March 20, 2010

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CIGNA – Health Savings 5000 – GEORGIA

A comparison of the Health Savings 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 Health Savings 5000 Application Health Savings 5000 Application
Brochure Health Savings 5000 Brochure Health Savings 5000 Brochure
Copay N/A N/A
Office Visit Primary Care Physician and Specialist: CIGNA pays 100% after deductible is fulfilled Primary Care Physician and Specialist: CIGNA pays 70% after deductible is fulfilled
Deductible Individual: $5,000, Family: $10,000 Individual: $10,000, Family: $20,000
Coinsurance CIGNA pays 100% of eligible charges CIGNA pays 70% of eligible charges
Coinsurance Limit N/A N/A
Out-of-Pocket Maximum Individual: $5,000, Family: $10,000 Individual: 15,000, Family: $30,000
Lifetime Maximum $5,000,000 per member $5,000,000 per member
Prescription Drugs Prescription Drugs (30-day supply):
  • Brand Name Prescription Drug Deductible (Per person, per year, in- and out-of-network combined, including Mail Order): Subject to integrated medical/pharmacy deductible
  • Generic: CIGNA pays 100%
  • Brand Name: CIGNA pays 100%
  • Non-Preferred Brand Name: CIGNA pays 100%
  • Self Injectables: CIGNA pays 100%
Mail Order Drugs (90-day supply):
  • Generic: CIGNA pays 100%
  • Brand Name: CIGNA pays 100%
  • Non-Preferred Brand Name: CIGNA pays 100%
  • Self Injectables: CIGNA pays 100%
 Prescription Drugs (30-day supply):
  • Brand Name Prescription Drug Deductible (Per person, per year, in- and out-of-network combined, including Mail Order): Subject to integrated medical/pharmacy deductible
  • Generic: CIGNA pays 100%
  • Brand Name: CIGNA pays 100%
  • Non-Preferred Brand Name: CIGNA pays 100%
  • Self Injectables: CIGNA pays 100%
Mail Order Drugs (90-day supply):
  • Generic: CIGNA pays 100%
  • Brand Name: CIGNA pays 100%
  • Non-Preferred Brand Name: CIGNA pays 100%
  • Self Injectables: CIGNA pays 100%
Emergency Room Hospital Emergency Room: CIGNA pays 100% after deductible is fulfilled Hospital Emergency Room: CIGNA pays 100% if true emergency, otherwise CIGNA pays 70% after deductible is fulfilled
Adult Preventative Care Adult Preventive Care (age 6 and older):
  • Office Visit: CIGNA pays 100%, deductible waived
  • Mammogram, PAP Smear, PSA, Colorectal Cancer Screening: CIGNA pays 100%, deductible waived
  • Routine Physicals ($300 maximum per member, per year): CIGNA pays 100%, deductible waived (includes immunizations, flu shots and lab work)
 Child preventive Care (through age 5):
  • Office Visit: CIGNA pays 70%, deductible waived
  • Immunizations/Lab work: CIGNA pays 70%, deductible waived
Child Preventative Care Child preventive Care (through age 5):
  • Office Visit: CIGNA pays 100%, deductible waived
  • Immunizations/Lab work: CIGNA pays 100%, deductible waived
 Child preventive Care (through age 5):
  • Office Visit: CIGNA pays 70%, deductible waived
  • Immunizations/Lab work: CIGNA pays 70%, deductible waived
Lab / X-Ray CIGNA pays 100% after deductible is fulfilled CIGNA pays 70% after deductible is fulfilled
Maternity Not covered (except for pregnancy complications) Not covered (except for pregnancy complications)
Physical Therapy CIGNA pays 100% after deductible is fulfilled (24 visit maximum per year, in- and out-of-network combined) CIGNA pays 70% after deductible is fulfilled (24 visit maximum per year, in- and out-of-network combined)
Skilled Nursing CIGNA pays 100% after deductible is fulfilled (30 day maximum per year for combined services, both in- and out-of-network) CIGNA pays 70% after deductible is fulfilled (30 day maximum per year for combined services, both in- and out-of-network)
Home Health Care CIGNA pays 100% after deductible is fulfilled (60 visit maximum per year, in- and out-of-network combined) CIGNA pays 70% after deductible is fulfilled (60 visit maximum per year, in- and out-of-network combined)
Mental Health
  • Inpatient: CIGNA pays 100% after deductible is fulfilled (30 day maximum per person, per year, in- and out-of-network combined)
  • Outpatient: CIGNA pays 100% after deductible is fulfilled (48 visit maximum per person, per year, in- and out-of-network combined)
  • Inpatient: CIGNA pays 70% after deductible is fulfilled (30 day maximum per person, per year, in- and out-of-network combined)
  • Outpatient: CIGNA pays 70% after deductible is fulfilled (48 visit maximum per person, per year, in- and out-of-network combined)
Hospital Care Inpatient Hospital Services: CIGNA pays 100% after deductible is fulfilled Inpatient Hospital Services: CIGNA pays 70% after deductible is fulfilled
Optional Benefits N/A N/A