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CIGNA HMO

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CIGNA HMO
The CIGNA HMO plan is offered nationally wherever the CIGNA HMO network is available. If you choose the CIGNA HMO for your medical plan coverage, you must select a primary care physician (PCP) for yourself and each dependent. Your PCP is your personal physician — the doctor you see for all your routine medical care, including your annual physical, immunizations, and questions about health.

If you need to see a specialist, be admitted to a hospital, or have lab or x-ray work done, your PCP must refer you to an appropriate CIGNA HMO provider or facility. If you enroll in this plan, you must use the CIGNA HMO network or your care will not be covered, except in an emergency.

Here is a summary of the CIGNA HMO key benefits. Be sure not to miss the great programs listed at the end of the summary.

CIGNA HMO
HMO Benefits	CIGNA HMO Network
Annual Deductible Individual Family (2 or more persons)	None None
Annual Out-of-Pocket Maximum Individual Family (2 or more persons)	None None
Lifetime Maximum	Unlimited
Plan Coinsurance (what the plan pays)	Plan pays 100%
Physician Office Visits Primary Care Office Visits (including OB/GYN) Specialist Office Visits	$20 per visit copay $20 per visit copay
Routine Preventative Care Routine Physical Exams (adult) Well Woman Care (including Pap Test) Mammogram Well Child Care	$20 per visit copay $20 per visit copay Plan pays 100% $20 per visit copay
Urgent Care Facility Visit	$50 per visit copay, waived if admitted (This copay applies even if facility does not participate in CIGNA HMO network.)
Emergency Room Visit	$100 per visit copay, waived if admitted (This copay applies even if facility does not participate in CIGNA HMO network.)
Ambulance	Plan pays 100%
Inpatient Hospital Admission Facility Services Professional Services (Surgeon, Radiologist, Pathologist, Anesthesiologist)	Plan pays 100% after $100 copay per admission Plan pays 100% Plan pays 100%
Outpatient Pre-admission Diagnostic Tests	Plan pays 100%
Advanced Radiology Tests (excludes mammography and maternity-related services)	$20 copay
Outpatient Hospital Facility Services Professional Services (Surgeon, Radiologist, Pathologist, Anesthesiologist)	Plan pays 100% after a $50 per visit copay
Second Opinion (Includes all physician billed charges)	$20 per visit copay
Inpatient Rehabilitation Facility Cardiac Rehabilitation Cognitive Rehabilitation Occupational Therapy Physical Therapy Speech Therapy	Plan pays 100% after $100 copay per admission (up to 60 days per calendar year.)
Short-Term Therapy (Outpatient) Cardiac Rehabilitation Chiropractic Therapy Cognitive Rehabilitation Occupational Rehabilitation Physical Therapy Speech Therapy	$20 per office visit copay (up to 60 days per calendar year.)
Home Health Care	Plan pays 100%, unlimited visits
Hospice Care Inpatient Outpatient Bereavement Counseling (up to 3 sessions per occurrence, per family)	Plan pays 100%
Skilled Nursing Facility — (up to 60 days per calendar year, no prior hospitalization required)	Plan Pays 100%
Outpatient Private Duty Nursing (unlimited visits)	Plan pays 100%
Maternity Care All prenatal and postnatal visits and delivery Hospital Admission Inpatient physician visits and Consultations Birthing Centers	$20 copay for initial visit to confirm pregnancy – no copay thereafter Plan pays 100% Plan pays 100% Plan pay 100% if associated with in-network hospital
Infertility Testing and Diagnosis Includes testing, diagnosis, and diagnostic surgical procedures, and determination of treatment to correct medical condition.	$20 per visit copay $200 surgical copay (diagnostic procedures only)
Durable Medical Equipment (Based on medical necessity/ appropriateness)	Plan pay 100%
Temporomandibular Joint Dysfunction (TMJ) Office Visit Inpatient Facility Outpatient Facility Physician Services Appliances Medically necessary surgery	$20 per visit copay Plan pays 100% after $100 per admission copay Plan pays 100% after a $50 per visit copay Plan pays 100% Plan pays 100% Plan pays 100%
Mental Health Treatment Inpatient (unlimited days) Outpatient (individual/group therapy)	Plan pays 100% after $100 copay per admission $20 per visit copay
Substance Abuse Treatment Inpatient (30-day per calendar year maximum) Outpatient (60-day per calendar year maximum)	Plan pays 100% after $100 copay per admission $20 per visit copay
Programs
Enhanced CIGNA Healthy Babies Program* Lactation Pumps Lactation Consultants Lamaze/Birthing classes *Member must enroll within 1st or 2nd trimester and remain compliant throughout pregnancy	100% Enrollment during 1st trimester: $250 allowance for approved items Enrollment during 2nd trimester: $100 allowance for approved items

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