CIGNA In-Net 50 Plan
This plan is only available to participants who were enrolled on June 30, 2013.
The CIGNA In-Net 50 plan offers in-network coverage only. That is to say that the provider must be contracted through the CIGNA Open Access Plus network, which is a national network (in-network providers are available nation-wide).
Features of this plan include:
$50 co-payment to visit a Primary Care Physician, OB-GYN, or Specialist.
No referrals are needed.
A $500 per day co-payment, to an annual maximum of $2,500, for hospitalization. Then, in-network hospitalization is covered at 100%.
$150 Emergency Room co-payment, which is waived if you (or a covered dependent) are admitted to the hospital.
$500 co-payment for outpatient surgery.
In-network prescription co-payments of: $15 for generic medications, $35 for preferred brand medications, and $75 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.
- An annual (calendar year) Out-of-Pocket Maximum of $5,000 for an individual and $10,000 for employee plus 1 or family coverage.
There is no coverage for out-of-network services. The only exception may apply for an emergency situation, in which the charges are specifically coded as such.
Per Paycheck Premiums (July 1, 2013 through June 30, 2014)