BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Maximum Reimbursable Charge
Maximum Reimbursable Charge is determined based on the lesser of the provider’s normal charge for a similar service or supply; or A policyholder-selected percentage of a fee schedule Cigna has developed that is based upon a methodology similar to a methodology utilized by Medicare to determine the allowable fee for the same or similar services within the geographic market. In some cases, a Medicare based schedule will not be used and the Maximum Reimbursable Charge for covered services is determined based on the lesser of: the provider’s normal charge for a similar service or supply; or the 80th percentile of charges made by providers of such service or supply in the geographic area where
Not Applicable
110%
it is received as compiled in a database selected by Cigna. If
sufficient charge data is unavailable in the database for that geographic area to determine the Maximum Reimbursable Charge, then data in the database for similar services may be used. Note: The provider may bill you for the difference between the provider’s normal charge and the Maximum Reimbursable Charge, in addition to applicable deductibles and coinsurance. Note: Some providers forgive or waive the cost share obligation (e.g. your deductible and/or coinsurance) that this plan requires you to pay. Waiver of your required cost share obligation can jeopardize your coverage under this plan. For more details, see the Exclusions Section. .
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