March 20, 2010

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CIGNA – Health Savings 3000 – FLORIDA

A comparison of the Health Savings 3000 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 Health Savings 3000 Application Health Savings 3000 Application
Brochure Health Savings 3000 Brochure Health Savings 3000 Brochure
Copay N/A N/A
Office Visit Primary Care Physician/Specialist- CIGNA pays 100% after plan deductible Primary Care Physician/Specialist- CIGNA pays 60% after plan deductible
Deductible Individual: $3,000, Family: $6,000 Individual: $6,000, Family; $12,000
Coinsurance CIGNA pays 100% after plan deductible CIGNA pays 60% after plan deductible
Coinsurance Limit N/A N/A
Out-of-Pocket Maximum Individual: $3,000, Family: $6,000 Individual: $9,000, Family: $18,000
Lifetime Maximum $5,000,000 in- and out-of-network combined $5,000,000 in- and out-of-network combined
Prescription Drugs
  • Retail Pharmacy: 30-day supply:
    • Pharmacy Brand Name Calendar Year Maximum - $5,000 per member, per year
      • Generic/Preferred Brand Name/Non-Preferred Brand Name- CIGNA pays 100% after plan deductible
      • Self Injectables- CIGNA pays 100% after plan deductible
  • Mail Order Pharmacy: 90-day supply:
    • Pharmacy Brand Name Calendar Year Maximum - $5,000 per member, per year
      • Generic/Preferred Brand Name/Non-Preferred Brand Name- CIGNA pays 100% after plan deductible
      • Self Injectables- CIGNA pays 100% after plan deductible
    		•
  • Retail Pharmacy: 30-day supply
  • Pharmacy Brand Name Calendar Year Maximum - $5,000 per member, per year
    • Generic/Preferred Brand Name/Non-Preferred Brand Name- CIGNA pays 50% after plan deductible
    • Self Injectables- CIGNA pays 50% after plan deductible
  • Mail Order Pharmacy: 90-day supply
    • Not covered
    		•
    Emergency Room
  • Hospital Emergency Room- CIGNA pays 100% after plan deductible
  • Ambulance - CIGNA pays 100% after plan deductible (Maximum payment of $3,000 per calendar year, Emergency transport only)Urgent Care Services - CIGNA pays 100% after plan deductible
    		•
  • Hospital Emergency Room- CIGNA pays 100% after plan deductible if true emergency; otherwise CIGNA pays 60% after plan deductible
  • Ambulance- CIGNA pays 100% after plan deductible if true emergency; otherwise, CIGNA pays 60% after plan deductible (Maximum payment of $3,000 per calendar year, Emergency transport only)
  • Urgent Care Services- CIGNA pays 100% after plan deductible if true emergency; otherwise CIGNA pays 60% after plan deductible
    		•
    Adult Preventative Care
  • Adult Preventive Care (age 7 and up):
    • Office Visit, Lab work, Immunizations, Flu Shot - CIGNA pays 100% up to a maximum payment of $300 per member, per calendar year
    • Mammograms, Pap Smears, PSA, and Colorectal Cancer Screening - CIGNA pays 100%, plan deductible waived
    		•
  • Children Through Age 6:
    • Office Visit, Lab work, Routine screenings, Flu Shot -CIGNA pays 100% up to maximum payment of $300 per member, per calendar year
    • Immunizations- CIGNA pays 100%, plan deductible waived
    • Child Preventative Care
  • Children Through Age 6:
    • Office Visit, Lab work, Routine screenings, Flu Shot -CIGNA pays 100% up to maximum payment of $300 per member, per calendar year
    • Lab work, Routine screenings, Flu Shot- CIGNA pays 100% up to maximum payment of $300 per calendar year
    • Immunizations- CIGNA pays 100%, plan deductible waived
  • Children Through Age 6:
    • Office Visit, Lab work, Routine screenings, Flu Shot -CIGNA pays 100% up to maximum payment of $300 per member, per calendar year
    • Immunizations- CIGNA pays 100%, plan deductible waived
    • Lab / X-Ray CIGNA pays 100% after deductible CIGNA pays 60% after deductible
    Maternity Not covered Not covered
    Physical Therapy Physical Therapy, Speech Therapy (only for children with Developmental Delays and 3 years old or younger), & Occupational Therapy – After plan deductible, CIGNA pays a maximum payment of $40 per visit (24 total visits per member, per year, in- and out-of-network combined) Physical Therapy, Speech Therapy (only for children with Developmental Delays and 3 years old or younger), & Occupational Therapy – After plan deductible, CIGNA pays a maximum payment of $40 per visit (24 total visits per member, per year in and out-of-network combined)
    Skilled Nursing Skilled Nursing Facility - After plan deductible, CIGNA pays $400 maximum payment per day (100 day maximum per calendar year) Skilled Nursing Facility - After plan deductible, CIGNA pays $400 maximum payment per day (100 day maximum per member, per calendar year)
    Home Health Care Home Health Care - CIGNA pays 100% after plan deductible (Maximum of 60 days per member, per calendar year)
  • Hospice - CIGNA pays 100% after plan deductible (Lifetime Maximum payment of $15,000 per member)
    		•
  • Home Health Care - CIGNA pays 60% after plan deductible (Maximum of 60 days per member, per calendar year)
  • Hospice - CIGNA pays 60% after plan deductible (Lifetime Maximum payment of $15,000 per member)
    		•
    Mental Health
  • Inpatient - After plan deductible, CIGNA pays a $200 maximum payment per day, $3,000 maximum per year, in- and out-of-network combined
  • Outpatient - After plan deductible CIGNA pays $30 maximum per visit, 24 visit maximum per year for both inpatient and outpatient, in- and out-of-network combined
    		•
  • Inpatient - After plan deductible, CIGNA pays a $200 maximum payment per day, $3,000 maximum per year, in- and out-of-network combined
  • Outpatient - After plan deductible CIGNA pays $30 maximum per visit, 24 visit maximum per year for both inpatient and outpatient, in- and out-of-network combined
    		•
    Hospital Care Inpatient Hospital Services - CIGNA pays 100% after plan deductible Inpatient Hospital Services - CIGNA pays 60% after plan deductible
    Optional Benefits N/A N/A