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, 2014 through June 30, 2015)
CIGNA In-Net 50 Plan Certificate of Coverage (COMING SOON!)