Cigna Medical
You have three plan options to choose from through Cigna. Cigna plans offer out-of-network coverage and additional wellness and support programs. All plans include free preventive care and free preventive care medications. Additionally, Cigna members have access to Paladina which offers affordable and convenient primary, preventive, and urgent care services. Please note that while Paladina does not show as a Cigna network provider, it is a care option for Cigna members.
Cigna One Guide
Cigna One Guide is here to ensure you’re able to make the best decisions possible when it comes to your health care needs.
Pre-Enrollment Support
Cigna One Guide is a service available to you during the enrollment period to help determine your health care needs and best plan option. You don’t have to be a current Cigna member to take advantage of this service. Your personal guide will help you:
- Easily understand the basics of health coverage
- Identify the types of health plans available to you
- Check if your doctors are in-network
- Get answers to other questions you have
If you could use support in understanding your health plan options, call 888-806-5042.
Post-Enrollment Support
Cigna members can continue to rely on the Cigna One Guide team. Your Cigna One Guide can help you:
- Learn how your coverage works
- Find in-network care providers
- Connect with health coaches
- Connect with dedicated one-on-one support for complex health situations
- Get cost estimates
To get in touch with your Cigna One Guide, visit www.mycigna.com, download the MyCigna app, or call 800-244-6224.
Cigna Medical Plan Comparison
You have access to three Cigna medical plan options. Cigna offers both in-network and out-of-network coverage. For employees who don’t have easy access to in-network facilities, members of Cigna also have access to primary care through Paladina.
| Plan Features | Cigna Copay Plus | Cigna Copay Basic | Cigna HDHP (HSA Qualified) | |||
|---|---|---|---|---|---|---|
| In-Network | Out-of-Network | In-Network | Out-of-Network | In-Network | Out-of-Network | |
| Annual Deductible | $750 individual* $2,000 family* |
$1,500 individual* $3,000 family* |
$1,250 individual* $2,500 family* |
$3,000 individual* $6,000 family* |
$1,750 individual** $3,500 family** |
$4,500 individual** $6,000 family** |
| Employee Coinsurance | 20% | 50% | 20% | 50% | 25% | 50% |
| Annual Out-of-Pocket Maximum*** |
$3,500 individual $7,000 family |
$7,000 individual $14,000 family |
$4,500 individual $9,000 family |
$10,000 individual $20,000 family |
$5,000 individual $8,000 individual within a family $10,000 family |
$9,000 individual $14,400 individual within a family $18,000 family |
| Annual Company HSA Contribution | None | None | Up to $720 | |||
| You pay: | ||||||
| Preventive Care Visit |
Covered in full | Covered in full | Covered in full | |||
| Primary Care Visit |
$20 copay | 50% after deductible | $20 copay | 50% after deductible | 25% after deductible | 50% after deductible |
| Paladina Primary Care Visit |
$0 copay | $0 copay | $40 copay | |||
| Specialist Visit | $40 copay | 50% after deductible | $40 copay | 50% after deductible | 25% after deductible | 50% after deductible |
| Urgent Care | $75 copay | 50% after deductible | $75 copay | 50% after deductible | 25% after deductible | 50% after deductible |
| Emergency Room (copay waived if admitted) |
$1,000 copay | 20% after deductible | 25% after deductible | |||
| Inpatient Services | 20% after deductible | 50% after deductible | 20% after deductible | 50% after deductible | 25% after deductible | 50% after deductible |
| Prescription Drugs: Retail (up to a 30-day supply) | ||||||
| Preventive | Covered in full if prescribed by a doctor | |||||
| Generic | $10 copay | Not covered | $7 copay | Not covered | $10 copay after deductible | Not covered |
| Brand Formulary | $30 copay | Not covered | $30 copay | Not covered | $40 copay after deductible | Not covered |
| Non-Formulary | $60 copay | Not covered | $60 copay | Not covered | $60 copay after deductible | Not covered |
| Specialty | 20% up to $120 copay |
Not covered | 20% up to $120 copay |
Not covered | 25% after deductible up to $120 copay |
Not covered |
| Prescription Drugs: Mail Order (up to a 90-day supply) | ||||||
| Generic | $20 copay | Not covered | $14 copay | Not covered | $20 copay after deductible |
Not covered |
| Brand Formulary | $60 copay | Not covered | $60 copay | Not covered | $80 copay after deductible |
Not covered |
| Non-Formulary | $120 copay | Not covered | $120 copay | Not covered | $120 copay after deductible |
Not covered |
| Specialty | 20% up to $240 copay |
Not covered | 20% up to $240 copay |
Not covered | 25% after deductible up to $240 copay |
Not covered |
*Deductible is embedded. Family members meet only their individual deductible and then their claims will be covered under the plan coinsurance; if the family deductible has been met prior to their individual deductible being met, their claims will be paid at the plan coinsurance.
**Deductible is aggregate. All family members contribute towards the family deductible. An individual cannot have claims covered under the plan coinsurance until the total family deductible has been satisfied.
***Out-of-pocket max is embedded. After each eligible family member meets his or her individual out-of-pocket maximum, the plan will pay 100% of their covered expenses. Or, after the family out-of-pocket maximum has been met, the plan will pay 100% of each eligible family member’s covered expenses.
No-Cost Preventive Prescriptions
Both Cigna and Kaiser medical plans include preventive care medications at no out-of-pocket cost to you. You can use your OptumRX member ID card to get free preventive care medications providing that the medication is:
- Prescribed by a health care professional
- Age and condition appropriate
- Filled at an in-network pharmacy
Examples of covered medications include:
- Asprin, folic acid, and other select common over-the-counter medications
- Nicotine cessation medications
- Human immunodeficiency virus preventive medications
- Breast cancer preventive medications
- Statin preventive medications
- Birth control products
- Flu shots and other vaccines
For pharmacy-related resources and tools including an in-network pharmacy locator, visit www.optumrx.com/oe_stateofcolorado. For customer service including home delivery, call 844-564-2201 or 800-498-5428 (TDHI for hearing impaired).
Finding a Doctor
Save money by using in-network services. To find a doctor, visit www.mycigna.com.
Is Your Doctor Not Currently In-Network? Submit a Doctor Request Form and Cigna will reach out to your doctor to see if they can be brought into the Cigna Network.
Surgical and Treatment Support Program
Cigna’s Surgical Treatment and Support Program covers you in the event of certain non-emergency surgeries. This benefit is offered at no additional cost to you and your covered dependents, and the eligible procedures are 100% covered by the plan with no copay or coinsurance (deductible must be met for Cigna HDHP participants).
Covered procedures include:
- Low back disk surgery
- Hip arthroplasty
- Hip replacement
- Knee arthroplasty
- Knee replacement
- Laminectomy
- Spinal fusion
To take advantage of this benefit, call 855-678-0042.
