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By registering on
www.mycigna.comyou can get the tools you need to
make better health care choices. Here is a sampling of what you can do and
find on the website…
■ View your claims
■ Access claim forms
■ Print an ID card
■ Look up your benefits
■ Find a doctor
■ Locate a pharmacy, refill a prescription
■ View an online statement
■ Estimate health care costs
■ Talk to a nurse
■ Look up health topics
ACA requirement - All copays are applied to the out-of
-pocket maximum, including Prescription Drug copays.
Cigna - Base Plan (OAP $1000/80%)
Benefit Plan
In-Network
(You Pay)
Out-of-Network
(You Pay)
Deductible
$1,000 / Single
$2,000 / Family
$3,000 / Single
$6,000 / Family
Coinsurance
20%
50%
Out-of-Pocket Maximum
$6,850 / Single
$13,700 / Family
$13,700 / Single
$27,400 / Family
Physician Office Visit
$35 Primary Care
$70 Specialist
Deductible, then you pay 50%
Preventive Care
0%
Deductible, then you pay 50%
Inpatient Hospital & Outpatient Surgery
Deductible, then you pay 20%
Deductible, then you pay 50%
Diagnostic Lab, X-Ray and Other Tests
0%
Deductible, then you pay 50%
Major Diagnostics
Deductible, then you pay 20%
Deductible, then you pay 50%
Emergency Room
$300 Copay
Urgent Care Center
$100 Copay
Deductible, then you pay 50%
Prescription Drug Coverage
(at Participating In-Network Pharmacies)
Tier One
$15 Copay
Tier Two
$45 Copay
Tier Three
$65 Copay
Mail Order Drug Coverage for a 90 Day Supply
$35/$125/$185 Copay
MEDICAL INSURANCE OPTIONS
EMPLOYEE COST
Type of Coverage
Monthly
Cost
Employee Only
$115.71
Employee & Spouse
$231.41
Employee & Child(ren)
$202.49
Employee & Family
$318.20