Important Questions
Answers
Why This Matters:
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Will you pay less if you use a network provider?
Yes. See www.cigna.com or call 1-866-494-2111 for a list of network providers.
Do you need a referral to see a specialist?
No.
You can see the specialist you choose without a referral.
All copayment and coinsurance costs shown in this chart are after your deductible has been met, if a deductible applies. What You Will Pay Common Medical Event Services You May Need In-Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most)
Limitations, Exceptions, & Other Important Information
Primary care visit to treat an injury or illness
$30 copay/visit Deductible does not apply $60 copay/visit Deductible does not apply
40% coinsurance
None
Specialist visit
40% coinsurance
None None None
No charge/visit**
40% coinsurance/visit 40% coinsurance/other services No charge/immunizations**
No charge/other services**
If you visit a health care provider's office or clinic
No charge/immunizations** No charge/immunizations** **Deductible does not apply
Coverage birth through age 5 Coverage age 6 and older
40% coinsurance/ immunizations
Preventive care/ screening/immunization
**Deductible does not apply
You may have to pay for services that aren’t preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.
Diagnostic test (x-ray, blood work)
No charge Deductible does not apply
If you have a test
40% coinsurance
None
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