March 21, 2010

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CIGNA – Health Savings 1500 – TENNESSEE

A comparison of the Health Savings 1500 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 1500 Application Health Savings 1500 Application
Brochure Health Savings 1500 Brochure Health Savings 1500 Brochure
Copay N/A N/A
Office Visit 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)
Deductible Individual: $1,500, Family: $3,000 Individual: $3,000, Family: $6,000
Coinsurance CIGNA pays 80% of eligible charges CIGNA pays 60% of eligible charges
Coinsurance Limit N/A N/A
Out-of-Pocket Maximum Individual: $3,000, Family: $6,000 Individual: $9,000, Family: $18,000
Lifetime Maximum $5,000,000 per member $5,000,000 per member
Prescription Drugs Prescription Drugs (30-day supply)
  • Generic/Brand Name/Non-Preferred Brand Name- you pay $10/$35/$60 (once the annual deductible amount is fulfilled by the member)
  • Self Injectables- CIGNA pays 70% (once the annual deductible amount is fulfilled by the member)
Mail Order Drugs (90-day supply)
  • Generic/Brand Name/Non-Preferred Brand Name- you pay $25/$85/$150 (once the annual deductible amount is fulfilled by the member)
  • Self Injectables- CIGNA pays 70% (once the annual deductible amount is fulfilled by the member)
 Prescription Drugs (30-day supply)
  • Generic/Brand Name/Non-Preferred Brand Name- CIGNA pays 50% (once the annual deductible amount is fulfilled by the member)
  • Self Injectables- CIGNA pays 50% (once the annual deductible amount is fulfilled by the member)
Mail Order Drugs (90-day supply)
  • Not applicable
Emergency Room CIGNA pays 80% (once the annual deductible amount is fulfilled by the member) CIGNA pays 80%, if true emergency; otherwise, CIGNA pays 60% (once the annual deductible amount is fulfilled by the member)
Adult Preventative Care Adult Preventive Care (age 16 and older)
  • Office Visit, Lab Work, Immunizations, Flu Shots - After plan deductible, CIGNA pays 100% up to a maximum payment of $300 per calendar year
  • PAP Smear, Bone Density Screening, PSA Screening - CIGNA pays 80% (once the annual deductible amount is fulfilled by the member)
  • Mammogram - CIGNA pays 100% deductible waived
 Child Preventive Care (to age 16)
  • Office Visit, Lab Work, Routine Screenings, Immunizations - CIGNA pays 60% deductible waived
Child Preventative Care Child Preventive Care (to age 16)
  • Office Visit, Lab Work, Routine Screenings, Immunizations - CIGNA pays 80% deductible waived
 Child Preventive Care (to age 16)
  • Office Visit, Lab Work, Routine Screenings, Immunizations - 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 CIGNA pays 80% (once the annual deductible amount is fulfilled by the member, 60 visits maximum per year, in- and out-of-network combined) CIGNA pays 60% (once the annual deductible amount is fulfilled by the member, 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 for 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 for 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