Cigna
We chose PPO with Open Access
20% of doctor visits
20% of prescriptions but if you are on medication that you have to take daily then you have to go through Medco and buy it at 3 months at a time.
$400 deductible for in network per person not to exceed total of $1200/whole family. Then it's $600 deductible per person out of network, $1800 for whole family.
Hospitalization is 20% up to $4000 per person, not to exceed $18000 for family.
Dental is $2000 per year per person in network.
You can chose to have FSA, Flexible Spending Account. You chose the amount you want to deposit into this account, you are exempt from paying taxes on it as long as you use it. Any money remaining will go to the IRS. A certain amount is taken from your check weekly and you are issued a card to use like a credit card.
Medical Deductibles In-Network Out-of-Network
Individual $400.00 $600.00
Family $1,200.00 $1,800.00
Medical - Member's Coinsurance In-Network Out-of-Network
Office Visit 20% 40%
Inpatient Hospital 20% 40%
Outpatient Hospital 20% 40%
Emergency Room 20% 40%
Urgent Care Center 20% 40%
Ambulance 20% 20%
Cardiac Rehabilitation 20% 40%
Chiropractic Care 20% 40%
Durable Medical Equipment 20% 40%
External Prosthetic Appliances 20% 40%
Family Planning 20% 40%
Home Health Care 20% 40%
Immunizations 0%** 40%
Inpatient Professional Services 20% 40%
Advanced Radiological Imaging 20% 40%
Preventive Care 20% Does Not Apply
Routine Foot Care 20% 40%
Short Term Rehabilitation 20% 40%
Skilled Nursing Facility 20% 40%
** Fields that display zero as the Member's Coinsurance Percent indicate that CIGNA covers this service at 100%.
Out of network services are covered only up to your plan’s “maximum reimbursable charge”; you pay any amount above that maximum. For specific information on your costs, please see your plan materials or call Member Services at the toll-free number on your CIGNA HealthCare ID card ... or click on the Contacts link above. Participating providers charge a discounted rate for CIGNA members. If you use a non-network provider, the provider may bill you for the difference between the billed charge and the maximum reimbursable charge. You are also responsible for applicable deductibles and coinsurance amounts.
Medical Out-of-Pocket Maximums In-Network Out-of-Network
Individual $4,000.00 $6,000.00
Family $12,000.00 $18,000.00
Medical Benefit Maximums In-Network Out-of-Network
Chiropractic Care (Dollar Amount) $500 Per Calendar Year $500 Per Calendar Year
Durable Medical Equipment (Dollar Amount) Unlimited Unlimited
External Prosthetic Appliances (Dollar Amount) Unlimited Unlimited
Home Health Care (Days) Unlimited Unlimited
Preventive Care (Dollar Amount) $1000 Per Calendar Year Does Not Apply
Short Term Rehabilitation (Days) Unlimited Unlimited
Skilled Nursing Facility (Days) 60 Per Calendar Year 60 Per Calendar Year
Lifetime Maximum Unlimited Unlimited
Medical Authorizations In-Network Out-of-Network
Emergency Services Notification Hours 48 Hours 48 Hours
Inpatient Precertification Required Required
Outpatient Precertification Required Required
Continued Stay Review Required Required
Failure to Notify CIGNA Does Not Apply $300.00
Precertification Not Approved Does Not Apply 100%
