Annual Family Deductible: Family deductible is applicable when there are two or more family members enrolled in the plan, and is satisfied when one, or any combination of enrolled family members, meet the annual family deductible amount. (For a family of two or more, the annual individual deductible is not applicable.) Applies to Cigna Health Savings Plans®.
Annual Individual Deductible: Individual deductible is applicable when only one person is enrolled in the plan, and is satisfied when that individual meets the annual individual deductible amount. Applies to Cigna Health Savings Plans®. Applies to Cigna Open Access Plans® and Cigna Open Access Value Plans SM.
Coinsurance: A percentage of the Cigna contracted rate or cost that you are responsible to pay out of your pocket.
Copayment (copay): A flat per service charge that customers are responsible to pay for services such as doctor visits or prescription drugs.
Deductible: The dollar amount customers must pay before the plan begins to pay for covered services. The deductible is satisfied when each family member has paid their individual deductible or when the total family deductible amount has been reached by any combination of family members. Applies to Cigna Open Access Plans® and Cigna Open Access Value Plans SM.
In-network health care professional: Any health care professional (physician, hospital, etc.) that participates in the Cigna network.These health care professionals are also called participating health care professionals and the plan generally covers more of the costs.
Inpatient care: Care given to a customer admitted to a hospital, hospice, skilled nursing center, or rehabilitation center.
Network: A group of doctors, hospitals, dentists, and other health care professionals who have agreed to charge a set rate for members of a health benefits plan. Also called participating health care professionals.
Out-of-network health care professional: Any health care professional (physician, hospital, etc.) that does not participate in a Cigna network. You may pay a larger share of the costs with these health care professionals.
Out-of-pocket costs: The amount you pay for copays, deductibles, coinsurance, or fees for health services or prescription drugs.
Out-of-pocket maximum: The most, or limit, customers will pay per year for covered health expenses before the plan pays 100% for the rest of that year.
Outpatient care: Any health care service provided to a customer who is not admitted to a center.
Premium: The monthly amount you pay to ensure you have the insurance benefits and health coverage you need. The amount paid each month whether or not you use health care expenses.
Preventive care: Health care, such as tests and examinations, to keep you healthy or to prevent illness. Examples include annual physical exams, Pap tests, pelvic exams, yearly mammograms, and flu shots.
Primary Care Physician (PCP): A doctor trained to give basic care, like a family doctor or pediatrician, who participates in Cigna's network. In many HMO plans, the primary care physician coordinates your care – which means you have to see your primary care physician before you see a specialist.
Specialist: Specialists usually have advanced training and education related to a specific condition or part of the body and usually charge higher fees than a PCP – so your plan may require you to pick up more of the cost. For example, your plan might specify a $30 copayment for a family doctor and $45 for a specialist
In Texas, Open Access Plus plans are considered Preferred Provider plans with certain managed care features; Health Savings Plans are considered Preferred Provider plans with certain managed care features and are compatible with a Health Savings Account (HSA).