CIGNA 100/70 Plan
The CIGNA 100/70 plan, offers both in- and out-of-network coverage.
- $10 co-payment to visit a Primary Care Physician or OB-GYN and a $15 co-payment to visit a Specialist.
- No referrals are needed.
- The annual (calendar year) Out-of-Pocket Maximum is $1,750 for individual coverage and $3,500 for employee +1 and family coverage
- Preventive care exams are covered at 100%.
- There is no charge for in-network hospitalization.
- $75 Emergency Room in-network co-payment, which is waived if you (or a covered dependent) are admitted to the hospital.
- In-network prescription co-payments of: $10 for generic medications, $25 for preferred brand medications, and $50 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.
- The deductible is $1,000 for individual coverage and $2,000 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 UCR (usual, customary and reasonable) 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 UCR 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.”