March 12, 2010

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CIGNA – Open Access 2000 – TENNESSEE

A comparison of the Open Access 2000 offered by CIGNA is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Application Open Access 2000 Application Open Access 2000 Application
Brochure Open Access 2000 Brochure Open Access 2000 Brochure
Copay Primary Care Physician - $25, Specialist - $50 CIGNA pays 60% after deductible is fulfilled
Office Visit Primary Care Physician - $25, Specialist - $50 CIGNA pays 60% after deductible is fulfilled
Deductible Individual: $2,000, Family: $6,000 Individual: $4,000, Family: $12,000
Coinsurance CIGNA pays 80% after deductible is fulfilled CIGNA pays 60% after deductible is fulfilled
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 in- and out-of-network combined $5,000,000 in- and out-of-network combined
Prescription Drugs
  • Retail Pharmacy (per 30 day supply):
    • Brand Name Deductible - $100 per person, per calendar year
    • Generic/Preferred Brand Name/Non-preferred Brand Name - $10/$35/$60
    • Self Injectables - CIGNA pays 80% after deductible is fulfilled
  • Mail Order Pharmacy (per 90 day supply):
    • Brand Name Deductible - $100 per person, per calendar year
    • Generic/Preferred Brand Name/Non-preferred Brand Name - $25/$85/$150
    • Self Injectables - CIGNA pays 80% after deductible is fulfilled
  • Retail Pharmacy (per 30 day supply):
    • Brand Name Deductible - $100 per person, per calendar year
    • Generic/Preferred Brand Name/Non-preferred Brand Name - CIGNA pays 50% after deductible is fulfilled
    • Self Injectables - CIGNA pays 50% after deductible is fulfilled
  • Mail Order Pharmacy (per 90 day supply):
    • Generic/Preferred Brand Name/Non-preferred Brand Name - Not covered
    • Self Injectables - Not covered
  • Emergency Room
  • Hospital Emergency Room - $150 additional deductible (waived if admitted) CIGNA pays 80% after deductible is fulfilled
  • Ambulance - CIGNA pays 80% after deductible is fulfilled (Calendar year maximum of $5,000)
  • Urgent Care Services - $50, deductible waived
  • Hospital Emergency Room - $150 additional deductible (waived if admitted) CIGNA pays 60% after deductible is fulfilled
  • Ambulance - CIGNA pays 60%after deductible is fulfilled (Calendar year maximum of $5,000)
  • Urgent Care Services - CIGNA pays 60% after deductible is fulfilled
  • Adult Preventative Care
  • Adult Preventive Care (age 7 and up):
    • Routine Physicals - Office visits $25/$50
    • Immunizations, Flu shots, Labs - CIGNA pays 100% up to a maximum payment of $300 per year, per person
    • Mammogram, Pap Smear, PSA and Colonoscopy - CIGNA pays 100%, deductible waived
  • Children Through Age 6:
    • Office Visit - CIGNA pays 60% after deductible is fulfilled
    • Immunizations - CIGNA pays 60% after deductible is fulfilled
  • Child Preventative Care
  • Children Through Age 6:
    • Office Visit - $25 copay
    • Specialist - $50 copay
    • Immunizations - CIGNA pays 100%, deductible waived
  • Children Through Age 6:
    • Office Visit - CIGNA pays 60% after deductible is fulfilled
    • Immunizations - CIGNA pays 60% after deductible is fulfilled
  • Lab / X-Ray Lab, X-ray, Ultrasound, CT Scan and MRI - CIGNA pays 80% after deductible is fulfilled Lab, X-ray, Ultrasound, CT Scan and MRI - CIGNA pays 60% after deductible is fulfilled
    Maternity Not covered Not covered
    Physical Therapy
  • Physical/Occupational/Speech Therapy - CIGNA pays a maximum of $30 per visit after deductible, per person, up to 24 combined visits per year
  • Spinal Manipulation - $50
  • Physical/Occupational/Speech Therapy - CIGNA pays a maximum of $30 per visit after deductible, per person, up to 24 combined visits per year
  • Spinal Manipulation - CIGNA pays 60% after deductible is fulfilled
  • Skilled Nursing Skilled Nursing - CIGNA pays 80% up to a $400 per day maximum after deductible is fulfilled (60 day maximum per year, in- and out-of-network combined Skilled Nursing - CIGNA pays 60% up to a $400 per day maximum after deductible is fulfilled (60 day maximum per year, in- and out-of-network combined
    Home Health Care Home Health Care - CIGNA pays 80% after deductible is fulfilled Home Health Care - CIGNA pays 60% after deductible is fulfilled
    Mental Health
  • Inpatient - CIGNA pays 80% after deductible is fulfilled – ($2,500 maximum payment per person, per year, in- and out-of-network combined)
  • Outpatient - CIGNA pays 80% after deductible is fulfilled (20 visit maximum per year, in- and out-of-network combined)
  • Inpatient - CIGNA pays 60% after deductible is fulfilled ($2,500 maximum payment per person, per year, in- and out-of-network combined)
  • Outpatient - CIGNA pays 60% after deductible is fulfilled (20 visit maximum per year, in- and out-of-network combined)
  • Hospital Care Inpatient Hospital Services - CIGNA pays 80% after deductible is fulfilled Inpatient Hospital Services - CIGNA pays 60% after deductible is fulfilled
    Optional Benefits N/A N/A