MEDICAL INSURANCE
Creative Sign Designs offers three medical plans through Cigna. To find participating providers go to www.mycigna.com and click on “Find a Doctor”, choose the appropriate provider type. In Step 2: Plan Name, choose “LocalPlus”. Complete the remaining information and click Search.
The chart below provides a brief overview of the medical plans. This chart is intended only to highlight the benefits available and should not be relied upon to fully determine your coverage. If the below illustration of benefits conflicts in any way with the Summary Plan Description (SPD), the SPD shall prevail. It is recommended that you review your exact description of services and supplies that are covered, those which are excluded or limited, and other terms and conditions of coverage .
(Base Plan) LocalPlus 70%
(Mid Plan) LocalPlus 80%
(High Plan) LocalPlus 100%
IN-NETWORK: Plan Year or Calendar Year Basis
Calendar Year
Calendar Year
Calendar Year
Deductible (Individual / Family)
$4,500 / $9,000
$3,000 / $6,000
$1,000 / $2,000
Coinsurance
70% / 30%
80% / 20%
100%
Maximum Out-of-Pocket (Individual/Family)
$7,150 / $14,300
$6,500 / $13,000
$4,000 / $8,000
Deductible, Coinsurance & Copayments
Deductible, Coinsurance & Copayments
Deductible, Coinsurance & Copayments
Maximum Out-of-Pocket Includes
Lifetime Maximum
Unlimited
Unlimited
Unlimited
PREVENTIVE CARE:
Wellness Immunizations Mammography/Colonoscopy COPAYMENTS: Referral Required Office Visits Consultations for Illness/Injury
Covered 100%
Covered 100%
Covered 100%
No
No
No
$40 Copayment
$40 Copayment
$25 Copayment
Specialist Visits
$65 Copayment
$65 Copayment
$40 Copayment
Inpatient Hospital
Deductible & Coinsurance
Deductible & Coinsurance
$500 Deductible
Outpatient Surgery
Deductible & Coinsurance
Deductible & Coinsurance
$500 Deductible
Emergency Room Urgent Care
$350 Copayment $75 Copay
$350 Copayment $100 Copay
$250 Copayment $75 Copay
OUTPATIENT DIAGNOSTIC SERVICES: Independent/Freestanding Lab Complex Diagnostic (MRI, CT, PET, Etc.) – Freestanding Facility
Covered 100%
Covered 100%
Covered 100%
$300 Copay
$300 Copay
$250 Copay
PRESCRIPTIONS:
Tier 1: $10 copay Tier 2: $45 Copay Tier 3: $90 Copay
Tier 1: $10 copay Tier 2: $40 copay Tier 3: $70 copay
Tier 1: $10 copay Tier 2: $45 copay Tier 3: $90 copay
Retail (30 day supply)
OUT-OF-NETWORK 2 Deductible (Individual / Family)
$9,000 / $18,000
$5,000 / $10,000
$5,000 / $10,000
Maximum Out-of-Pocket (Individual/Family)
$14,300 / $28,600
$13,000 / $26,000
$10,000 / $20,000
Coinsurance
50% / 50%
50% / 50%
70% / 30%
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