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.
- 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.
- 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."
Per Paycheck Premiums (July 1, 2015 through June 30, 2016)
Network Choice 90/70 Plan Certificate of Coverage (COMING SOON!)