2021 Cigna Connect Gold Options


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Cigna Connect Gold Overview

Gold plans usually have the highest monthly premiums but the lowest costs when you get care. These plans are good for individuals that see their doctors/use medical services frequently and take multiple prescription medicines.

Plan NameCigna Connect -0Cigna connect 1000
Deductible$0$1,000/$2,000
Coinsurance0%30%
Out-of-Pocket Maximum$0$8,150/$16,300
PCP/Specialist$0$20/$60

Cigna Connect-0

Summary of Benefits

Important Questions Answers Why this Matters:
What is the overall deductible?$0 person/ $0 familySee the Common Medical Events chart below for your costs for services this plan covers
Are there services covered before you meet your deductible?Yes.This plan covers some items and services even if you haven’t yet met the deductible amount
Are there other
deductibles for specific
services?
NoYou don’t have to meet deductibles for specific services
What is the out-of-pocket
limit for this plan?
$0 person/ $0 familyThis plan does not have an out-of-pocket limit on your expenses
What is not included in
the out-of-pocket limit?
Premiums, balance-billing charges, penalties for failure to obtain preauthorization for services and health care this plan
doesn’t cover.
This plan does not have an out-of-pocket limit on your expenses
Will you pay less if you use a network provider? Yes. See www.cigna.com/ifpproviders or call 1-866-494-2111
for a list of network providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Do you need a referral to see a specialist?YesThis plan will pay some or all of the costs to see a specialist for covered services but only if you have a referral before you see the specialist.
Common Medical EventServices You May Need

Your cost if you use
a Participating
Provider (You will pay the least)

Your cost if you use
a Non-Participating
Provider (You will pay the most)

Limitations & Exceptions, & Other Important Information
If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness

No Charge. Includes
Virtual medical visit
with a Dedicated
Virtual Care Physician

Not covered

Refer to the policy for more information about Virtual Care Services.
Specialist visit

No Charge

Not covered

None
Preventive care/screening/immunization

No charge

Not covered

You may have to pay for services that aren’t preventive. Ask your provider if the services are needed are preventive. Then check what your plan will pay for.
If you have a testDiagnostic test (x-ray, blood work)

No Charge

Not covered

None
Imaging (CT / PET scans, MRIs)

No Charge

Not covered

None
If you need drugs to
treat your illness or
condition. More information about
prescription drug
coverage is available at
www.cigna.com/ifpdrug-list
Preferred generic drugs

No charge (retail/home
delivery)

Not coveredLimited to a 30 day supply at any participating pharmacy or up to a 90 day supply at a
designated 90 day retail pharmacy/home delivery.
Generic drugs

No charge (retail/home
delivery)

Not covered
Preferred brand drugs

No charge (retail/home
delivery)

Not covered

Non-preferred drugs

No charge (retail/home
delivery)

Not covered

Specialty drugs and other high cost drugsNo charge (retail/home
delivery)
 Not covered
If you have outpatient
surgery
Facility fee (e.g., ambulatory surgery center)No Charge

Not covered

None
Physician/surgeon fees

No Charge

Not covered

If you need immediate
medical attention
Emergency room care

No Charge

No Charge

You pay the same level as In-network if it is an emergency as defined in your plan, otherwise not covered.
Emergency medical transportation

No Charge

No Charge

You pay the same level as In-network if it is an emergency as defined in your plan, otherwise not covered.
Urgent care

No Charge

No Charge

You pay the same level as In-network if it is an emergency as defined in your plan, otherwise not covered.
If you have a hospital
stay
Facility fee (e.g., hospital room)

No Charge

Not covered

None
Physician/surgeon fee

No Charge

Not covered

If you have mental
health, behavioral
health, or substance
abuse needs
Outpatient servicesNo Charge

Not covered

None
Inpatient services

No Charge

Not covered

None
If you are pregnantOffice visits

No Charge

Not covered

Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery professional services

No Charge

Not covered

Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery facility services

No Charge

Not covered

Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
If you need help
recovering or have other special health needs
Home health care

No Charge

Not covered

None

 

Cardiac – Limited to a maximum of 36
treatment sessions within a 6 month period.

 

 

None

 

None

Rehabilitation services

No Charge

Not covered

Habilitation services

No Charge

Not covered

Skilled nursing care

No Charge

Not covered

Durable medical equipment

No Charge

Not covered

None
Hospice serviceNo Charge

Not covered

None
If your child needs
dental or eye care
Children’s eye exam

No Charge

Not covered

Children up to age 19. Coverage limited to one exam/year
Children’s glasses

No Charge

Not covered

Children up to age 19. Coverage limited to one pair of glasses/year.
Children’s dental check-up

Not Covered

Not Covered

Coverage is available through a stand-alone dental policy

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
  • Acupuncture
  • Cosmetic Surgery
  • Dental care (Adult)
  • Dental care (Child) (coverage available through a stand-alone dental policy)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Routine eye care (Adult)
  • Routine foot care
  • Weight loss programs
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
  • Bariatric surgery
  • Chiropractic care (limited to 25 visits annual max)
  • Elective abortion
  • Hearing aids (limited to 1 hearing aid per ear every 2 years)
  • Infertility treatment
  • Private-duty nursing

