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.myCigna.com or call 1-800-Cigna24 for a list of network providers.
Do you need a referral to see a specialist?
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 $40 copay/visit Deductible does not apply No charge/visit** No charge/screening** No charge/immunizations**
50% coinsurance Not covered/visit
None None None None
If you visit a health care provider's office or clinic
50% coinsurance/screening Not covered/immunizations
Preventive care/ screening/ immunization
You may have to pay for services that aren’t preventive. Ask your provider if the services you need are preventive. Then check what your plan will pay for.
**Deductible does not apply
50% coinsurance/x-ray 50% coinsurance/blood work 50% coinsurance/independent lab
Diagnostic test (x-ray, blood work) Imaging (CT/PET scans, MRIs)
If you have a test
50% penalty for no precertification.
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