myCigna Copay Assure Silver Health Plan

  • Annual Deductible -
    $0  Individual  |  $0  Family
  • Out of Pocket Maximum -
    $6,350  Individual  |  $12,700  Family
  • Office Visits -
    $30  Primary  |  $60  Specialist

    Copay

BENEFITIn NetworkOut of Network
Annual Individual Deductible (medical/pharmacy are integrated)$0$500
Annual Family Deductible$0$1,000
Individual OOP maximum$6,350$25,000
Family OOP maximum$12,700$50,000
CoinsuranceYou pay 30%You pay 50% after deductible
Primary Care Physician$30  CopayYou pay 50% after deductible
Specialist Physician$60  CopayYou pay 50% after deductible
Office Related ServicesYou pay 30%You pay 50% after deductible
Preventive CareIn NetworkOut of Network
Preventive Care for All AgesYou pay 0%You pay 50% after deductible
Inpatient CareIn NetworkOut of Network
Facility Services (Inpatient Room and Board, Lab & X-ray, Operating Room, etc.)You pay $2000 per dayYou pay 50% after deductible
Physician ServicesYou pay 0%You pay 50% after deductible
Outpatient ServicesIn NetworkOut of Network
Lab, X-ray and UltrasoundYou pay 40%You pay 50% after deductible
Imaging - CT/PET and MRIYou pay $750You pay 50% after deductible
Cardiac & Pulmonary RehabilitationYou pay $60 per visitYou pay 50% after deductible
Short Term Rehabilitative TherapyYou pay $60 per visitYou pay 50% after deductible
Outpatient Surgery - FacilityYou pay $2000You pay 50% after deductible
Outpatient Surgery - Physicians ServicesYou pay 30%You pay 50% after deductible
Emergency & Urgent Care ServicesIn NetworkOut of Network
Emergency Room ServicesYou pay $500You pay the same level as In-Network if it is an emergency, as defined by the plan otherwise 50% after the deductible
Urgent CareYou pay $75You pay the same level as In-Network if it is an emergency, as defined by the plan otherwise 50% after the deductible
AmbulanceYou pay $500You pay the same level as In-Network if it is an emergency, as defined by the plan otherwise 50% after the deductible
Other Health Care FacilitiesIn NetworkOut of Network
Skilled Nursing FacilityYou pay $300 per dayYou pay 50% after deductible
Home HealthYou pay $100 per dayYou pay 50% after deductible
HospiceYou pay 30%You pay 50% after deductible
Durable Medical EquipmentYou pay 30%You pay 50% after deductible
Mental HealthIn NetworkOut of Network
Inpatient Mental HealthYou pay $2000 per dayYou pay 50% after deductible
Outpatient Mental HealthYou pay 30%You pay 50% after deductible
Prescription DrugsIn NetworkOut of Network
Tier 1 - Retail Preferred GenericYou pay $4You pay 50% after deductible
Tier 2 - Retail Non-Preferred GenericYou pay $25You pay 50% after deductible
Tier 3 - Retail Preferred BrandYou pay $60You pay 50% after deductible
Tier 4 - Retail Non-preferred BrandYou pay 50%You pay 50% after deductible
Tier 5 - Retail SpecialtyYou pay 40%You pay 50% after deductible
Tier 1 - Home Delivery Preferred GenericYou pay $10You pay 50% after deductible
Tier 2 - Home Delivery Non-Preferred GenericYou pay $50You pay 50% after deductible
Tier 3 - Home Delivery Preferred BrandYou pay $150You pay 50% after deductible
Tier 4 - Home Delivery Non-Preferred BrandYou pay 50%You pay 50% after deductible
Tier 5 - Home Delivery SpecialtyYou pay 30%You pay 50% after deductible

When you’re healthy, but want basic protection…

Life is for living, not for worrying. You’re healthy, but you want coverage in case that changes. This plan will help put your mind at ease. You’ll have a copay for many in-network medical services, including doctor office visits—with no deductible to monitor. “Predictable” best describes this plan. 

  • Low copays are all you’ll pay for many in-network covered services like doctor visits, outpatient services and qualifying urgent care and emergency visits.
  • In-network, the amount you pay for covered inpatient hospital services and outpatient surgery is capped at a per day/per admission rate. 
  • Once you’ve met the annual out-of-pocket maximum, Cigna pays 100% of expenses for covered medical services in that year.
  • Copays as low as $4 for many popular generic prescription drugs, and significant discounts on brand name drugs, when you use a participating pharmacy.

In every myCigna Plan...

to help keep you healthy...

Cigna’s plans provide many benefits that can help keep you and your family healthy. These include: 

  • Yearly checkups (including lab work) and preventive care (like routine in-network checkups or colon and breast cancer screenings, when your doctor determines it’s time) at no additional cost when you stay in-network, to help keep medical expenses low.
  • Access to a select group of local, quality doctors and hospitals in Cigna’s LocalPlus® Network, to get the best value from your plan. For important LocalPlus Network information, in your area or when you're away from home and need care, please review the LocalPlus Network flyer. Find providers in the LocalPlus Network by visiting Cigna.com/ifp-providers.  Prescription drugs delivered to your home. Call Cigna Home Delivery Pharmacy® and we'll send a 90-day supply of your prescription drugs to your home for less than what you would typically pay at a local pharmacy.
  • Discounts on our health and wellness products and programs, from weight management, nutrition and fitness programs, to tobacco counseling and alternative medicine.1
  • Online health management tools that let you find a doctor, pay your monthly premium, view your claim history, print temporary ID cards or learn about healthy living habits with our online Health & Wellness library.
  • Our 24-hour Health Information Line, with specialists available 24/7 to help answer questions about common health concerns.

 

1Healthy Rewards is a discount program. This program is in addition to, not instead of, your plan benefits. Healthy Rewards programs are separate from your medical benefits. A discount program is NOT insurance, and you must pay the entire discounted charge. Some Healthy Rewards programs are not available in all states and programs may be discontinued at any time. Participating providers are independent contractors solely responsible for any care or services provided.

**For additional visits, plan deductible and coinsurance apply.