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Cigna Plan G HDHP 2

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

GENERAL INFORMATION

Who's covered?

Individual

In Network?

No

Annual Deductible

$4000

Out of Pocket Max

$12000

NON-EMERGENT SERVICES

Outpatient

Not covered

Preventative Care

Primary Care

80% after deductible

80% after deductible

Specialist Visit

80% after deductible

Telemedicine Visit

80% after deductible

EMERGENT SERVICES

Inpatient

Not covered

Urgent Care

100% after deductible

Emergency Room

Not covered

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