USD offers several medical plan options that are designed to provide quality care for you and your family:
Before you choose your medical plan, it’s important to understand the differences between Health Maintenance Organizations (HMOs) and Consumer Driven Health Plans (CDHPs).
| What is unique about an HMO? | What is unique about the CDHP? |
|---|---|
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HMO plans provide coverage through in-network doctors. You need to select a primary care physician (PCP) who then refers you to specialists if you need them. You are responsible for copays when you receive most services.
Coverage for out-of-network providers is not available with these plans. If you seek non-emergency treatment from an out-of-network provider, you will be responsible for the full cost of services.
Starting or growing your family is exciting, but it is not always easy. Our medical plans include coverage for the diagnosis and treatment of infertility. For additional plan details, please review the Summaries of Benefits and Coverage (SBCs) and other Medical plan documents on the MySanDiego portal Employee Resources tab.
| 2025 Plan Features | Cigna HMO1 | Kaiser Permanente HMO1 | SIMNSA HMO2 |
|---|---|---|---|
| You pay: | You pay: | You pay: | |
| Annual Deductible | None | None | None |
| Annual Out-of-Pocket Maximum | $1,500/individual $3,000/family | $1,500/individual $3,000/family | $6,350/individual $12,700/family |
| Lifetime Maximum | Unlimited | Unlimited | Unlimited |
| Preventive Care | No charge | No charge | No charge |
| PCP Office Visit | $30 copay | $30 copay | $7 copay |
| Telemedicine Visit | $30 copay | No charge | $7 copay |
| Specialist Office Visit | $40 copay | $40 copay | $7 copay |
| Diagnostic Lab & X-ray | No charge | No charge | No charge |
| Complex Imaging (CT/PET Scans, MRI) | $100 copay per type of scan/day | No charge | No charge (Preauthorization is required for certain services) |
| Urgent Care | $25 copay | $30 copay | In-network: $25 copay Outside Mexico: $50 copay |
| Emergency Room (copay waived if admitted) | $150 copay per visit | $150 copay per visit |
In-network: $250 copay per visit |
| Inpatient Hospital Services | $250 copay per admission | $250 copay per admission | No charge |
| Outpatient Mental Health Services | $30 copay | Individual: $30 copay Group: $15 copay | $7 copay |
| Inpatient Mental Health Services | $250 copay per admission | $250 copay per admission | No charge |
| Chiropractic | $30 copay (Unlimited visits) | $15 copay (Up to 30 visits/year) | Not covered |
| Child Eye Exams (Contact lens exams not covered) | Not covered | No charge | $7 copay |
1Available to employees in California only.
2Services in Mexico only. You must be a Mexican National in order to enroll in this plan, which means 1. A person born in Mexico; 2. A person born in another country with a Mexican mother, father, or both; 3. A person who marries someone from Mexico and lives in Mexico; or 4. A foreigner who becomes naturalized in Mexico. Contact the Benefits team for more details.
If you enroll in the CDHP, you pay the full cost of eligible services (including prescriptions) until you reach the deductible. Once you reach the deductible, eligible services are coinsurance-based (you pay a percentage of the cost) until you reach the out-of-pocket maximum. There is some out-of-network coverage, but you will often pay more than if you stay in-network.
You aren’t required to choose a PCP like you do under HMO plan(s), and referrals are often not required to see specialists.
You may also have the option to participate in a Health Savings Account (HSA). See the HSA section for more details.
