Employee Benefits

*These are In-Network Values	Cigna Open Access Plus  $500	Cigna- HDHP  (high deductible)
Deductible	$500/Person $1,000/Family	$1,600/Person $3,000/Family
Out-of-Pocket Max	$6,000/Person $12,000/Family	$4,000/Person $8,000/Family
Preventive Services	100% Coverage	100% Coverage
Office Visits	$50/office  $75/Urgent Care	20% AD
Hospital Service	Inpatient 20% AD Outpatient 20% AD	Inpatient 20% AD Outpatient 20% AD
Mental Health Services	Inpatient 20% AD Outpatient 20% AD	Inpatient 20% AD Outpatient 20% AD
Emergency Room	$250 Co-Pay	20% AD
Pharmacy Retail 30 Day Supply	Generic Preferred $15 Brand $45 Non-Preferred Brand $75	Generic Preferred $15 AD Brand $45 AD Non-Preferred Brand $95
Cost - Monthly	Employee Only $40.39  Two-Party $212.49 Family $269.34	Employee Only $16.68 Two-Party $150.44 Family $192.81
HealthJoy	Included	Included

$500 SBC
$500 Summary
$1,600 SBC
$1,600 Summary

Cigna Dental	Total DHMO	Total DPPO
Preventive	100% Coverage
Basic	Copay Schedule	20% AD
Major	Copay Schedule	50% AD
Orthodontics	No Coverage	50% - $1000 Lifetime Max
Annual Max	No Annual Max	$1,250/Person
Deductible	None	$50/Person $150/Family
Cost - Monthly	Employee Only $0.00 Two-Party $15.00 Family $20.00	Employee Only $10.00 Two-Party $40.00 Family $50.00
		For every consecutive year on the plan, each member will reveive increased maximums by the schedule outlines below. The annual maximum benefit for each member will never exceed $2,000.

Cigna DPPO

Cigna Vision	EyeMed– In Network
Exam	$10
Standard Lenses
Single	$10
Bifocal	$10
Trifocal	$10
Lenticular	$10
Frames	$120 allowance +20%
Contacts	$120 allowance
Cost– Monthly	Employee Only $4.54 Two-Party $7.98 Family $12.51

Flexible Spending (FSA) – NBS

FSA accounts are for those who enroll in the traditional medical plan coverage.

• FSA funds are used to pay for certain medical, dental, or vision expenses, including co-payments and deductibles with pre tax dollars
• Funds must be use by 12/31/2024 | otherwise funds will be forfeited.
• Medical flexible spending limit is $3,200.
• Dependent Care flexible spending limit depends on your federal tax filing status.
  • The limit is $5,000 if you are married and filing a joint return or if you are a single parent.
  • The limit is $2,500 if you are married and filing separately.
    
    

Health Savings Account (HSA) – Health Equity

HSA accounts are for those who enroll in the high deductible plan.

• HSA funds are used to pay for certain medical, dental, or vision expenses, including co-payments and deductibles with pre tax dollars.
• Funds roll over from year to year, and belong to account holder for life. 

HSA Contributions	Employee Max	Westminster's Max
Employee	$4,150	$500
Employee +	$8,300	$1,000
Employee 55+	Additional $1,000	–

*Westminster contribution is included in the employee’s max

View generally permitted medical and dental expenses.

Account Types

Westminster offers two different medical plans through Regence Blue Cross Blue Shield.

*These are In-Network Values	BCBS - Traditional	BCBS - HDHP (High Deductible)
Deductible	$500/Person $1,000/Family	$1,500/Person $3,000/Family
Out-of-Pocket Max	$6,000/Person $12,000/Family	$4,000/Person $6,000/Family
Preventive Services	100% Coverage	100% Coverage
Office Visits	$50  $65  $55	20% AD
Hospital Service	Inpatient 20% AD Outpatient 20% AD	Inpatient 20% AD Outpatient 20% AD
Mental Health Services	Inpatient 20% AD Outpatient 20% AD	Inpatient 20% AD Outpatient 20% AD
Emergency Room	$250 Co-Pay	20% AD
Pharmacy Retail 30 Day Supply	Generic Preferred $15 Brand $45 Non-Preferred $75	Generic Preferred $15 AD Brand $45 AD Non-Preferred $95 AD
Cost - Monthly	Employee Only $28.59 Two-Party $184.45 Family $241.14	Employee Only $4.68 Two-Party $121.81 Family $159.29

Pharmacy is included in the medical plan.

Dental Select	Gold Copay	Platinum Max Rewards
Preventive	100% Coverage
Basic	Copay Schedule	20% AD
Major	Copay Schedule	50% AD
Orthodontics	No Coverage	50% - $1000 Lifetime Max
Annual Max	No Annual Max	$1,250/Person
Deductible	None	$50/Person $150/Family
Cost - Monthly	Employee Only $0.00 Two-Party $15.00 Family $20.00	Employee Only $10.00 Two-Party $40.00 Family $50.00
		For every consecutive year on the plan, each member will reveive increased maximums by the schedule outlines below. The annual maximum benefit for each member will never exceed $2,000.

This plan is mainly for glasses and contacts. The plan covers the following services:

• A standard eye exam with a $10 co-pay once every 12 months
• Contact lenses allowance up to $120 once every 12 months
• Lenses covered at 100% once every 12 months
• Frames allowance up to $100 every 12 months

If you have a medical condition that involves eyes and vision, you will want to refer to your medical plan for coverage.

View the DentalSelect Vision Plan Summary for more information about the plan.

Account Types

Flexible Spending (FSA) – NBS

• Medical flexible spending limit is $3,050.
• Dependent Care flexible spending limit depends on your federal tax filing status.
  • The limit is $5,000 if you are married and filing a joint return or if you are a single parent.
  • The limit is $2,500 if you are married and filing separately.
• Commuter benefit parking arrangement limit is $300 per month.

Health Savings Account (HSA) – Health Equity

HSA funds are used to pay for certain medical, dental, or vision expenses, including co-payments and deductibles. View generally permitted medical and dental expenses.