Cigna Connect 1000

Summary of Benefits

Important Questions Answers Why this Matters:
What is the overall deductible?$1,000 Individual or
$2,000 Family
Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible.
Are there services covered before you meet your deductible?Yes. Preventive care, office visits subject to a copayment, Prescription drugs subject to a copayment, Urgent care and eye exam/glasses for children are covered before you meet your deductible.This plan covers some items and services even if you haven’t yet met the deductible amount. But a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost-sharing and before you meet your deductible. See a list of covered preventive
services at https://www.healthcare.gov/coverage/preventive-care-benefits/.
Are there other
deductibles for specific
services?
NoYou don’t have to meet deductibles for specific services
What is the out-of-pocket
limit for this plan?
$8,150 Individual or
$16,300 Family
The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met.
What is not included in
the out-of-pocket limit?
Premiums, balance-billing charges, penalties for failure to
obtain preauthorization for services and health care this plan
doesn’t cover.
Even though you pay these expenses, they don’t count toward the out-of-pocket limit.
Will you pay less if you use a network provider? Yes. See www.cigna.com/ifpproviders or call 1-866-494-2111
for a list of network providers.
This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing). Be aware, your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services.
Do you need a referral to
see a specialist?
YesThis plan will pay some or all of the costs to see a specialist for covered services but only if you have a referral before you see the specialist.
Common Medical EventServices You May Need

Your cost if you use
a Participating
Provider (You will pay the least)

Your cost if you use
a Non-Participating
Provider (You will pay the most)

Limitations & Exceptions, & Other Important Information
If you visit a health care provider’s office or clinicPrimary care visit to treat an injury or illness

$20 copayment/visit;
deductible does not
apply. Virtual visit with a Cigna Telehealth
Connection Physician
No charge.

Not covered

Refer to the policy for more information about Virtual Telehealth Visits.
Specialist visit

$60 copayment/visit;
deductible does not
apply.

Not covered

None
Preventive care/screening/immunization

No charge

Not covered

You may have to pay for services that aren’t preventive. Ask your provider if the services are needed are preventive. Then check what your plan will pay for.
If you have a testDiagnostic test (x-ray, blood work)

30% coinsurance

Not covered

None
Imaging (CT / PET scans, MRIs)

30% coinsurance

Not covered

None
If you need drugs to
treat your illness or
condition. More information about
prescription drug
coverage is available at
www.cigna.com/ifpdrug-list
Preferred generic drugs

$10 copayment (retail)/
$30 copayment (home
delivery); deductible
does not apply

Not coveredLimited to a 30 day supply at any participating pharmacy or up to a 90 day supply at a
designated 90 day retail pharmacy/home delivery. You pay copayment for each 30-day
supply (retail).
Generic drugs

$25 copayment (retail)/
$75 copayment (home
delivery); deductible
does not apply

Not covered
Preferred brand drugs

$35 copayment (retail)/
$105 copayment (home
delivery); deductible
does not apply

Not covered

Non-preferred drugs

50% coinsurance
(retail/home delivery)

Not covered

Specialty drugs and other high cost drugs40 % coinsurance (retail/home therapy) Not covered
If you have outpatient
surgery
Facility fee (e.g., ambulatory surgery center)30% coinsurance

Not covered

None
Physician/surgeon fees

30% coinsurance

Not covered

If you need immediate
medical attention
Emergency room care

$1,000 copayment/visit

$1,000 copayment/visit

You pay the same level as In-network if it is an emergency as defined in your plan, otherwise not covered.
Emergency medical transportation

30% coinsurance

30% coinsurance

You pay the same level as In-network if it is an emergency as defined in your plan, otherwise not covered.
Urgent care

$50 copayment /visit;
deductible does not
apply

$50 copayment /visit;
deductible does not
apply

You pay the same level as In-network if it is an emergency as defined in your plan, otherwise not covered.
If you have a hospital
stay
Facility fee (e.g., hospital room)

30% coinsurance

Not covered

None
Physician/surgeon fee

30% coinsurance

Not covered

If you have mental
health, behavioral
health, or substance
abuse needs
Outpatient services$20 copayment /visit;
deductible does not
apply and 30%
coinsurance for all other
outpatient services.

Not covered

None
Inpatient services

30% coinsurance

Not covered

None
If you are pregnantOffice visits

30% coinsurance

Not covered

Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery professional services

30% coinsurance

Not covered

Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
Childbirth/delivery facility services

30% coinsurance

Not covered

Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).
If you need help
recovering or have other special health needs
Home health care

30% coinsurance

Not covered

None

Cardiac – Limited to a maximum of 36
treatment sessions within a 6 month period.

None

 

None

Rehabilitation services

30% coinsurance

Not covered

Habilitation services

30% coinsurance

Not covered

Skilled nursing care

30% coinsurance

Not covered

Durable medical equipment

30% coinsurance

Not covered

None
Hospice service30% coinsurance

Not covered

None
If your child needs
dental or eye care
Children’s eye exam

No Charge

Not covered

Children up to age 19. Coverage limited to one exam/year
Children’s glasses

No Charge

Not covered

Children up to age 19. Coverage limited to one pair of glasses/year.
Children’s dental check-up

No Charge

Not Covered

Coverage is available through a stand-alone dental policy

Excluded Services & Other Covered Services:

Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services.)
  • Acupuncture
  • Cosmetic Surgery
  • Dental care (Child) (coverage available through a stand-alone dental policy)
  • Long-term care
  • Non-emergency care when traveling outside the U.S.
  • Routine eye care (Adult)
  • Routine foot care
  • Weight loss programs
Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.)
  • Bariatric surgery
  • Chiropractic care (limited to 25 visits annual max)
  • Elective abortion
  • Hearing aids (limited to 1 hearing aid per ear every 2 years)
  • Infertility treatment
  • Private-duty nursing