Cigna of Arizona Open Access 2000 Plan Information
Annual Individual Deductible
$1,000, $2,000
Annual Family Deductible
$3,000, $6,000
Coinsurance
Cigna pays 80% of eligible charges
Individual Out of Pocket Maximum
$2,500
Family Out of Pocket Maximum
$5,000
Life Time Maximum
$5,000,000 per member
Physician Services
Non-Specialist office visit: $25Copay
Specialist office visit: $50 Copay
Inpatient Physician Services: 80%
Surgery: 80%
Preventive Care
Children (through age 6) office visit: $25/$50 Copay
Children Immunizations: 100% deductible waived
Mammogram, Pap Smear, PSA, and Colonscopy: 100% deductible waived
Routine Physical: $25/$50 Copay
Inpatient Hospital Facility Services
In-Hospital Care Services: 80%
Outpatient Services
Lab, X-Ray, Ultrasound: 80%
CT scan and MRI: 80%
Cardio Pulmonary Rehab: 80%
Chiropractic Services,Physical Therapy,Occupational Therapy, Speech Therapy: $30 per visit/per member
Spinal Manipulation Therapy: $50 Copay
Outpatient Surgery: 80%
Emergency and Urgent Care Services
Hospital Emergency Room: 80%
Urgent Care Services: $50 Copay
Ambulance: 80%
Other Health Care Facilities
Skilled Nursing Facility, Rehabilitation Hospital and Sub Acute Facilities: 80%
Home Health: 80%
Hospice: 80%
Durable Medical Equipment
(Calendar year maximum of $5,000) 80%
Mental Health
In Patient: 80%
Out Patient: 80%
Prescription Drugs
Brand Name Deductible: $100 per member
Generic:$10 per 30-day supply
Brand Name: $35 per 30-day supply
Non Preferred Brand Name: $60 per 30-day supply
Self Injectibles: 80%
Other Cigna of Arizona health insurance plans:
