| Copay |
Primary Care Physician: $40 (Deductible waived)
Specialist Physician: $60 (Deductible waived) |
Cigna pays 60% |
| OfficeVisit |
Office Visit -
- Primary Care Physician: $40 copay (Deductible waived)
- Specialist Physician: $60 copay (Deductible waived)
|
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): $250 per member per year
- Retail Pharmacy -
- Generic: You pay $10
- Brand Name: You pay $3
|
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 p
|
| Emergency Room |
Emergency & Urgent Care Services -
- Hospital Emergency Room ($100 additional Deductible, waived if admitted): Cigna pays 80%
- Outpatient Professional Services (Including Radiology, Pathology and ER Physician): Cigna pays 80%
- Urgent Care S
|
Emergency & Urgent Care Services -
- Hospital Emergency Room ($100 additional deductible, waived if admitted): Cigna pays the same level as in Network if "true" emergency as defined in your plan, otherwise Cigna pays 60%
- Outpatient Professiona
|
| 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% |
| 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% |
| Lab / X-Ray |
Lab, X-ray -
- Physician's Office: Cigna pays 100% to a maximum of $200 per year, combined with services provided at Independent/Lab X-Ray Facility THEN 80% After Deductible
- Independent/Lab X-ray Facility: Cigna pays 100% to a maximum of $20
|
Lab, X-ray -
- Physician's Office: Cigna pays 60%
- Independent/Lab X-ray Facility: Cigna pays 60%
Ultrasound, 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, Occupational and Chiropractic Therapy: Cigna pays a maximum of $40 per visit |
Cardiac & Pulmonary Rehabilitation (Calendar year maximum of 36 visits, combined in and out-of-network): Cigna pays 60%
Physical, Occupational and Chiropractic Therapy: Cigna pays a maximum of $40 per visit |
| Home Health Care |
Home Health (Calendar year maximum of 60 visits, combined in and out-of-network): Cigna pays 80%
Hospice: Cigna pays 80% |
Home Health (Calendar year maximum of 60 visits, combined in and out-of-network): Cigna pays 60%
Hospice: Cigna pays 60% |
| Mental Health |
Inpatient (Includes Acute, Partial & Residential Treatment): Cigna pays up to a maximum of $200 per day
Outpatient (Includes Individual, Group & Intensive Outpatient Treatment): Cigna pays maximum of $30 per visit |
Inpatient (Includes Acute, Partial & Residential Treatment): Cigna pays up to a maximum of $200 per day
Outpatient (Includes Individual, Group & Intensive Outpatient Treatment): Cigna pays maximum of $30 per visit |
| 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% |
