Choate House on the Pace Pleasantville campus

Network Core Plan

(January 1, 2021 through December 31, 2021)

The Network Core Plan offers in-network coverage only. That is to say that your provider must be contracted through the Cigna Open Access Plus network, which is a national network (in-network providers are available nation-wide).

The features of this plan include:

  • $30 co-payment to visit a Primary Care Physician, $50 to see a Specialist.
  • No referrals are needed.
  • In-network mental health and substance abuse outpatient visits are covered at the primary office visit copayment ($30). Previously, these services were covered at the specialist office visit copayment ($50).
  • The annual (calendar year) Out-of-Pocket Maximum is $2,000 for individual coverage and $4,000 for employee +1 and family coverage.
  • Preventive care exams (PDF) are covered at 100%.
  • No charge for in-network hospitalization.
  • $85 Emergency Room co-payment, which is waived if you (or a covered dependent) are admitted to the hospital.
  • In-network prescription co-payments of: $20 for generic medications, $45 for preferred brand medications, and $70 for non-preferred brand medications, after the calendar year deductible for non-generic prescriptions ($125 per person, $375 for +1 and family) has been satisfied. $0 co-payments for generic preventive medications on this list (PDF).
  • Please review the Cigna Value 3-Tier Prescription Drug List (PDF), especially the section entitled, “Medications That Are Not Covered” (beginning on Page 18).

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.