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Network Choice 90/70 Plan

The Network Choice 90/70 plan, offers both in- and out-of-network coverage. This plan introduces a deductible and coinsurance for both in- and out-of-network services.

In-Network Benefits

  • A regular office visit to a Primary Care Physician, Ob/Gyn or Specialist requires a $25 co-payment.
  • No referrals are needed.
  • Preventive care exams are covered at 100%.
  • All services beyond a regular office visit , including lab work performed at an in-network independent lab, is subject first to a $250 calendar year deductible for individual coverage, $500 calendar year deductible for employee + 1 and family coverage, then 10% member co-insurance. This includes lab work and x-ray s performed at an outpatient hospital facility, outpatient surgery, and inpatient hospitalization.
  • $80 Emergency Room co-payment, which is waived if you (or a covered dependent ) are admitted to the hospital.
  • The calendar year (in-network) Out-of-Pocket Maximum is $1,200 for an individual and $2,400 for employee + 1 and family coverage.
  • In-network prescription co-payments of: $15 for generic medications, $30 for preferred brand medications, and $55 for non-preferred brand medications, after the calendar year deductible for non-generic prescriptions ($125 per person, $375 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 calendar year deductible is $1,200 for individual coverage and $2,400 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 300% of Medicare 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 300% of Medicare 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."

Network Choice 90/70 Plan Summary

Per Paycheck Premiums (July 1, 2015 through June 30, 2016)

Network Choice 90/70 Plan Certificate of Coverage (COMING SOON!)