CIGNA High Deductible Health Plan (HDHP) - UCAR Finance ...

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In addition, if at any time a Primary Care Physician ceases to be a Participating Provider, you or your Dependent will be notified for the purpose of selecting a new Primary Care Physician, if you choose. HC-IMP1 04-10 V1 10 myCIGNA.com
For You and Your Dependents Open Access Plus Medical Benefits The Schedule Open Access Plus Medical Benefits provide coverage for care In-Network and Out-of-Network. To receive Open Access Plus Medical Benefits, you and your Dependents may be required to pay a portion of the Covered Expenses for services and supplies. That portion is the Deductible or Coinsurance. If you are unable to locate an In-Network Provider in your area who can provide you with a service or supply that is covered under this plan, you must call the number on the back of your I.D. card to obtain authorization for Out-of- Network Provider coverage. If you obtain authorization for services provided by an Out-of-Network Provider, benefits for those services will be covered at the In-Network benefit level. Coinsurance The term Coinsurance means the percentage of charges for Covered Expenses that an insured person is required to pay under the plan. Deductibles Deductibles are also expenses to be paid by you or your Dependent. Deductibles are in addition to any Coinsurance. Once the Deductible maximum in The Schedule has been reached, you and your family need not satisfy any further medical deductible for the rest of that year. Out-of-Pocket Expenses Out-of-Pocket Expenses are Covered Expenses incurred for In-Network and Out-of-Network charges that are not paid by the benefit plan because of any: • Coinsurance. • Plan deductibles. Charges will not accumulate toward the Out-of-Pocket Maximum for Covered Expenses incurred for: • non-compliance penalties. • provider charges in excess of the Maximum Reimbursable Charge. When the Out-of-Pocket Maximum shown in The Schedule is reached, Injury and Sickness benefits are payable at 100% except for: • non-compliance penalties. • provider charges in excess of the Maximum Reimbursable Charge. Accumulation of Plan Deductibles and Out-of-Pocket Maximums Deductibles and Out-of-Pocket Maximums will cross-accumulate (that is, In-Network will accumulate to Out-of-Network and Out-of-Network will accumulate to In-Network). All other plan maximums and service-specific maximums (dollar and occurrence) also cross-accumulate between In- and Out-of-Network unless otherwise noted. Contract Year Contract Year means a twelve month period beginning on each 01/01. Multiple Surgical Reduction Multiple surgeries performed during one operating session result in payment reduction of 50% to the surgery of lesser charge. The most expensive procedure is paid as any other surgery. 11 myCIGNA.com
Page 1: University Corporation for Atmosphe
Page 4 and 5: Women’s Health and Cancer Rights
Page 6 and 7: Explanation of Terms You will find
Page 8 and 9: provided by other parties to the Po
Page 12 and 13: Assistant Surgeon and Co-Surgeon Ch
Page 14 and 15: BENEFIT HIGHLIGHTS IN-NETWORK OUT-O
Page 22 and 23: • inpatient services at any parti
Page 24 and 25: • are unable to obtain the requir
Page 26 and 27: • counseling for occupational pro
Page 28 and 29: covered subject to the following co
Page 30 and 31: Prescription Drug Benefits For You
Page 32 and 33: • treatment of an Injury or Sickn
Page 34 and 35: Coordination of Benefits This secti
Page 36 and 37: Medicare Eligibles CIGNA will pay a
Page 38 and 39: Recovery of Overpayment When an ove
Page 40 and 41: in the Plan. You must request enrol
Page 42 and 43: If a child placed for adoption is n
Page 44 and 45: of the request. If more time is nee
Page 46 and 47: advance of the Committee’s decisi
Page 48 and 49: Medicare (Part A, Part B or both) w
Page 50 and 51: Trade Act of 2002 The Trade Act of
Page 52 and 53: In addition, if you disagree with t
Page 54 and 55: Employee The term Employee means a
Page 56 and 57: • rendered in the least intensive
Page 58 and 59: for injectables covered under the p
Page 60 and 61:
What You Should Know about CIGNA Ch
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