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rag/cigna_5000_classic.txt

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+PLAN: Cigna 5000 Classic
+UID: Cigna 5000 Classic
+Category: Major Medical
+Type: PPO
+Marketing Name: Cigna - 5000 Plan
+Average Price: $979.04
+Short Description: A high-deductible PPO plan with clear cost-sharing and strong coverage for major medical needs.
+Long Description: With a $5,000 deductible and copays starting at $45, the Cigna 5000 Plan gives you strong protection at a lower monthly cost. It’s perfect if you’re looking for a PPO that covers the big stuff but doesn’t overcharge for the basics.
+
+PRICING:
+  Coverage 4: $1488.80
+  Coverage 3: $906.22
+  Coverage 2: $1003.32
+  Coverage 1: $517.85
+
+DETAILS:
+
+COVERAGE:
+  Notes: Yes.
+
+If your plan doesn't meet the Minimum Value Standards, you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace.
+  Coverage Tier: All
+  Emergency Room: You pay the full cost until your deductible is met, then 20% of the covered amount.
+  Monthly Premium: None
+  Lifetime Maximum: No Maximum
+  Professoinal Fees: You pay the full cost until your deductible is met, then 20% of the covered amount.
+  Referral Required: No
+  Urgent Care Copay: 90
+  Employee Contribution: TBD by Group
+  Employer Contribution: TBD by Group
+  Inpatient Hospital Stay: You pay the full cost until your deductible is met, then 20% of the covered amount.
+  Habilitation - In Network: You pay the full cost until your deductible is met, then 0% of the covered amount subject to plan's allowable fee.
+  Included no cost services: 0% Copay Telemedicine, Virtual Primary Care, Advocay Services 
+  Prescription Drug Deductible: You just pay low copays for medications right away—no deductible needs to be met.
+  Habilitation - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Home heslth care - In Network: You pay the full cost until your deductible is met, then 20% of the covered amount subject to plan's allowable fee.
+  Hospice services - In Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Specialist Copay - In Network:  20% after deductable met
+  Emergency Medical Transporation: You pay the full cost until your deductible is met, then 20% of the covered amount.
+  Primary Care Copay - In Network: 45
+  Your Rights to Continue Coverage: There are agencies that can help if you have a complaint against your plan for a denial of a claim. This complaint is called a grievance or appeal. For more information about your rights, look at the explaination of benefits you will receivefor that medical claim. Your plan documents also provide complete information to submit a claim, appeal, or a grievance for any reason to your plan.For more information about your rights, this notice, or assistance, contact: Acuity at 1-866-872-6356 or Department of Labor's Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.
+  Deductible (Family) - In  Network: 10000
+  Home heslth care - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Hospice services - Out of Network: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is :Department of Labor's Employee Benefits Security Administration at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform. Other coverage options may be available to you too, including buying individual insurance coverage through the Health Insurance Marketplace. For more information about the Marketplace, visit www.HealthCare.gov or call 1-800-318-2596.
+  Skilled nursing care - In Network: You pay the full cost until your deductible is met, then 20% of the covered amount subject to plan's allowable fee.
+  Specialist Copay - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount.
+  Your Grievance and Appeals Rights: Yes.  
+
+If you don't have Minimum Essential Coverage for a month, you'll have to make a payment when you file your tax return unless you qualify for an exemption from the requirement that you have health coverage for that month.
+  Specialty Drugs - Network Provider: 50% coinsurance
+  Primary Care Copay - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount.
+  Chiropractic Care Copay - In Network: 20
+  Deductible (Family) - Out of Network: 14000
+  Deductible (Individual) - In  Netwok: 5000
+  Pregnancy office visits - In Network: You pay the full cost until your deductible is met, then 20% of the covered amount subject to plan's allowable fee.
+  Rehabilitation Services - In Network: You pay the full cost until your deductible is met, then 0% of the covered amount subject to plan's allowable fee.
