myCigna Copay Assure Silver Health Plan
- Annual Deductible -
Individual | Family$0 Individual | $0 Family
- Out of Pocket Maximum -
Individual | Family$6,350 Individual | $12,700 Family
- Office Visits -
Primary | Specialist$30 Primary | $60 Specialist
|BENEFIT||In Network||Out 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|
|Coinsurance||You pay 30%||You pay 50% after deductible|
|Primary Care Physician||$30 Copay||You pay 50% after deductible|
|Specialist Physician||$60 Copay||You pay 50% after deductible|
|Office Related Services||You pay 30%||You pay 50% after deductible|
|Preventive Care||In Network||Out of Network|
|Preventive Care for All Ages||You pay 0%||You pay 50% after deductible|
|Inpatient Care||In Network||Out of Network|
|Facility Services (Inpatient Room and Board, Lab & X-ray, Operating Room, etc.)||You pay $2000 per day||You pay 50% after deductible|
|Physician Services||You pay 0%||You pay 50% after deductible|
|Outpatient Services||In Network||Out of Network|
|Lab, X-ray and Ultrasound||You pay 40%||You pay 50% after deductible|
|Imaging - CT/PET and MRI||You pay $750||You pay 50% after deductible|
|Cardiac & Pulmonary Rehabilitation||You pay $60 per visit||You pay 50% after deductible|
|Short Term Rehabilitative Therapy||You pay $60 per visit||You pay 50% after deductible|
|Outpatient Surgery - Facility||You pay $2000||You pay 50% after deductible|
|Outpatient Surgery - Physicians Services||You pay 30%||You pay 50% after deductible|
|Emergency & Urgent Care Services||In Network||Out of Network|
|Emergency Room Services||You pay $500||You pay the same level as In-Network if it is an emergency, as defined by the plan otherwise 50% after the deductible|
|Urgent Care||You pay $75||You pay the same level as In-Network if it is an emergency, as defined by the plan otherwise 50% after the deductible|
|Ambulance||You pay $500||You 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 Facilities||In Network||Out of Network|
|Skilled Nursing Facility||You pay $300 per day||You pay 50% after deductible|
|Home Health||You pay $100 per day||You pay 50% after deductible|
|Hospice||You pay 30%||You pay 50% after deductible|
|Durable Medical Equipment||You pay 30%||You pay 50% after deductible|
|Mental Health||In Network||Out of Network|
|Inpatient Mental Health||You pay $2000 per day||You pay 50% after deductible|
|Outpatient Mental Health||You pay 30%||You pay 50% after deductible|
|Prescription Drugs||In Network||Out of Network|
|Tier 1 - Retail Preferred Generic||You pay $4||You pay 50% after deductible|
|Tier 2 - Retail Non-Preferred Generic||You pay $25||You pay 50% after deductible|
|Tier 3 - Retail Preferred Brand||You pay $60||You pay 50% after deductible|
|Tier 4 - Retail Non-preferred Brand||You pay 50%||You pay 50% after deductible|
|Tier 5 - Retail Specialty||You pay 40%||You pay 50% after deductible|
|Tier 1 - Home Delivery Preferred Generic||You pay $10||You pay 50% after deductible|
|Tier 2 - Home Delivery Non-Preferred Generic||You pay $50||You pay 50% after deductible|
|Tier 3 - Home Delivery Preferred Brand||You pay $150||You pay 50% after deductible|
|Tier 4 - Home Delivery Non-Preferred Brand||You pay 50%||You pay 50% after deductible|
|Tier 5 - Home Delivery Specialty||You 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.
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