Starting or growing your family is exciting, but it is not always easy. Our medical plans include coverage for the diagnosis and treatment of infertility. For additional plan details, please review the Summaries of Benefits and Coverage (SBCs) and other Medical plan documents on the MySanDiego portal Employee Resources tab.
| Plan Features | Cigna CDHP with HSA | |
|---|---|---|
| In-Network | Out-of-Network | |
| Annual HSA Contribution from USD | $500/individual; $1,000/family | |
| You pay: | You pay: | |
| Annual Deductible | $1,700/person $3,400/individual in a family $3,400/family1 |
$2,800/person $5,600/family1 |
| Annual Out-of-Pocket Maximum2 | $3,400/person $3,400/individual in a family $6,800/family1 |
$5,400/person $5,600/individual in a family $10,800/family1 |
| PCP Office Visit | 20% after deductible | 40% after deductible |
| Telemedicine Visit | 20% after deductible | Not covered |
| Specialist Office Visit | 20% after deductible | 40% after deductible |
| Diagnostic Lab & X Ray | 20% after deductible | 40% after deductible |
| Complex Imaging3 (CT, PET, MRI) | 20% after deductible | 40% after deductible |
| Physical, Occupational, and Speech Therapy and Chiropractic Care | 20% after deductible | 40% after deductible |
| Inpatient Hospital Services | 20% after deductible | 40% after deductible |
| Emergency Room | 20% after deductible | 20% after deductible |
| Urgent Care | 20% after deductible | 20% after deductible |
| Inpatient Mental Health | 20% after deductible | 40% after deductible |
| Outpatient Mental Health | 20% after deductible | 40% after deductible |
1IEach enrolled family member must meet their ownindividual in a family deductible and out-of-pocket maximum until the total amount of deductible and out-of-pocket expenses paid by all family members meets the family deductible and out-of-pocket maximum.
2This is the most you will pay for care in a single plan year. After this amount is reached, the insurance carrier pays the remaining costs at 100%. The Affordable Care Act (ACA) prohibits insurance companies from setting yearly or lifetime limits on what they will pay for essential health benefits (unlimited lifetime maximum).
3Precertification is required for certain services. Reference official plan documents for details.
4Up to 60 visits combined. No more than 20 visits can be for chiropractic care.
When you enroll in one of USD’s medical plan options, you’ll receive prescription drug coverage based on that plan.
| Prescription Type | Cigna HMO (CA Employees Only) |
Kaiser Permanente HMO (CA Employees Only) |
SIMNSA HMO | Cigna CDHP with HSA1 |
|---|---|---|---|---|
| Prescription Drugs: Retail (in-network) Up to a 30-day supply | ||||
| Generic | $15 copay | $15 copay | $10 copay | 30% after deductible, up to $250 max |
| Brand Formulary | $35 copay | $35 copay | 40% after deductible, up to $250 max | |
| Non-Formulary2 | $60 copay | N/A | 50% after deductible, up to $250 max | |
| Specialty | 20%, up to $80 max | 30%, up to $150 max | 50% after deductible, up to $250 max | |
| Prescription Drugs: Mail Order (in-network) Up to a 90-day supply (Kaiser: 100-day mail order supply) | ||||
| Generic | $30 copay | $30 copay | N/A | 30% after deductible, up to $750 max |
| Brand Formulary | $70 copay | $70 copay | 40% after deductible, up to $750 max | |
| Non-Formulary | $120 copay | N/A | 50% after deductible, up to $750 max | |
1Some prescription medications used to prevent any of the following medical conditions are not subject to the individual and/or family plan deductible: hypertension, high cholesterol, diabetes, asthma, osteoporosis, stroke, prenatal nutrient deficiency.
2If the non-formulary prescription is determined medically necessary by the provider and approved by Kaiser, the member will be charged the appropriate brand formulary copay.
When possible, save money by going generic. Many prescription drugs have generic counterparts with the same active ingredients. These generic versions cost less out-of-pocket.
If you need more than a single fill, consider a mail order option. Mail order prescriptions offer you a 3-month supply for the cost of 2 months, which saves you money.
In addition to mail order, Cigna members can get a 90-day supply of maintenance medications at participating pharmacies.
Kaiser members can go to www.kp.org/pharmacy or call the number on your prescription label to have prescriptions shipped at no extra charge.
This page gives a brief overview of USD’s medical plans. For additional plan details, please review the Summaries of Benefits and Coverage (SBCs) and other Medical plan documents on the MySanDiego portal Employee Resources tab.