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Cigna Plan E PPO 3

Unless stated otherwise, percentages reflect proportion of cost covered by insurance plan.

GENERAL INFORMATION

Who's covered?

Family

In Network?

Yes

Annual Deductible

$1500

Out of Pocket Max

$9000

NON-EMERGENT SERVICES

Outpatient

80% after deductible

Preventative Care

Primary Care

$0

$20 copay

Specialist Visit

$40 copay

Telemedicine Visit

$20 copay

EMERGENT SERVICES

Inpatient

80% after deductible

Urgent Care

$75 copay

Emergency Room

$150 copay

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