| Copay |
N/A |
N/A |
| OfficeVisit |
Office Visit -
- Primary Care Physician: Cigna pays 80%
- Specialist Physician: Cigna pays 80%
|
Office Visit -
- Primary Care Physician: Cigna pays 60%
- Specialist Physician: Cigna pays 60%
|
| Deductible true |
Individual: $3,000, Family: $6,000 (All benefits listed are subject to the deductible unless otherwise noted) |
Individual: $3,000, Family: $6,000 (All benefits listed are subject to the deductible unless otherwise noted) |
| Coinsurance |
Cigna pays 80% of eligible charges |
Cigna pays 60% 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): $500 per member per year
- Retail Pharmacy -
- Generic: You pay $10 per 30-day supply
- Brand Nam
|
Prescription Drugs - - Prescription Drug Deductible (Combined Retail & Home Delivery Pharmacy, deductible only applies to Brand Name Drugs): $500 per member per year
- Retail Pharmacy -
- Generic: You pay 50%
- Brand Name: You pay 50%
|
| Emergency Room |
Emergency & Urgent Care Services -
- Hospital Emergency Room: Cigna pays 80%
- Outpatient Professional Services (Including Radiology, Pathology and ER Physician): Cigna pays 80%
- Urgent Care Services: Cigna pays 80%
- Ambulance: Cigna pay
|
Emergency & Urgent Care Services -
- Hospital Emergency Room: Cigna pays 80%
- Outpatient Professional Services (Including Radiology, Pathology and ER Physician): Cigna pays 80%
- Urgent Care Services: Cigna pays the same level as in Network
|
| 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 60% after deductible |
| 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 60% after deductible |
| Lab / X-Ray |
Lab, X-ray, Ultrasound: Cigna pays 80%
CT/PET Scans and MRI: Cigna pays 80% |
Lab, X-ray, Ultrasound: Cigna pays 60%
CT/PET Scans and MRI: Cigna pays 60% |
| Maternity |
Not Covered |
Not Covered |
| Physical Therapy |
Cardiac & Pulmonary Rehabilitation (Calendar year maximum of 36 visits, combined in and out-of-network): Cigna pays 80%
Physical and Occupational Therapy: Cigna pays maximum of $40 per visit |
Cardiac & Pulmonary Rehabilitation (Calendar year maximum of 36 visits combined in and out-of-network): Cigna pays 60%
Physical and Occupational Therapy: Cigna pays maximum of $40 per visit |
| Home Health Care |
Home Health (Calendar year maximum of 80 visits, combined in and out-of-network): Annual Deductible waived, $50 Home Health deductible applies then Cigna pays 80%
Hospice: Cigna pays 80% |
Home Health (Calendar year maximum of 80 visits, combined in and out-of-network): Annual Deductible waived, $50 Home Health deductible applies then Cigna pays 75%
Hospice: Cigna pays 60% |
| Mental Health |
Inpatient (Includes Acute, Partial & Residential Treatment): Cigna pays 80%
Outpatient (Includes Individual, Group & Intensive Outpatient Treatment): Cigna pays 80% |
Inpatient (Includes Acute, Partial & Residential Treatment): Cigna pays 60%
Outpatient (Includes Individual, Group & Intensive Outpatient Treatment): Cigna pays 60% |
| Hospital Care |
Surgery (in any setting): Cigna pays 80%
Facility Services (Inpatient Room and Board, Pharmacy, Lab & X-ray, Operating Room, etc.): Cigna pays 80%
Physician Services: Cigna pays 80%
Outpatient Surgery: Cigna pays 80% |
Surgery (in any setting): Cigna pays 60%
Facility Services (Inpatient Room and Board, Pharmacy, Lab & X-ray, Operating Room, etc.): Cigna pays 60%
Physician Services: Cigna pays 60%
Outpatient Surgery: Cigna pays 60% |
