Cigna
Cigna HSA BRONZE
Cigna PPO SILVER
Cigna PPO GOLD
IN-NETWORK
VPP Contribution
$1,100 (funded biweekly)
N/A
N/A
Deductible (Indiv/Fam)
$4,000/$8,000
$5,000/$10,000
$2,000/$4,000
Coinsurance
90%
70%
90%
Preventive Care Visit
100% Covered
100% Covered
100% Covered
Primary Care Visit
$40 after deductible
$50 Copay
$35 Copay
Specialist Visit
$60 after deductible
$75 Copay
$60 Copay
Virtual Visit
$10 after deductible
$10 Copay
$10 Copay
Hospital
10% after deductible
30% after deductible
10% after deductible
Emergency Room
$200 after deductible
Urgent Care
$100 after deductible
Lab Tests/Diagnostics – Office*
0% after deductible
No Charge
No Charge
Lab Tests/Diagnostics - Hospital
10% after deductible
30% after deductible 10% coinsurance, no ded.
Major Diagnostic/Imaging - Office Major Diagnostic/Imaging - Hospital Pharmacy/Rx – Retail (31 days)
100% after deductible
$200 after deductible
$200 no deductible
$200 no deductible
$10/$30/$50 after ded.
$20/$40/$60
$15/$35/$50
Pharmacy/Rx – Mail Order (90 days)
$25/$75/$125 after ded.
$50/$100/$150
$38/$88/$125
Max Out of Pocket
$6,550/$13,100 (with ded.) $7,900/$15,800 (with ded.) $7,150/$14,300 (with ded.)
OUT OF NETWORK
Deductible
$6,000 Ind./$12,000 Fam.
$10,000 Ind./$20,000 Fam.
$5,000 Ind./$10,000 Fam.
Coinsurance
50% after deductible
50% after deductible
50% after deductible
Out of Pocket (with ded.)
$10,000 Ind./$20,000 Fam. $15,000 Ind./$30,000 Fam. $10,000 Ind./$20,000 Fam.
* Participating laboratories are LabCorp and Quest Diagnostics
The above plan summaries are illustrative. Always check your Cigna benefit summaries and certificates of coverage for final detailed plan information.
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