | $75.00 |
Gold Plan
The chart below provides an overview of how the Gold Plan works and how each type of service is covered by the insurance plan. Refer to the Gold Plan benefit summary for more details.
| Benefit | In-Network | Out-of-Network |
|---|---|---|
| Plan Year Deductible | $1,000 Individual $2,000 Family | $3,000 Individual $6,000 Family |
| Out-of-Pocket Maximum | $5,000 Individual $10,000 Family | $6,000 Individual $12,000 Family |
| Office Visits (PCP) | $20 Copay per Visit | 40% Coinsurance after Deductible |
| Specialist Visits | $40 Copay per Visit | 40% Coinsurance after Deductible |
| Routine Physicals | No Charge | 40% Coinsurance after Deductible |
| Diagnostic Lab/X-Ray | No Charge | 40% Coinsurance after Deductible |
| Diagnostic Imaging (CT Scans, MRIs, PET Scans) | 20% Coinsurance after Deductible | 40% Coinsurance after Deductible |
| Inpatient Hospital | 20% Coinsurance after Deductible | 40% Coinsurance after Deductible |
| Outpatient Hospital | 20% Coinsurance after Deductible | 40% Coinsurance after Deductible |
| Urgent Care Visits | $30 Copay per Visit after Deductible | $30 Copay per Visit after deductible |
| Emergency Room Visits | $150 Copay per Visit (Waived if admitted) after Deductible | |
| Prescription Drugs | In-Network | Out-of-Network |
| Retail Pharmacy - 30 Day Supply | Generic - $15 Copay Preferred - $30 Copay Non-Preferred - $60 Copay | Not Covered |
| Mail Order - 90 Day Supply | Generic - $30 Copay Preferred - $60 Copay Non-Preferred - $150 Copay | Not Covered |
| Expanded Preventative Medications Pharmacy 2021 Generic Only Preventive Drug List | $5 Copay | Not Covered |
Opt-Out Medical Credit
- If you are enrolled in a Medical Plan elsewhere, you may be eligible to qualify for a $300 medical credit per quarter.
- When completing your enrollment in the Benefits Portal be prepared to upload proof of coverage documentation in order to receive the credit.
Silver Plan
The chart below provides an overview of how the Silver Plan works and how each type of service is covered by the insurance plan. Refer to the Silver Plan benefit summary for more details.
| Benefit | In-Network | Out-of-Network |
|---|---|---|
| Plan Year Deductible | $3,000 Individual $6,000 Family | $6,000 Individual $12,000 Family |
| Out-of-Pocket Maximum | $8,550 Individual $17,100 Family | $12,000 Individual $24,000 Family |
| Office Visits (PCP) | $30 Copay per Visit | 50% Coinsurance after Deductible |
| Specialist Visits | $60 Copay per Visit | 50% Coinsurance after Deductible |
| Routine Physicals | No Charge | 50% Coinsurance after Deductible |
| Diagnostic Lab/X-Ray | No Charge | 50% Coinsurance after Deductible |
| Diagnostic Imaging (CT Scans, MRIs, PET Scans) | 20% Coinsurance after Deductible | 50% Coinsurance after Deductible |
| Inpatient Hospital | 20% Coinsurance after Deductible | 50% Coinsurance after Deductible |
| Outpatient Hospital | 20% Coinsurance after Deductible | 50% Coinsurance after Deductible |
| Urgent Care Visits | $50 Copay per Visit after Deductible | $50 Copay per Visit after Deductible |
| Emergency Room Visits | $150 Copay per Visit (Waived if admitted) | |
| Prescription Drugs | In-Network | Out-of-Network |
| Retail Pharmacy 30 Day Supply | Generic - $20 Copay Preferred - $40 Copay Non-Preferred - $80 Copay | Not Covered |
| Mail Order 90 Day Supply | Generic - $40 Copay Preferred - $80 Copay Non-Preferred - $200 Copay | Not Covered |
| Expanded Preventative Medications Pharmacy 2021 Generic Only Preventive Drug List | $5 Copay | Not Covered |
Opt-Out Medical Credit
- If you are enrolled in a Medical Plan elsewhere, you may be eligible to qualify for a $300 medical credit per quarter.
- When completing your enrollment in the Benefits Portal be prepared to upload proof of coverage documentation in order to receive the credit.
SaveonSP Program
Specialty medications can cost a lot of money. That’s why your plan offers a program called SaveonSP, which can help lower your out-of-pocket costs to $0. And there’s no extra cost to participate.
Enroll in SaveonSP and save.
Certain specialty medications are eligible for the SaveonSP program. If you’re filling an eligible medication, a representative from SaveonSP will call you to talk about enrolling in the program.
If you choose to participate, you’ll pay $0 for your medication. If you choose not to participate in SaveonSP, you’ll pay a higher copay when you fill your medication.
Conditions supported by SaveonSP include, but are not limited to:
- Hepatits C
- Multiple Sclerosis
- Psoriasis
- Inflammatory Bowel Disease
- Rheumatoid Arthritis
- Oncology
Here’s an example of how it works.
John’s taking a specialty medication that’s eligible for the SaveonSP program. His copay is currently $70. His new copay will be $1,000.
- If he participates in SaveonSP, he won’t pay anything ($0) out-of-pocket. His full copay will be paid through a manufacturer copay assistance program, and the copay won’t count toward his deductible or out-of-pocket maximum.
- If he decides not to participate in SaveonSP, he’ll pay his full copay of $1,000 out-of-pocket. And the copay John pays won’t count toward his deductible or out-of-pocket maximum.
- SaveonSP is an Express Scripts program, and Express Scripts is now a Cigna company. SaveonSP, Express Scripts and Cigna are working together to better serve you and all of your pharmacy, health and wellness needs.
- The drug classes, medications and associated copays included in this program are subject to change. Check your plan materials to see which medications are eligible for the SaveonSP program.
Omada for Cigna
Omada is a digital lifestyle change program. It combines the latest technology with ongoing support so you can make the changes that matter most – whether that’s around eating, activity, sleep, or stress. It’s an approach shown to help you lose weight and reduce the risks of type 2 diabetes and heart disease.
- Eat Healthier – Learn the fundamentals of making smart food choices.
- Increase Activity – Discover easy ways to move more and boost your energy.
- Overcome Challenges – Gain skills that allow you to break barriers to change.
- Strengthen Habits – Zero in on what works for you, and find lasting motivation.
- Stay Healthy for Life – Continue to set and reach your goals with strategies and support.
More great news:
You’ll receive this program at no additional cost if you or your adult dependents are enrolled in the Coca-Cola Northeast medical plan offered through Cigna and are at risk for diabetes or heart disease, and are accepted into the program.
Take Omada’s 1 minute health screener to see if you’re eligible.
www.omadahealth.com/cokenortheast
The Omada program is administered by Omada Health, Inc. an independent third party service provider. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company or its affiliates. The Omada program is not administered by Cigna. It is administered solely by Omada Health, Inc. which is responsible for the program.