March 19, 2010

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CIGNA – Open Access Value 2500 – TEXAS

A comparison of the Open Access Value 2500 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 Open Access Value 2500 Application Open Access Value 2500 Application
Brochure Open Access Value 2500 Brochure Open Access Value 2500 Brochure
Copay Primary Care Physician: $40; Specialist: $60 CIGNA pays 50% after plan deductible
Office Visit Primary Care Physician: $40 copay, Specialist: $60 copay Primary Care Physician: CIGNA pays 50% after deductible is fulfilled, Specialist: CIGNA pays 50% after deductible is fulfilled
Deductible Individual: $2,500, Family: $5,000 Individual: $5,000, Family: $10,000
Coinsurance CIGNA pays 70% of eligible charges CIGNA pays 50% of eligible charges
Coinsurance Limit N/A N/A
Out-of-Pocket Maximum Individual: $5,000, Family: $10,000 Individual: $10,000, Family: $20,000
Lifetime Maximum $5,000,000 per member $5,000,000 per member
Prescription Drugs Brand Name Prescription Drug Deductible: $500 per member, per year (Does not apply to Generic) Pharmacy Brand Name Calendar Year Maximum - $3,000 per member per year Retail Pharmacy:
  • Generic/Preferred Brand Name/Non-preferred Brand Name: $20/$40/$75
  • Self Injectables: CIGNA pays 50% after plan deductible
  • Mail Order Pharmacy:
    • Generic/Preferred Brand Name/Non-Preferred Brand Name: $50/$100/$180
    • Self Injectables: CIGNA pays 50% after plan deductible
    		•  Brand Name Prescription Drug Deductible: $500 per member, per year (Does not apply to Generic) Pharmacy Brand Name Calendar Year Maximum - $3,000 per member per year Retail Pharmacy:
    • Generic/Preferred Brand Name/Non-preferred Brand Name: CIGNA pays 50% after plan deductible
    • Self Injectables: CIGNA pays 50% after plan deductible
  • Mail Order Pharmacy:
    • Generic/Preferred Brand Name/Non-preferred Brand Name: Not covered
    • Self Injectables: Not covered
    		•
    Emergency Room
  • Hospital Emergency Room (including radiology, pathology and ER physician and ancillary charges): CIGNA pays 70% after deductible is fulfilled ($200 additional deductible, waived if admitted)
  • Ambulance (Emergency transport only, Calendar year maximum CIGNA payment of $3,000): CIGNA pays 70% after deductible is fulfilled
    		•
  • Hospital Emergency Room (including radiology, pathology and ER physician and ancillary charges): CIGNA pays 70% if true emergency; otherwise, 50% after deductible is fulfilled ($200 additional deductible, waived if admitted)
  • Ambulance (Emergency transport only, Calendar year maximum CIGNA payment of $3,000): CIGNA pays 70% if true emergency; otherwise, CIGNA pays 50% after deductible is fulfilled
    		•
    Adult Preventative Care Adult Preventive Care (age 7 and older):
    • Primary Care Physician: $30
    • Specialist: $60
    • Mammogram, Pap Smear, PSA, Colorectal Cancer screening: CIGNA pays 70%, deductible waived
    • All other routine services (Calendar year maximum of $200 per member, combined in and out of network): CIGNA pays 70%, deductible waived
    		 Child Preventive Care (through age 6):
    • Office Visit: CIGNA pays 50% after deductible
    • Immunizations: CIGNA pays 100%, deductible waived
    • All other routine services (Calendar year maximum of $200 per member, combined in and out of network): CIGNA pays 50% after deductible
    Child Preventative Care Child Preventive Care (through age 6):
    • Primary Care Physician: $30
    • Specialist: $60
    • Immunizations: CIGNA pays 100%, deductible waived
    • All other routine services (Calendar year maximum of $200 per member, combined in and out of network): CIGNA pays 70%, deductible waived
    		 Child Preventive Care (through age 6):
    • Office Visit: CIGNA pays 50% after deductible
    • Immunizations: CIGNA pays 100%, deductible waived
    • All other routine services (Calendar year maximum of $200 per member, combined in and out of network): CIGNA pays 50% after deductible
    Lab / X-Ray CIGNA pays 70% after deductible is fulfilled CIGNA pays 50% after deductible is fulfilled
    Maternity Not Covered Not Covered
    Physical Therapy Short Term Rehabilitative Therapy (including Physical and Occupational Therapy): CIGNA pays a maximum $25 per visit after deductible is fulfilled (Calendar year maximum of 24 visits, in and out of network combined services) Short Term Rehabilitative Therapy (including Physical and Occupational Therapy): CIGNA pays a maximum $25 per visit after deductible is fulfilled (Calendar year maximum of 24 visits, in and out of network combined services)
    Skilled Nursing CIGNA pays maximum $400 per day after deductible is fulfilled (Calendar year maximum of 50 days, in and out of network combined services) CIGNA pays maximum $400 per day after deductible is fulfilled (Calendar year maximum of 50 days, in and out of network combined services)
    Home Health Care CIGNA pays 70% after deductible is fulfilled (Calendar year maximum of 60 days, combined in and out of network) CIGNA pays 50% after deductible is fulfilled (Calendar year maximum of 60 days, combined in and out of network)
    Mental Health
  • Inpatient: CIGNA pays maximum $200 per day after deductible is fulfilled (Neurological or other organic disease only; Lifetime maximum CIGNA payment of $3,000)
  • Outpatient: CIGNA pays maximum $30 per visit after deductible is fulfilled, one visit per day (Neurological or other organic disease only; Calendar year maximum of 24 days, combined in and out of network)
    		•
  • Inpatient: CIGNA pays maximum $200 per day after deductible is fulfilled (Neurological or other organic disease only; Lifetime maximum CIGNA payment of $3,000)
  • Outpatient: CIGNA pays maximum $30 per visit after deductible is fulfilled, one visit per day (Neurological or other organic disease only; Calendar year maximum of 24 days, combined in and out of network)
    		•
    Hospital Care Inpatient Hospital Facility Services
    • Semi Private Room and Board In-Hospital Care Services (inpatient room and board, pharmacy, x-ray and laboratory, operating room, etc.): CIGNA pays 70% after deductible is fulfilled
    		 Inpatient Hospital Facility Services
    • Semi Private Room and Board In-Hospital Care Services (inpatient room and board, pharmacy, x-ray and laboratory, operating room, etc.): CIGNA pays 50% after deductible is fulfilled
    Optional Benefits Open Access Value 2500 Open Access Value 2500