March 20, 2010

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CIGNA – Open Access 5000 – CONNECTICUT

A comparison of the Open Access 5000 offered by CIGNA is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application Open Access 5000 Application Open Access 5000 Application
Brochure Open Access 5000 Brochure Open Access 5000 Brochure
Copay Primary Care Physician - $30, Specialist - $60 CIGNA pays 60%
Office Visit Primary Care Physician - $30 copay (deductible waived), Specialist - $60 copay (deductible waived) CIGNA pays 60% (once the annual deductible amount is fulfilled by the member)
Deductible Individual: $5,000, Family: $10,000 Individual: $10,000, Family: $20,000
Coinsurance CIGNA pays 80% of eligible charges CIGNA pays 60% of eligible charges
Coinsurance Limit N/A N/A
Out-of-Pocket Maximum Individual: $5,000, Family: $10,000 Individual: $10,000, Family: $20,000
Lifetime Maximum $5,000,000 per member $5,000,000 per member
Prescription Drugs Retail Pharmacy (30-day supply):
  • Brand Name Deductible- $500 (combined in- and out-of-network )
  • Generic/Brand Name/Non-Preferred Brand Name- $10/$35/$60
  • Self Injectables - CIGNA pays 70%
Mail Order Pharmacy (90-day supply):
  • Generic/Brand Name/Non-Preferred Brand Name- $25/$85/$150
  • Self Injectables - CIGNA pays 70%
 Retail Pharmacy (30-day supply):
  • Brand Name Deductible- $500 (combined in- and out-of-network )
  • Generic/Brand Name/Non-Preferred Brand Name/Self Injectables - CIGNA pays 50%
Mail Order Pharmacy (90-day supply)
  • Not Applicable
Emergency Room $100 Additional Deductible, plan deductible then CIGNA pays 80% ($100 additional deductible waived if admitted) $100 Additional Deductible, plan deductible then CIGNA pays 80%, if true emergency; otherwise, CIGNA pays 60% ($100 additional deductible waived if admitted)
Adult Preventative Care Adult Preventive Care (age 16 and older):
  • Office Visit - $30/$60 copay
  • Lab Work, Immunizations, Flu Shot - CIGNA pays 100% up to a maximum payment of $300 per calendar year, deductible waived
  • PAP Smear, Bone Density Screening, PSA Screening - CIGNA pays 80%, after deductible
  • Mammogram - CIGNA pays 100% deductible waived
 Child Preventive Care (to age 16): CIGNA pays 60% deductible waived
Child Preventative Care Child Preventive Care (to age 16):
  • Office Visit - $30/$60 copay
  • Lab Work, Routine Screenings, Immunizations - CIGNA pays 80% deductible waived
 Child Preventive Care (to age 16): CIGNA pays 60% deductible waived
Lab / X-Ray CIGNA pays 80% (once the annual deductible amount is fulfilled by the member) CIGNA pays 60% (once the annual deductible amount is fulfilled by the member)
Maternity Not covered Not covered
Physical Therapy After plan deductible, CIGNA pays a maximum of $40 per visits for 24 visits per year – Physical, Occupational Therapy After plan deductible, CIGNA pays a maximum of $40 per visits for 24 visits per year – Physical, Occupational Therapy
Skilled Nursing After plan deductible CIGNA pays $400 maximum payment per day (100 day maximum per year for combined services, both in- and out-of-network) After plan deductible CIGNA pays $400 maximum payment per day (100 day maximum per year for combined services, both in- and out-of-network)
Home Health Care After plan deductible, CIGNA pays 80% (60 visits maximum per year, in- and out-of-network combined) After plan deductible, CIGNA pays 60% (60 visits maximum per year, in- and out-of-network combined)
Mental Health
  • Inpatient - After plan deductible CIGNA pays $200 maximum payment per day $3,000 maximum benefit per year, in- and out-of-network combined
  • Outpatient - After plan deductible CIGNA pays $30 maximum per visit 24 visit maximum per year in- and out-of-network combined
    		•
  • Inpatient - After plan deductible CIGNA pays $200 maximum payment per day $3,000 maximum benefit per year, in- and out-of-network combined
  • Outpatient - After plan deductible CIGNA pays $30 maximum per visit 24 visit maximum per year in- and out-of-network combined
    		•
    Hospital Care Inpatient Hospital Services- CIGNA pays 80% Facility charges, physician services and all in-hospital care (once the annual deductible amount is fulfilled by the member) Inpatient Hospital Services- CIGNA pays 60% Facility charges, physician services and all in-hospital care (once the annual deductible amount is fulfilled by the member)
    Optional Benefits N/A N/A