BENEFIT HIGHLIGHTS
IN-NETWORK
OUT-OF-NETWORK
Gene Therapy Includes prior authorized gene therapy products and services directly related to their administration, when Medically Necessary. Gene therapy must be received at an In- Network facility specifically contracted with Cigna to provide the specific gene therapy. Gene therapy at other In- Network facilities is not covered.
Gene Therapy Product
Subject to In-Network facility cost share based on place of service; separate from facility charges
Not Covered
Inpatient Facility
80% after plan deductible
Not Covered
Outpatient Facility
80% after plan deductible
Not Covered
Physician’s Services
80% after plan deductible
Not Covered
Travel Maximum: $10,000 per episode of gene therapy
No charge after plan deductible (available only for travel when prior authorized to receive gene therapy at a participating In-Network facility specifically contracted with Cigna to provide the specific gene therapy)
Not Covered
Maternity Care Services Initial Visit to Confirm Pregnancy
80% after plan deductible
50% after plan deductible
Note: OB/GYN providers will be considered either as a PCP or Specialist, depending on how the provider contracts with the Insurance Company. All subsequent Prenatal Visits, Postnatal Visits and Physician’s Delivery Charges (i.e. global maternity fee) Physician’s Office Visits in addition to the global maternity fee when performed by an OB/GYN or Specialist Delivery - Facility (Inpatient Hospital, Birthing Center)
80% after plan deductible
50% after plan deductible
80% after plan deductible
50% after plan deductible
80% after plan deductible
50% after plan deductible
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