BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Durable Medical Equipment Calendar Year Maximum: Unlimited . Outpatient Dialysis Services Physician's Office Visit
80% after plan deductible
50% of the Maximum Reimbursable Charge after plan deductible
No charge after the $30 PCP or $40 Specialist per office visit copay
50% of the Maximum Reimbursable Charge after plan deductible 50% of the Maximum Reimbursable Charge after plan deductible 50% of the Maximum Reimbursable Charge after plan deductible 50% of the Maximum Reimbursable Charge after plan deductible
Outpatient Facility Services
80% after plan deductible
Physician's Services
80% after plan deductible
Home Setting
80% after plan deductible
Breast Feeding Equipment and Supplies Note: Includes the rental of one breast pump per birth as ordered or prescribed by a physician. Includes related supplies.
No charge
In-Network coverage only
myCigna.com
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