94 lines
9.5 KiB
Text
94 lines
9.5 KiB
Text
PLAN: Cigna 7350 Value
|
||
UID: Cigna 7350 Value
|
||
Category: Major Medical
|
||
Type: PPO
|
||
Marketing Name: Cigna - 7350 Value Plan
|
||
Average Price: $847.77
|
||
Short Description: Our lowest-cost PPO plan, ideal for healthy individuals who want essential protection and peace of mind.
|
||
Long Description: The Cigna 7350 Value Plan offers the lowest premium of all. It comes with a $7,350 deductible and matching out-of-pocket max, plus $50 copays for doctors and $100 for specialists. Preventive care is free. It’s a great fit for those who don’t go to the doctor often but want peace of mind just in case.
|
||
|
||
PRICING:
|
||
Coverage 4: $1288.12
|
||
Coverage 3: $784.87
|
||
Coverage 2: $868.74
|
||
Coverage 1: $449.38
|
||
|
||
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 0% of the covered amount.
|
||
Monthly Premium: None
|
||
Lifetime Maximum: No Maximum
|
||
Professoinal Fees: You pay the full cost until your deductible is met, then 0% of the covered amount.
|
||
Referral Required: No
|
||
Urgent Care Copay: 100
|
||
Employee Contribution: TBD by Group
|
||
Employer Contribution: TBD by Group
|
||
Inpatient Hospital Stay: You pay the full cost until your deductible is met, then 0% 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 in full until deductible met ; after that, the plan covers 100% subject to plan's allowable fee.
|
||
Home heslth care - In Network: You pay the full cost until your deductible is met, then 0% of the covered amount subject to plan's allowable fee.
|
||
Hospice services - In Network: You pay in full until deductible met ; after that, the plan covers 100% subject to plan's allowable fee.
|
||
Specialist Copay - In Network: 100
|
||
Emergency Medical Transporation: You pay the full cost until your deductible is met, then 0% of the covered amount.
|
||
Primary Care Copay - In Network: 50
|
||
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: 14700
|
||
Home heslth care - Out of Network: You pay in full until deductible met ; after that, the plan covers 100% 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 0% 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 50% 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 0% of the covered amount.
|
||
Chiropractic Care Copay - In Network: 20
|
||
Deductible (Family) - Out of Network: 29400
|
||
Deductible (Individual) - In Netwok: 7350
|
||
Pregnancy office visits - In Network: You pay the full cost until your deductible is met, then 0% 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 in full until deductible met ; after that, the plan covers 100% subject to plan's allowable fee.
|
||
Durable medical equipment - In Network: You pay the full cost until your deductible is met, then 0% of the covered amount subject to plan's allowable fee.
|
||
Chiropractic Care Copay - Out of Network: NA
|
||
Deductible (individual) - Out of Netwok: 14700
|
||
Pregnancy office visits - Out of Network: You pay in full until deductible met ; after that, the plan covers 100% subject to plan's allowable fee.
|
||
Rehabilitation Services - Out of Network: You pay in full until deductible met ; after that, the plan covers 100% 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 0% 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 0% of the covered amount subject to plan's allowable fee.
|
||
Coinsurance % (Plan pays/Member Pays) - In Network: Plan pays 100%
|
||
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 0% of the covered amount.
|
||
Cildbirth/delivery facility services - Out of Network: You pay in full until deductible met ; after that, the plan covers 100% 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 0% of the covered amount subject to plan's allowable fee.
|
||
Coinsurance % (Plan pays/Member Pays) - Out of Network: 50%/50%
|
||
Blood test to help diagnose a condition - Out of Network: You pay in full until deductible met ; after that, the plan covers 100% subject to plan's allowable fee.
|
||
Preventative Care/Screening/Immunization - Out of Network: Not Covered
|
||
Childbirth/delivery professional services - Out of Network: You pay in full until deductible met ; after that, the plan covers 100% subject to plan's allowable fee.
|
||
Imaging tests like X-Rays, CT/PET Scans, or MRI's - In Network: You pay in full until deductible met ; after that, the plan covers 100% subject to plan's allowable fee.
|
||
Out Patient Services, Surgical Services (Procedure & Anesthesia): You pay the full cost until your deductible is met, then 0% of the covered amount.
|
||
Imaging tests like X-Rays, CT/PET Scans, or MRI's - Out of Network: You pay in full until deductible met ; after that, the plan covers 100% 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 0% 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 0% of the covered amount.
|
||
Outpatient mental/ behavioral health, and substance abuse services - In Network: $50 copay
|
||
Inpatient mental/ behavioral health, and substance abuse services - Out of Network: You pay in full until deductible met ; after that, the plan covers 100% 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 0% 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
|