Cigna Nationwide Plan Highlights
| Nationwide Plans Highlights | |
|---|---|
| Cigna Open Access Plus (OAP) Traditional PPO Plan |
Cigna High Deductible Health Plan (HDHP) |
|
|
Cigna Medical Plans Summary
Below is a summary of the benefits included with Traditional OAP and HDHP plan options.
| Cigna Open Access Plus (OAP) Traditional PPO Plan | ||
|---|---|---|
| Plan Features | In-Network | Out-of-Network1,2 |
| Plan Deductible (Indiv./Fam.) | $750 per person; Not to exceed $2,250 per family |
|
| Out-of-pocket Maximum (Indiv./Fam.) | $3,000 per person; Not to exceed $6,000 per family |
$6,000 per person; Not to exceed $15,000 per family |
| Plan Coinsurance | 20% after deductible1 | $40% after deductible1 |
| Lifetime Maximum | Unlimited | |
| Office Visit |
$25 | 40% after deductible1 |
| Specialist Office Visit | $40 | 40% after deductible1 |
| Preventive Care Office Visit | No charge | 40% after deductible1 |
| Basic Lab & X-ray | 20% after deductible1 | 40% after deductible1 |
| Complex Lab & X-ray | 20% after deductible1 | 40% after deductible1 |
| Hospital Services | 20% after deductible1 | 40% after deductible1 |
| Emergency Room | $150 Copay per visit (waived if admitted) | |
| Prescription Drug (up to a 30 day supply) | ||
| Generic |
$15 copay | Not Covered |
| Preferred Brand |
$250 deductible, then $35 copay | Not Covered |
| Non Preferred brand |
$250 deductible, then $55 copay | Not Covered |
| Mail Order Pharmacy (up to a 90 day supply) |
2x copay | Not Covered |
1 In addition to dollar and percentage copays, you are responsible for deductibles, unless otherwise specified. Coverage applies after you’ve met the deductible and up to the covered expense limit. Charges that are considered covered expenses will apply toward satisfaction of a deductible except as specifically indicated in your summary plan description (SPD) booklet. For out-of-network services you are responsible for amounts billed over the covered expense. If there is any conflict between the information in this guide and the plan documents, the plan documents will govern.
2 Out-of-network payments are based on Cigna’s maximum reimbursable charge for non-Cigna hospitals and non-Cigna outpatient surgery centers.
The above information is provided for illustrative purposes only. Refer to the applicable carrier material for an exact description of plan benefits and conditions.
| Cigna High Deductible Health Plan (HDHP) | ||
|---|---|---|
| Plan Features | In-Network1,2 | Out-of-Network1,2 |
| Plan Deductible (Indiv./Fam.) | $1,600 per person when enrolled with employee-only coverage / $3,200 per person (this deductible applies if any dependents are enrolled) Not to exceed $4,500 per family |
|
| Out-of-pocket Maximum (Indiv./Fam.) | $4,000 per person / Not to exceed $8,000 per family |
$7,000 per person / Not to exceed $14,000 per family |
| Plan Coinsurance | 15% after deductible1 | $40% after deductible1 |
| Lifetime Maximum | Unlimited | |
| Office Visit |
15% after deductible1 | 40% after deductible1 |
| Preventive Care Office Visit | No charge | 40% after deductible1 |
| Specialist Office Visit | 15% after deductible1 | 40% after deductible1 |
| Basic Lab & X-ray | 15% after deductible1 | 40% after deductible1 |
| Complex Lab & X-ray | 15% after deductible1 | 40% after deductible1 |
| Hospital Services | 15% after deductible1 | 40% after deductible1 |
| Emergency Room | 15% after deductible1 | |
| Prescription Drug (up to a 30 day supply) | ||
| Generic |
15% after deductible1 | Not Covered |
| Preferred Brand |
15% after deductible1 | Not Covered |
| Non Preferred brand |
15% after deductible1 | Not Covered |
| Mail Order Pharmacy (up to a 90 day supply) |
15% after deductible1 | Not Covered |