BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Condition-Specific Care Physical Therapy Services Addresses spine, knee, hip, or shoulder pain, up to 5 visits, subject to Outpatient Physical Therapy maximum(s). To qualify, you must enroll in the Cigna Pathwell Bone & JointSM program and complete the program’s Welcome Assessment Outpatient Cardiac Rehabilitation Calendar Year Maximum: 36 days
No charge after plan deductible
In-Network coverage only
80% after plan deductible
50% of the Maximum Reimbursable Charge after plan deductible
Chiropractic Care Calendar Year Maximum: 20 days Physician’s Office Visit
80% after plan deductible
50% of the Maximum Reimbursable Charge after plan deductible
Home Health Care Services Calendar Year Maximum:
80% after plan deductible
50% of the Maximum Reimbursable Charge after plan deductible
120 days (includes outpatient private nursing when approved as Medically Necessary) Dialysis services in the home setting will not accumulate to the Home Health Care maximum (The limit is not applicable to Mental Health and Substance Use Disorder conditions.)
Hospice
Inpatient Services
80% after plan deductible
50% of the Maximum Reimbursable Charge after plan deductible 50% of the Maximum Reimbursable Charge after plan deductible
Outpatient Services
80% after plan deductible
(same coinsurance level as Home
Health Care Services)
myCigna.com
24
Made with FlippingBook Annual report