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. You can see the specialist you choose without a referral.
Will you pay less if you use a network provider?
Yes. See www.cigna.com or call 1-800-Cigna24 for a list of network providers.
Do you need a referral to see a specialist?
No.
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
20% coinsurance/visit 20% coinsurance/MDLIVE visit 20% coinsurance/visit 20% coinsurance/MDLIVE visit
50% coinsurance
None
Specialist visit
50% coinsurance
None
If you visit a health care provider's office or clinic
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.
Preventive care/ screening/ immunization
No charge Deductible does not apply
Not covered
Diagnostic test (x-ray, blood work) Imaging (CT/PET scans, MRIs)
20% coinsurance
50% coinsurance
None
If you have a test
20% coinsurance
50% coinsurance
None
If you need drugs to treat your illness or condition More information about prescription drug coverage
20% coinsurance/prescription (retail 30 days), 20% coinsurance/prescription (retail & home delivery 90 days)
Coverage is limited up to a 90-day supply (retail and home delivery); up to a 30-day supply (retail and home delivery) for Specialty drugs. Certain limitations may apply,
50% coinsurance/prescription (retail); Not covered (home delivery)
Generic drugs (Tier 1)
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