Cigna Nationwide Plan Highlights
| Nationwide Plans Highlights | |
|---|---|
| Cigna Open Access Plus (OAP) Traditional PPO Plan |
Cigna High Deductible Health Plan (HDHP) |
|
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Cigna Medical Plans Summary
Below is a summary of the benefits included with Traditional OAP and HDHP plan options.
| Cigna Open Access Plus (OAP) Traditional PPO Plan | ||
|---|---|---|
| Plan Features | In-Network | Out-of-Network |
| Plan Deductible (Indiv./Fam.) | $750 per person; Not to exceed $2,250 per family |
|
| Out-of-pocket Maximum (Indiv./Fam.) | $3,250 per person; Not to exceed $7,750 per family |
$6,000 per person; Not to exceed $15,000 per family |
| Plan Coinsurance | 20% after deductible | $40% after deductible |
| Lifetime Maximum | Unlimited | |
| Office Visit |
$40 Copay | 40% after deductible |
| Preventive Care Office Visit | No charge | 40% after deductible |
| Specialist Office Visit | $60 Copay | 40% after deductible |
| Basic Lab & X-ray | 20% after deductible | 40% after deductible |
| Complex Lab & X-ray | 20% after deductible | 40% after deductible |
| Hospital Services | 20% after deductible | 40% after deductible |
| Emergency Room | $150 Copay per visit (waived upon admission) | |
| Prescription Drug (up to a 30 day supply) | ||
| Deductible | $250 | |
| Generic / Brand / Non-Formulary |
$15 / $35 / $ 55 | Not Covered |
| Mail Order Pharmacy (up to a 90 day supply) |
$30 / $70 / $110 | Not Covered |
| Cigna High Deductible Health Plan (HDHP) | ||
|---|---|---|
| Plan Features | In-Network | Out-of-Network |
| Plan Deductible (Indiv./Fam.) | $3,000 per person; Not to exceed $5,000 per family |
|
| Out-of-pocket Maximum (Indiv./Fam.) | $5,200 per person / Not to exceed $10,000 per family (deductible included) | $7,000 per person / Not to exceed $14,000 per family (deductible included) |
| Plan Coinsurance | 10% after deductible | $40% after deductible |
| Lifetime Maximum | Unlimited | |
| Office Visit |
10% after deductible | 40% after deductible |
| Preventive Care Office Visit | No charge | 40% after deductible |
| Specialist Office Visit | 10% after deductible | 40% after deductible |
| Basic Lab & X-ray | 10% after deductible | 40% after deductible |
| Complex Lab & X-ray | 10% after deductible | 40% after deductible |
| Hospital Services | 10% after deductible | 40% after deductible |
| Emergency Room | 10% after deductible | |
| Prescription Drug (up to a 30 day supply) | ||
| Deductible Generic / Brand / Non-Formulary Mail Order Pharmacy (up to a 90 day supply) |
Plan deductible applies then member pays 20% until plan Out of Pocket Maximum is met. |
Not Covered |