March 19, 2010

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CIGNA – 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
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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):
  • Integrated medical/pharmacy deductible
  • Brand Name Calendar Year Maximum: $5,000 per insured
  • 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):
  • Integrated medical/pharmacy deductible
  • Brand Name Calendar Year Maximum: $5,000 per insured
  • Generic: CIGNA pays 50%
  • Brand Name: CIGNA pays 50%
  • Non-Preferred Brand Name: CIGNA pays 50%
  • Self Injectables: CIGNA pays 50%
Mail Order Drugs (90-day supply):
  • Generic: Not applicable
  • Brand Name: Not applicable
  • Non-Preferred Brand Name: Not applicable
  • Self Injectables: Not applicable
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):
  • Office Visit, Lab Work, Immunizations, Flu Shot: Deductible waived, CIGNA pays 100% up to a maximum payment of $200 per calendar year
  • Mammogram, Contraceptive Services & Devices, Pap Smear, PSA Screening and Colorectal Cancer Screening and the associated office visit: CIGNA pays 100% after deductible is fulfilled
Children (through age 3):
  • Office Visit, Flu Shot, Lab Work, Routine Screenings, Immunizations: CIGNA pays 70% after deductible is fulfilled
Child Preventative Care Children (through age 3):
  • Office Visit, Flu Shot, Lab Work, Routine Screenings, Immunizations: CIGNA pays 100%, deductible waived
Children (through age 3):
  • Office Visit, Flu Shot, Lab Work, Routine Screenings, Immunizations: CIGNA pays 70% after deductible is fulfilled
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
  • Inpatient: CIGNA pays 100% after deductible is fulfilled
  • Outpatient: CIGNA pays 100% after deductible is fulfilled
  • Inpatient: CIGNA pays 70% after deductible is fulfilled
  • Outpatient: CIGNA pays 70% after deductible is fulfilled
  • 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