Cigna Connect Flex Gold 700 Rx Copay – EPO
Network type: EPO
Coverage tier: Gold
Primary care visit: No charge
Specialist visit: $60 copay
Urgent care visit: $40 copay
Description
Health Care Plan Details
| Network type | EPO |
| Deductible | $700 per person $700 per person |
| Out-of-pocket max | $9,000 per person $18,000 per family |
| Metal tier | Gold |
Visit Copay
| Primary care visit | No charge |
| Specialist visit | $60 copay |
| Preventive care visit | No charge |
Urgent, Emergency Care, and Hospital Care
| Urgent care | $40 copay |
| Emergency room | $500 copay after deductible |
| Ambulance | 25% coinsurance after deductible |
| Hospital stay (facility) | 25% coinsurance after deductible |
| Hospital stay (physician) | 25% coinsurance after deductible |
| Outpatient procedure (facility) | 25% coinsurance after deductible |
| Outpatient procedure (physician) | 25% coinsurance after deductible |
| Physical rehabilitation | No charge |
Maternitowny and Pregnancy
| Well baby care | No charge |
| Labor, delivery, hospital stay | 25% coinsurance after deductible |
Pharmacy, Drugs, and Medication
| Generic | $10 copay |
| Brand | $55 copay |
| Non-preferred Brand | $500 copay |
| Specialty | $725 copay |
Lab Tests and Diagnostic Procedures
| X-rays | 25% coinsurance after deductible |
| Imaging (CT/PET/MRI) | 25% coinsurance after deductible |
| Blood work | $50 copay |
Mental and Psychiatric Health Care
| Mental Health outpatient services | 25% coinsurance after deductible |
| Psychiatric hospital stay | 25% coinsurance after deductible |
Health Plan Provider Information
| Health Plan Benefits | https://www.cigna.com/static/www-cigna-com/docs/ifp/m-24-sbc-co-944423-g-connectflex700rx.pdf |
| Drug and medication plan formulary | https://www.cigna.com/ifp-drug-lists |
| Search doctor list | https://www.cigna.com/ifp-providers |
