| Copay |
Primary Care Physician: $30 (Deductible waived)
Specialist Physician: $40 (Deductible waived) |
Cigna pays 50% |
| OfficeVisit |
Office Visit -
- Primary Care Physician: $30 copay (Deductible waived)
- Specialist Physician: $40 copay (Deductible waived)
|
Office Visit -
- Primary Care Physician: Cigna pays 50%
- Specialist Physician: Cigna pays 50%
|
| Deductible true |
Individual: $1,000, Family: $2,000 (All benefits listed are subject to the deductible unless otherwise noted) |
Individual: $2,000, Family: $4,000 (All benefits listed are subject to the deductible unless otherwise noted) |
| Coinsurance |
Cigna pays 70% of eligible charges |
Cigna pays 50% of eligible charges |
| Coinsurance Limit |
N/A |
N/A |
| Out-of-Pocket Maximum |
N/A |
N/A |
| Lifetime Maximum |
Unlimited |
Unlimited |
| Prescription Drugs |
Prescription Drugs -
- Prescription Drug Deductible (Combined Retail & Home Delivery Pharmacy, deductible only applies to Brand Name Drugs): $250 per member per year
- Retail Pharmacy -
- Generic: You pay $10 per 30-day supply
- Brand
|
Prescription Drugs -
- Prescription Drug Deductible (Combined Retail & Home Delivery Pharmacy, deductible only applies to Brand Name Drugs): $250 per member per year
- Retail Pharmacy -
- Generic: Cigna pays 50%
- Brand Name: Cigna pay
|
| Emergency Room |
Emergency & Urgent Care Services -
- Hospital Emergency Room ($100 Access Fee, waived if admitted): Cigna pays 70%
- Outpatient Professional Services (Including Radiology, Pathology and ER Physician): Cigna pays 70%
- Urgent Care Services: Ci
|
Emergency & Urgent Care Services -
- Hospital Emergency Room ($100 Access Fee, waived if admitted): Cigna pays the same level as in Network if "true" emergency as defined in your plan, otherwise Cigna pays 50%
- Outpatient Professional Services
|
| Adult Preventative Care |
Preventive Care for All Ages (Routine physicals and other routine preventive services): Cigna pays 100% (Deductible waived) |
Preventive Care for All Ages (Routine physicals and other routine preventive services): Cigna pays 50% |
| Child Preventative Care |
Preventive Care for All Ages (Routine physicals and other routine preventive services): Cigna pays 100% (Deductible waived) |
Preventive Care for All Ages (Routine physicals and other routine preventive services): Cigna pays 50% |
| Lab / X-Ray |
Lab, X-ray, and Ultrasound: Cigna pays 70%
CT/PET Scans and MRI: Cigna pays 70% |
Lab, X-ray, and Ultrasound: Cigna pays 50%
CT/PET Scans and MRI: Cigna pays 50% |
| Maternity |
Maternity,Inpatient Hospital Stay and Pre and Post Natal OBGYN Visits: 70% after deductible Infertility Services: Not covered |
Maternity,Inpatient Hospital Stay and Pre and Post Natal OBGYN Visits: 50% after deductible Infertility Services: Not covered |
| Physical Therapy |
Cardiac & Pulmonary Rehabilitation (Unlimited visits): Cigna pays 70%
Physical, Occupational, Speech Therapy and Spinal Manipulation (Calendar year maximum of 24 visits, combined in and out-of-network): Cigna pays 70% |
Cardiac & Pulmonary Rehabilitation (Unlimited visits): Cigna pays 50%
Physical, Occupational, Speech Therapy and Spinal Manipulation (Calendar year maximum of 24 visits, combined in and out-of-network): Cigna pays 50% |
| Home Health Care |
Home Health (Calendar year maximum of 30 visits, combined in and out-of-network): Cigna pays 70%
Hospice: Cigna pays 70% |
Home Health (Calendar year maximum of 30 visits, combined in and out-of-network): Cigna pays 50%
Hospice: Cigna pays 50% |
| Mental Health |
Inpatient (Includes Acute, Partial & Residential Treatment; Calendar year maximum of 30 days, combined in and out-of-network): Cigna pays 70%
Outpatient (Includes Individual, Group & Intensive Outpatient Treatment (Calendar year maximum of 20 vi |
Inpatient (Includes Acute, Partial & Residential Treatment; Calendar year maximum of 30 days, combined in and out-of-network): Cigna pays 50%
Outpatient (Includes Individual, Group & Intensive Outpatient Treatment (Calendar year maximum of 20 vi |
| Hospital Care |
Surgery (in any setting): Cigna pays 70%
Facility Services (Inpatient Room and Board, Pharmacy, Lab & X-ray, Operating Room, etc.): Cigna pays 70%
Physician Services: Cigna pays 70%
Outpatient Surgery: Cigna pays 70% |
Surgery (in any setting): Cigna pays 50%
Facility Services (Inpatient Room and Board, Pharmacy, Lab & X-ray, Operating Room, etc.): Cigna pays 50%
Physician Services: Cigna pays 50%
Outpatient Surgery: Cigna pays 50% |
