CIGNA Open Access Plus Copay Plan

The plan summary provides a detailed listing of care options and coverages.

General coverages are listed here for a quick overview.

In-Network options and coverages are as follows: 

Deductible $500/$1,000
Coinsurance 80% after deductible
Physician Copay $25
Preventive Office Copay
 Covered 100%
Outpatient Copay 80% after deductible
Inpatient Copay 80% after deductible
Home Health Care 80% after deductible
Emergency Care 80% no deductible
Urgent Care $35
Retail Prescriptions $10/$25/$40 copay
Mail Order Prescriptions
(90-day supply)		 $20/$50/$80 copay
Enhanced Preventive Drugs N/A
Mental Health (MH) /
Substance Abuse (SA) 		 
MH/SA Inpatient Facility Svcs
 80% after deductible
MH/SA Outpatient Facility Svcs 80% after deductible
MH/SA Outpatient Svcs $25
Routine Vision Exam
(Every 24 months)
 $25
Max Out-Of-Pocket $2,000/$4,000

Out-of-Network options and coverages are as follows:

Deductible $500/$1,000
Coinsurance 60% after deductible
Physician Copay 60% after deductible
Preventive Office Copay
 60% after deductible
Outpatient Copay 60% after deductible
Inpatient Copay 60% after deductible
Home Health Care 60% after deductible
Emergency Care 80% no deductible
Urgent Care $35
Prescriptions

IN NETWORK
COVERAGE ONLY
Mental Health (MH) /
Substance Abuse (SA) 		 
MH/SA Inpatient Facility Svcs
 60% after deductible
MH/SA Outpatient Facility Svcs 60% after deductible
MH/SA Outpatient Svcs 60% after deductible
Routine Vision Exam
(Every 24 months)
 $45
Max Out-Of-Pocket $2,000/$4,000