2024 Cigna Plus Gold Options
Cigna Plus 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 Name | Plus Gold CMS Standard |
| Deductible | $1,500 individual and 25% coinsurance after deductible |
| Coinsurance | $1,500/$3,000 |
| Out-of-Pocket Maximum | $8,700/$17,400 |
| PCP/Specialist | You pay $30, deductible waived/You pay $60, deductible waived |
Cigna Plus CMS Standard Gold
| Important Questions | Answers | Why this Matters: |
| What is the overall deductible? | $1,500 person/ $3,000 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 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? |
No | You don’t have to meet deductibles for specific services |
| What is the out-of-pocket limit for this plan? |
$8,700 person/ $17,400 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? |
Yes | This 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 Event | Services You May Need |
Your cost if you use |
Your cost if you use |
Limitations & Exceptions, & Other Important Information |
| If you visit a health care provider’s office or clinic | Primary care visit to treat an injury or illness |
$30 copayment/visit; deductible does not apply. |
Not covered |
Refer to the policy for more information about Virtual Care Services. |
| 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 test | Diagnostic test (x-ray, blood work) |
25% coinsurance |
Not covered |
None |
| Imaging (CT / PET scans, MRIs) |
25% 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 |
$15 copayment (retail)/ $45 copayment (home delivery); deductible does not apply. |
Not covered | Limited 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 |
$15 copayment (retail)/ $45 copayment (home delivery); deductible does not apply. |
Not covered | ||
| Preferred brand drugs |
$30 copayment (retail)/ $90 copayment (home delivery); deductible does not apply. |
Not covered |
||
| Non-preferred drugs |
$60 copayment (retail)/ $180 copayment (home delivery); deductible does not apply. |
Not covered |
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| Specialty drugs and other high cost drugs | $250 copayment (retail)/ $250 copayment (home delivery); deductible does not apply. | Not covered | ||
| If you have outpatient surgery |
Facility fee (e.g., ambulatory surgery center) | 25% coinsurance |
Not covered |
None |
| Physician/surgeon fees |
25% coinsurance |
Not covered |
||
| If you need immediate medical attention |
Emergency room care |
25% coinsurance |
0% coinsurance |
You pay the same level as In-network if it is an emergency as defined in your plan, otherwise not covered. |
| Emergency medical transportation |
25% coinsurance |
0% coinsurance |
You pay the same level as In-network if it is an emergency as defined in your plan, otherwise not covered. | |
| Urgent care |
$45 copayment/visit; deductible does not apply. |
0% coinsurance |
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) |
25% coinsurance |
Not covered |
None |
| Physician/surgeon fee |
25% coinsurance |
Not covered |
||
| If you have mental health, behavioral health, or substance abuse needs |
Outpatient services | $30 copayment/visit; deductible does not apply and 25% coinsurance all other outpatient services. |
Not covered |
None |
| Inpatient services |
25% coinsurance |
Not covered |
None | |
| If you are pregnant | Office visits |
25% 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 |
25% 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 |
25% 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 |
25% coinsurance |
Not covered |
None
Cardiac – Limited to a maximum of 36
None
None |
| Rehabilitation services |
$30 copayment /visit for physical, occupational and speech therapy; deductible does not apply; 25% coinsurance for all other services. |
Not covered |
||
| Habilitation services |
$30 copayment/visit; deductible does not apply |
Not covered |
||
| Skilled nursing care |
25% coinsurance |
Not covered |
||
| Durable medical equipment |
25% coinsurance |
Not covered |
None | |
| Hospice service | 25% 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 | 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.) |
|
| Other Covered Services (Limitations may apply to these services. This isn’t a complete list. Please see your plan document.) |
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