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Safe, Secure & Absolutely FreeCIGNA – Health Savings 2500 – SOUTH CAROLINA
A comparison of the Health Savings 2500 offered by CIGNA is detailed out below for both Network and Non-Network coverage.
| Network | Non-Network | |
|---|---|---|
|
||
| Network | See Provider | See Provider |
| Application | Health Savings 2500 Application | Health Savings 2500 Application |
| Brochure | Health Savings 2500 Brochure | Health Savings 2500 Brochure |
| Copay | N/A | N/A |
| Office Visit | Primary Care Physician: CIGNA pays 100% after deductible is fulfilled, Specialist: CIGNA pays 100% after deductible is fulfilled | Primary Care Physician: CIGNA pays 70% after deductible is fulfilled, Specialist: CIGNA pays 70% after deductible is fulfilled |
| Deductible | Individual: $2,500, Family: $5,000 | Individual: $5,000, Family: $10,000 |
| Coinsurance | CIGNA pays 100% of eligible charges | CIGNA pays 70% of eligible charges |
| Coinsurance Limit | N/A | N/A |
| Out-of-Pocket Maximum | Individual: $2,500, Family: $5,000 | Individual: $5,000, Family: $10,000 |
| Lifetime Maximum | $5,000,000 per member | $5,000,000 per member |
| Prescription Drugs | Prescription Drugs (30-day supply):
|
Prescription Drugs (30-day supply):
|
| Emergency Room | Hospital Emergency Room: CIGNA pays 100% after deductible is fulfilled | Hospital Emergency Room: CIGNA pays 100% after deductible is fulfilled |
| Adult Preventative Care | Preventive Care (age 4 and older):
|
Children (through age 3):
|
| Child Preventative Care | Children (through age 3):
|
Children (through age 3):
|
| Lab / X-Ray | CIGNA pays 100% after deductible is fulfilled | CIGNA pays 70% after deductible is fulfilled |
| Maternity | Not Covered | Not Covered |
| Physical Therapy | Physical Therapy, and Occupational Therapy: After plan deductible, CIGNA pays a maximum of $40 per visit (24 visit maximum per year for combined services, both in- and out-of-network) | Physical Therapy, and Occupational Therapy: After plan deductible, CIGNA pays a maximum of $40 per visit (24 visit maximum per year for combined services, both in- and out-of-network) |
| Skilled Nursing | Skilled Nursing Facility, Rehabilitation Hospital and Sub-acute Facilities: After plan deductible CIGNA pays $400 maximum payment per day (100 day maximum per year for combined services, both in- and out-of-network) | Skilled Nursing Facility, Rehabilitation Hospital and Sub-acute Facilities: 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 | CIGNA pays 100% after deductible is fulfilled (80 visit maximum per year, in- and out-of-network combined | CIGNA pays 75% after deductible is fulfilled (80 visit maximum per year, in- and out-of-network combined |
| Mental Health | ||
| Hospital Care | In-Hospital Services (semi-private inpatient room and board, pharmacy, x-ray and laboratory, operating room, etc.): CIGNA pays 100% after deductible is fulfilled | In-Hospital Services (semi-private inpatient room and board, pharmacy, x-ray and laboratory, operating room, etc.): CIGNA pays 70% after deductible is fulfilled |
| Optional Benefits | Health Savings 2500 | Health Savings 2500 |