+  Skilled nursing care - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Durable medical equipment - In Network: You pay the full cost until your deductible is met, then 20% of the covered amount subject to plan's allowable fee.
+  Chiropractic Care Copay - Out of Network: NA
+  Deductible (individual) - Out of  Netwok: 7000
+  Pregnancy office visits - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Rehabilitation Services - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Specialty Drugs - Out of Network Provider: Not covered
+  Durable medical equipment - Out of Network: You pay the full cost until your deductible is met, then 20% of the covered amount subject to plan's allowable fee.
+  Out of Pocket Maximum (Family) - In Network: 14700
+  Routine Preventive Services (Non-Diagnostic): No Member Cost Sharing - Deductible Waived
+  Out of Pocket Maximum (family) - Out of Network: 29400
+  Does this plan meet the Minimum Value Standards?: None
+  Out of Pockert Maximum (Individual) - In Network: 7350
+  Cildbirth/delivery facility services - In Network: You pay the full cost until your deductible is met, then 20% of the covered amount subject to plan's allowable fee.
+  Coinsurance % (Plan pays/Member Pays) - In Network: 80% / 20%%
+  Does This Plan provide Minimum Essential Coverage?: For more information about limitations and exceptions, see the plan or policy document at https://www.acuity-grp.com
+  Out of Pocket Maximum (Individual) - Out of Network: 14700
+  Blood test to help diagnose a condition - In Network: You pay the full cost until your deductible is met, then 20% of the covered amount.
+  Cildbirth/delivery facility services - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Free Standing Lab & Diagnostic Services (Lab & x-ray): You pay the full cost until your deductible is met, then 0% of the covered amount.
+  Preventative Care/Screening/Immunization - In Network: 0% Coinsurance
+  Childbirth/delivery professional services - In Network: You pay the full cost until your deductible is met, then 20% of the covered amount subject to plan's allowable fee.
+  Coinsurance % (Plan pays/Member Pays) - Out of Network: 60% / 40%
+  Blood test to help diagnose a condition - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Preventative Care/Screening/Immunization - Out of Network: Not Covered
+  Childbirth/delivery professional services - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Imaging tests like X-Rays, CT/PET Scans, or MRI's - In Network: You pay the full cost until your deductible is met, then 20% of the covered amount subject to plan's allowable fee.
+  Out Patient Services, Surgical Services (Procedure & Anesthesia): You pay the full cost until your deductible is met, then 20% of the covered amount.
+  Imaging tests like X-Rays, CT/PET Scans, or MRI's - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Generic medication (30-day supply) from a pharmacy in your plan’s network: $15 copay
+  Generic medication (31-90-day supply) from a pharmacy in your plan’s network: $45 copayemnt
+  Inpatient mental/ behavioral health, and substance abuse services - In Network: You pay the full cost until your deductible is met, then 20% of the covered amount subject to plan's allowable fee.
+  Complex Diagnositc Services (CT, MRI, Ultra Sound, PET, Nuclear Med.) (Network): You pay the full cost until your deductible is met, then 20% of the covered amount.
+  Outpatient mental/ behavioral health, and substance abuse services - In Network: $45 copay
+  Inpatient mental/ behavioral health, and substance abuse services - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Outpatient mental/ behavioral health, and substance abuse services - Out of Network: You pay the full cost until your deductible is met, then 40% of the covered amount subject to plan's allowable fee.
+  Brand-name medication that’s on your plan’s preferred list (30-day supply from an in-network pharmacy): $65 copay
+  Brand-name medication that’s on your plan’s preferred list (31-90-day supply) from an in-network pharmacy): $90 copayemnt
+  Brand-name medication that’s not on your plan’s preferred list (30-day supply) from an in-network pharmacy): $100 copay
+  Brand-name medication that’s not on your plan’s preferred list (31-90-day supply) from an in-network pharmacy): $150 copayemnt