BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Substance Use Disorder Inpatient
80% after plan deductible
50% of the Maximum Reimbursable Charge after plan deductible
Includes Acute Inpatient Detoxification, Acute Inpatient Rehabilitation and Residential Treatment Calendar Year Maximum: Unlimited
Outpatient
Outpatient - Office Visits Includes individual, family and group psychotherapy; medication management, virtual care, etc. Calendar Year Maximum: Unlimited Dedicated Virtual Providers MDLIVE Behavioral Services Outpatient - All Other Services Includes Outpatient Detoxification, Partial Hospitalization, Intensive Outpatient Services, virtual care, etc. Calendar Year Maximum: Unlimited
No charge after the $30 per visit copay
50% of the Maximum Reimbursable Charge after plan deductible
No charge after the $20 per visit copay
In-Network coverage only
80% after plan deductible
50% of the Maximum Reimbursable Charge after plan deductible
.
myCigna.com
35
Made with FlippingBook - Online magazine maker