CIGNA Open Access Plus Coinsurance Plan with CIGNA Choice Fund HSA

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 $3,000/$6,000
Coinsurance 100% after deductible
Physician Copay 100% after deductible
Preventive Office Copay
Covered 100%
Outpatient Copay 100% after deductible
Inpatient Copay 100% after deductible
Home Health Care 100% after deductible
Emergency Care 100% after deductible
Urgent Care 100% after deductible
Retail Prescriptions 100% after deductible
Mail Order Prescriptions 
(90-day supply)
100% after deductible
Enhanced Preventive
Drugs
Retail $10/$25/$40 copay;
90-Day $20/$50/$80 copay;
deductible does not apply
Mental Health (MH) /
Substance Abuse (SA)
 
MH/SA Inpatient Facility Svcs
100% after deductible
MH/SA Outpatient Facility Svcs 100% after deductible
MH/SA Outpatient Svcs 100% after deductible
Routine Vision Exam
(Every 24 months)
Covered 100%
Max Out-Of-Pocket $3,000/$6,000

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

Deductible $5,000/$10,000
Coinsurance 80% after deductible
Physician Copay 80% after deductible
Preventive Office Copay
80% after deductible
Outpatient Copay 80% after deductible
Inpatient Copay 80% after deductible
Home Health Care 80% after deductible
Emergency Care 100% after deductible
Urgent Care 100% after deductible
Prescriptions

IN NETWORK
COVERAGE ONLY

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 80% after deductible
Routine Vision Exam
(Every 24 months)
$45
Max Out-Of-Pocket

$10,500/$21,000