BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Medical Pharmaceuticals Inpatient Facility
80% after plan deductible
50% of the Maximum Reimbursable Charge after plan deductible
Cigna Pathwell Specialty Medical Pharmaceuticals
Cigna Pathwell Specialty Network provider: 80% after plan deductible Non-Cigna Pathwell Specialty Network Providers: Not Covered
In-Network coverage only
Other Medical Pharmaceuticals
80% after plan deductible
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 (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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