Cigna Silver PPO
These plans are for those who are looking for comprehensive coverage that includes low office visit copayments.
Cigna Silver PPO - 2015
Health Insurance Plans for Individuals and Families
These plans are for those who are looking for comprehensive coverage that includes low office visit copayments with an unlimited number of office visits per calendar year and no charge for annual
physical exams. There is an individual calendar deductible of $2,000 and a family deductible of $4,000. All covered services contribute to the out-of-pocket maximum. Preventive care services, such as routine physical exams and mammogram screenings, are at no charge. This is the most popular Cigna plan in California and will satisfy your mandated individual health insurance requirement also known as "minimum essential health coverage ".
| Plan Name | Silver PPO |
| Medical Deductible | Individual: $2,000 Family: $4,000 |
| Drug Benefits Deductible | Individual: $250 Family: $500 |
| Default Medical Coinsurance | 20% |
| Default Drug Coinsurance | 20% |
| Annual Out-of-Pocket | |
| Out of Pocket Max for Med and Drug EHB Benefits (Total) | Individual: $6,250 Family: $12,500 |
| Emergency Health | |
| Urgent Care Centers or Facilities | $90 |
| Emergency Room Services | $250 Copay after deductible |
| Emergency Transportation/Ambulance | $250 Copay after deductible |
| Home Health Care | |
| Home Health Care Services | 20% |
| Hospitalization Services | |
| Inpatient Physician and Surgical Services | 20% |
| Habilitation Services | $45 |
| Inpatient Hospital Services (e.g., Hospital Stay) | 20% Coinsurance after deductible |
| Skilled Nursing Facility | 20% Coinsurance after deductible |
| Substance Abuse Disorder Outpatient Services | $45 |
| Substance Abuse Disorder Inpatient Services | 20% Coinsurance after deductible |
| Maternity Care | |
| Delivery and All Inpatient Services for Maternity Care | 20% Coinsurance after deductible |
| Prenatal and Postnatal Care | No Charge |
| Other Services | |
| Mental/Behavioral Health Inpatient Services | 20% Coinsurance after deductible |
| Durable Medical Equipment | 20% Coinsurance after deductible |
| Hospice Services | No Charge |
| Bariatric Surgery | 20% Coinsurance after deductible |
| Mental/Behavioral Health Outpatient Services | $45 |
| Acupuncture | 20% Coinsurance after deductible |
| Rehabilitative Speech Therapy | $45 |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $45 |
| Allergy Testing | 20% Coinsurance after deductible |
| Chemotherapy | 20% Coinsurance after deductible |
| Diabetes Education | 20% Coinsurance after deductible |
| Dialysis | 20% Coinsurance after deductible |
| Infusion Therapy | 20% Coinsurance after deductible |
| Prosthetic Devices | 20% Coinsurance after deductible |
| Radiation | 20% Coinsurance after deductible |
| Reconstructive Surgery | 20% Coinsurance after deductible |
| Transplant | 20% Coinsurance after deductible |
| Treatment for Temporomandibular Joint Disorders | 20% Coinsurance after deductible |
| Outpatient Services | |
| Outpatient Surgery Physician/Surgical Services | 20% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | 20% |
| Outpatient Rehabilitation Services | $45 |
| Prescription Drug Coverage | |
| Generic Drugs | $15 |
| Non-Preferred Brand Drugs | $70 Copay after deductible |
| Preferred Brand Drugs | $50 Copay after deductible |
| Specialty Drugs | 20% Coinsurance after deductible |
| Preventative Care | |
| Well Baby Visits and Care | No Charge |
| Preventive Care/Screening/Immunization | No Charge |
| Professional Services | |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $45 |
| Imaging (CT/PET Scans, MRIs) | 20% Coinsurance after deductible |
| X-rays and Diagnostic Imaging | 20% Coinsurance after deductible |
| Specialist Visit | $65 |
| Laboratory Outpatient and Professional Services | $45 |
| Primary Care Visit to Treat an Injury or Illness | $45 |
Benefits stated above are using in network preferred providers only. Click here for provider information.
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