Cigna Healthcare Plans

Health Plan Transparency Machine Readable Files https://www.ticmrf.com/59-6000572

This link leads to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and includes negotiated service rates and out-of-network allowed- amounts between health plans and healthcare providers. The machine-readable files are formatted to allow researchers, regulators, and application developers to more easily access and analyze data.

Healthcare Plan Comparison

Cigna OAP Extended Network

  • No referrals needed when seeking care from a specialists
  • Includes In & Out-of-Network Providers
  • If you and/or your covered dependents are away from your local area you can access care using any OAP provider in the nation.
  • Significant premium deferential between the OAP Extended plan and the other two Cigna plans.

Cigna OAP Extended Network

  • No referrals are needed when seeking care from a Specialist
  • Includes In & Out-of-Network Providers
  • If you and/or your covered dependents are in your local area, or when in any LocalPlus network area, you must receive care from a health care professional or facility in this network to receive in-network coverage. If you and/or your covered dependents are temporarily away from your local area or another LocalPlus network area, you have extra peace of mind knowing you can access in-network providers or hospitals through Cigna’s nationwide Away From Home Care feature.
  • If you choose to go outside the LocalPlus network when one is available (or outside the Away From Home Care feature when LocalPlus isn’t available), you will receive out-of-network coverage.

Cigna OAP Extended Network

  • No referrals are needed when seeking care from a Specialist.
  • Narrow network (In-Network Providers only). You must live in the tri-county (Miami-Dade, Broward, and Palm Beach) service area. However, emergency and most urgent care services are covered at the in-network benefit level without an authorization.
  • You and your covered dependent(s) are required to select a Primary Care Provider (PCP) at the time of enrollment. However, you may visit any participating provider in the network and receive the same level of coverage. If a PCP is not selected, Cigna will assign you a participating provider based on your ZIP code.
  • You can connect with a board-certified doctor without leaving your home or office with MDLIVE®. Perfect for when you’re traveling or unable to access your PCP. Visit myCigna.com or call MDLIVE at 888.726.3171 when you need virtual care.

Prescription Coverage

Pharmacy Networks:

Behavioral Health

Urgent & Convenience Care Centers

Tools & Resources

FAQ

1. What is a co-payment?

A co-payment is a fixed dollar amount you pay for covered healthcare services. The amount will
vary by type of plan and covered service.

2. What is a Tier 1 provider?

A Tier 1 provider is a provider of a designated network that has been identified by Cigna to have demonstrated the best outcome in management in patient treatment. This network includes both primary care physicians and specialists.

3. What specialties are included in this network?

There are 22 specialist providers located in South Florida.

4. How do I determine if my specialist is a Tier 1 provider?

Log-in to www.mycigna.com and click on Find Care and Costs. You can search by name or specialty. Once you’re on the online directory, look for Tier 1 provider designation.

5. Do I need a referral to see a specialist?

No. Referrals are not needed in any of the three Cigna healthcare plans.

6. What is an annual deductible?

An annual deductible is the annual amount you are responsible for medical services provided in a hospital or hospital-affiliated facility. This amount is separate from any co-payments.

7. What does the annual maximum out-of-pocket (MOOP) mean?

The annual maximum out-of-pocket is the amount you are responsible for before the plan pays 100 percent.

8. What does the plan co-insurance mean?

The plan co-insurance is the percentage by plan you pay for medical services provided in a hospital or hospital-affiliated facility. Co-insurance does not apply to fixed co-payments.

9. What happens if I am hospitalized?

Hospital admissions are subject to deductibles and co-insurance.