CIGNA 100/70 Plan

The CIGNA 100/70 plan, offers both in- and out-of-network coverage.

 

In-Network Benefits:

  • $10 co-payment to visit a Primary Care Physician or OB-GYN and a $15 co-payment to visit a Specialist.
     
  • No referrals are needed.
     
  • Preventive care examsare covered at 100%.
     
  • There is no charge for in-network hospitalization.
     
  • $75 Emergency Room in-network co-payment, which is waived if you (or a covered dependent) are admitted to the hospital.
     
  • In-network prescription co-payments of: $10 for generic medications, $25 for preferred brand medications, and $50 for non-preferred brand medications, after the calendar year deductible for non-generic prescriptions ($100 per person, $300 for employee +1 and family coverage) has been satisfied. Certain maintenance medications are available via mail order for 1 co-payment for a 90-day supply.

 

Out-of-Network Benefits:

  • The deductible is $1,000 for individual coverage and $2,000 for employee + 1 and family coverage.
     
  • After the (calendar year) deductible is met, all services are subject to 30% employee co-insurance, until the Out-of-Pocket Maximum is reached.
     
  • The annual (calendar year) Out-of-Pocket Maximum, which is based on UCR (usual, customary and reasonable) rates, is $2,500 for individual  coverage and $5,000 for employee + 1 and family coverage. For out-of-network providers, you may, in fact, pay more than the Out-of-Pocket Maximum if your provider charges rates that are above the UCR guidelines.
     
  • In most cases, for out-of-network services, employees pay in advance for services and submit a claim form to CIGNA Healthcare. All claim forms are located on the Human Resources web page under “Forms.”

 

CIGNA 100/70 Plan Summary

Per Paycheck Premiums (July 1, 2013 through June 30, 2014)

CIGNA 100/70 Plan Certificate of Coverage