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CIGNA GLOBAL OCN GLOBAL PLAN
80
Employee Pays
Services Received Outside of the United States
Deductible
Individual
$1,000
Maximum Out of Pocket
Individual
$2,000
Lifetime Maximum
Unlimited
Physician Office Visit
General / Specialist
Employee pays 20% After Deductible is met
Preventive Care
Wellness Care
Routine Physical Exams
Gynecological Exams
PSA & DRE
Mammograms
100% Covered
Inpatient Hospital Services
Employee pays 20% After Deductible is met
Inpatient Hospital Services Room
and Board
Employee pays 20% After Deductible is met
Hospital Emergency Room
Employee pays 20% After Deductible is met
Short Term Rehabilitation
(60 day maximum per calendar year
for all therapies combined)
Office Visit
Outpatient
Employee pays 20% After Deductible is met
Mental Illness and Substance Abuse
Office Visit
Inpatient
Outpatient
Employee pays 20% After Deductible is met
Smoking Cessation
Employee pays 20% After Deductible is met
Medical Evacuation
Included
Employee Assistance Program
Included
Care within the United States
Excluded