BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Medical Pharmaceuticals Inpatient Facility
80% after plan deductible
50% of the Maximum Reimbursable Charge after plan deductible In-Network coverage only
Cigna Pathwell Specialty Medical Pharmaceuticals
Cigna Pathwell Specialty Network provider: 80% after plan deductible Non-Cigna Pathwell Specialty Network Providers: Not Covered 80% after plan deductible
Other Medical Pharmaceuticals
50% of the Maximum Reimbursable Charge after plan deductible
Gene Therapy Includes prior authorized gene therapy products and services directly related to their administration, when Medically Necessary. Gene therapy must be received at an In- Network facility specifically contracted with Cigna to provide the specific gene therapy. Gene therapy at other In- Network facilities is not covered. Gene Therapy Product
Subject to In-Network facility cost share based on place of service; separate from facility charges
In-Network coverage only
Inpatient Facility Outpatient Facility Physician’s Services
80% after plan deductible 80% after plan deductible 80% after plan deductible
In-Network coverage only In-Network coverage only In-Network coverage only In-Network coverage only
Travel Maximum: $10,000 per episode of gene therapy
No charge after plan deductible (available only for travel when prior authorized to receive gene therapy at a participating In-Network facility specifically contracted with Cigna to provide the specific gene therapy)
myCigna.com
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