To find a network provider: Go to cigna.com z Find a doctor, dentist or facility z When asked how member is covered, select “Employer or School” z You can search by type of doctor, name of provider or address z If asked name of plan, select PPO If you need assistance, please call J.P. Farley at 800.634.0173 or visit jpfarley.com/find-a-provider.php and choose Cigna PPO .
MEDICAL J.P. FARLEY ADMINISTRATOR -
USING THE CIGNA PPO NETWORK Your medical benefits are administered by J.P. Farley offered through Cigna’s network, providing coverage for both in-network and out-of-network. You will always have stronger benefits when visiting in-network providers. Your prescription drug coverage is provided through SmithRx. Please note that you will receive one ID card to use for both medical services and prescription drugs.
Starting April 1, 2024, J.P. Farley will administer your current medical benefits. You will receive an ID card packet which includes a transition flyer. This flyer will provide instructions for healthcare providers on how to submit claims from April 1 until April 30, 2024. Effective May 1, 2024, J.P. Farley will commence administering your new medical benefits. From this date onwards, all claims can be submitted to your plan for processing in accordance with the directions provided on the new ID card.
Medical Plans effective 05/01/2024
Core Plan
Buy-Up Plan
In-Network Preventive Care
Covered 100% Covered 100%
Covered 100% Covered 100%
Telehealth (Teladoc)
Primary Physician Office Visit
$30 copay $50 copay
$25 copay $50 copay
Specialist Office Visit
Diagnostic Test (X-Ray, Blood Work)
Independent Lab/Facility: $25 copay Independent Lab/Facility: $25 copay
Independent Facility: $200 copay per scan
Independent Facility: $200 copay per scan
Advanced Imaging (MRI, CAT)
Outpatient Surgery
Ambulatory Surgery Center: $150 copay Ambulatory Surgery Center: $150 copay
Urgent Care
$50 copay
$75 copay
$300 copay + 20% coinsurance (deductible waived)
Emergency Room
Deductible + 20% coinsurance
Prescription Drugs - Retail (30-day supply) Generic/Brand Preferred/Brand Non- Preferred/Specialty* Prescription Drugs - Mail Order (90-day supply) Generic/Brand Preferred/Brand Non-Preferred
$10/$40/$70
$10/$40/$70
$20/$80/$140 $20/$80/$140 Services not listed with a copay (such as outpatient surgery or a hospitalization) are subject to deductible, then coinsurance until the out-of-pocket maximum is satisfied. Plan Year Deductible (Individual/Family) $5,000/$10,000 $3,000/$6,000 Coinsurance (Member Pays) 20% 20% Out-of-Pocket Maximum (Individual/Family) $10,000/$20,000 $6,750/$13,500 Out-of-Network Plan Year Deductible (Individual/Family) N/A $9,000/$18,000 Coinsurance (Member Pays) N/A 40% Out-of-Pocket Maximum (Individual/Family) N/A $18,000/$36,000
This is a summary of coverage; please refer to your summary plan description for the full scope of coverage. *Specialty medications are not covered by this plan. They are provided under a separate plan through SmithRx.
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