CIGNA Open Access Plus In-Network 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 | None |
| Coinsurance | 100% |
| Physician Copay | $25 |
| Preventive Office Copay |
Covered 100% |
| Outpatient Copay | $250 |
| Inpatient Copay | $500 |
| Home Health Care | No Charge |
| Emergency Care | $75 |
| Urgent Care | $35 |
| Retail Prescriptions | $10/$25/$40 copay |
| 90-Day Prescriptions | $20/$50/$80 copay |
| Enhanced Preventive Drugs | N/A |
| Mental Health (MH) / Substance Abuse (SA) |
|
| MH/SA Inpatient Facility Svcs |
$500 per admiss, then 100% |
| MH/SA Outpatient Facility Svcs | No Charge |
| MH/SA Outpatient Svcs | $25 |
| Routine Vision Exam (Every 24 months) |
$25 |
| Max Out-Of-Pocket | $1,500/$3,000 |
Out-of-Network care options:
| Routine Vision Exam (Every 24 months) |
$45 |
All other Out-of-Network care options are not covered by this plan.
