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

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BENEFIT HIGHLIGHTS IN-NETWORK OUT-OF-NETWORK Emergency and Urgent Care Services Physician’s Office Visit 90% after plan deductible 90% after plan deductible Hospital Emergency Room 90% after plan deductible 90% after plan deductible Outpatient Professional services (radiology, pathology and ER Physician) Urgent Care Facility or Outpatient Facility X-ray and/or Lab performed at the Emergency Room/Urgent Care Facility (billed by the facility as part of the ER/UC visit) Independent x-ray and/or Lab Facility in conjunction with an ER visit Advanced Radiological Imaging (i.e. MRIs, MRAs, CAT Scans, PET Scans etc.) 90% after plan deductible 90% after plan deductible 90% after plan deductible 90% after plan deductible 90% after plan deductible 90% after plan deductible 90% after plan deductible 90% after plan deductible 90% after plan deductible 90% after plan deductible Ambulance 90% after plan deductible 90% after plan deductible Inpatient Services at Other Health Care Facilities Includes Skilled Nursing Facility, Rehabilitation Hospital and Sub- Acute Facilities Contract Year Maximum: . 60 days combined Laboratory and Radiology Services (includes pre-admission testing) 90% after plan deductible 70% after plan deductible Physician’s Office Visit 90% after plan deductible 70% after plan deductible Outpatient Hospital Facility 90% after plan deductible 70% after plan deductible Independent X-ray and/or Lab Facility Advanced Radiological Imaging (i.e. MRIs, MRAs, CAT Scans and PET Scans) 90% after plan deductible 70% after plan deductible Physician’s Office Visit 90% after plan deductible 70% after plan deductible Inpatient Facility 90% after plan deductible 70% after plan deductible Outpatient Facility 90% after plan deductible 70% after plan deductible 16 myCIGNA.com
BENEFIT HIGHLIGHTS IN-NETWORK OUT-OF-NETWORK Outpatient Short-Term Rehabilitative Therapy and Chiropractic Services 90% after plan deductible 70% after plan deductible Contract Year Maximum: 60 days for all therapies combined Includes: Cardiac Rehab Physical Therapy Speech Therapy Occupational Therapy Pulmonary Rehab Cognitive Therapy Chiropractic Therapy (includes Chiropractors) . Home Health Care Contract Year Maximum: Unlimited (includes outpatient private nursing when approved as medically necessary) Hospice 90% after plan deductible 70% after plan deductible Inpatient Services 90% after plan deductible 70% after plan deductible Outpatient Services (same coinsurance level as Home Health Care) Bereavement Counseling Services provided as part of Hospice Care 90% after plan deductible 70% after plan deductible Inpatient 90% after plan deductible 70% after plan deductible Outpatient 90% after plan deductible 70% after plan deductible Services provided by Mental Health Professional Covered under Mental Health Benefit Covered under Mental Health Benefit 17 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 10 and 11: In addition, if at any time a Prima
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
Page 62: once to better understand side effe

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