Cigna Connect 0B

99248TN0060104
Silver
EPO

Cigna Connect 0B is a Silver EPO plan by Cigna Healthcare.

IMPORTANT: You are viewing the 2023 version of Cigna Connect 0B 99248TN0060104. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

Cigna Connect 0B is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Cigna Connect 0B 99248TN0060104.
Insurer: Cigna Healthcare
Network Type: EPO
Metal Type: Silver
HSA Eligible?: No
Plan ID: 99248TN0060104

Cost-Sharing Overview

Cigna Connect 0B offers the following cost-sharing.

Notes:

  • Some plans have separate cost-sharing for medical and drugs, while other plans offer combined cost-sharing. The cost-sharing amounts above are combined medical and drug costs unless otherwise noted.
  • You are viewing the standard version of this plan. Your costs may be lower depending on your income. Use the “get a quote” button below to see your estimated premium and out-of-pocket costs after assistance.
Ready to sign up for Cigna Connect 0B?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

Plan Features

Cigna Connect 0B offers the following features and referral requirements.

Wellness Program: No
Disease Program: Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy
Notice Pregnancy: No
Referral Specialist: No
Specialist Requiring Referral:
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Cigna Connect 0B covers when you are out of the service area or out of the country.

Out of Country Coverage: Yes
Out of Country Coverage Description: Emergency Services Only
Out of Service Area Coverage: Yes
Out of Service Area Coverage Description: Emergency Services Only
National Network: No

Additional Benefits and Cost-Sharing

Cigna Connect 0B includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Infusion Therapy
Covered
50.00% 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
50.00% 100.00%
Nutritional Counseling
Covered
50.00% 100.00% Unlimited visits limited to Nutritional Counseling associated with Home Health and Diabetes Management. Services associated with Preventive Care are covered at the Preventive Care benefit level and treatment described in connection with a mental health or substance abuse diagnosis are covered at the Outpatient Mental Health benefit level
Reconstructive Surgery
Covered
50.00% 100.00%
Gender Affirming Care
Tier 2 Generic Drugs
Covered
$35.00 100.00% Up to a 30 day supply at any participating pharmacy, or up to a 90 day supply at any participating 90 day retail pharmacy. You pay a copayment for each 30 day supply.
Primary Care Visit to Treat an Injury or Illness
Covered
$45.00 100.00% Refer to the policy for more information about Virtual Care Services.
Specialist Visit
Covered
$100.00 100.00% Includes Mental Health Office Visits and Substance Use Disorder Office Visits.
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$100.00 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
50.00% 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
50.00% 100.00%
Hospice Services
Covered
50.00% 100.00%
Routine Dental Services (Adult)
Infertility Treatment
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Routine Eye Exam (Adult)
Urgent Care Centers or Facilities
Covered
$60.00 $60.00 Out-of-network: You pay the same level as In-network if it is an emergency as defined in your plan, otherwise Not covered.
Home Health Care Services
Covered
50.00% 100.00%60 Visit(s) per Year
Emergency Room Services
Covered
50.00% 50.00% Out-of-network: You pay the same level as In-network if it is an emergency as defined in your plan, otherwise Not covered.
Emergency Transportation/Ambulance
Covered
50.00% 50.00% Out-of-network: You pay the same level as In-network if it is an emergency as defined in your plan, otherwise Not covered.
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
50.00% 100.00%
Inpatient Physician and Surgical Services
Covered
50.00% 100.00%
Bariatric Surgery
Cosmetic Surgery
Skilled Nursing Facility
Covered
50.00% 100.00%60 Days per Year
Prenatal and Postnatal Care
Covered
50.00% 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
50.00% 100.00%
Mental/Behavioral Health Outpatient Services
Covered
50.00% 100.00% This benefit applies to All Other Outpatient Services excluding Office Visits. Please refer to the Specialist Office Visit benefit and to the SBC for more information.
Mental/Behavioral Health Inpatient Services
Covered
50.00% 100.00%
Substance Abuse Disorder Outpatient Services
Covered
50.00% 100.00% This benefit applies to All Other Outpatient Services excluding Office Visits. Please refer to the Specialist Office Visit benefit and to the SBC for more information.
Substance Abuse Disorder Inpatient Services
Covered
50.00% 100.00%
Generic Drugs
Covered
$5.00 100.00% Cost sharing shown applies to Tier 1-Preferred Generic Drugs only. See Summary of Benefits and the policy or service agreement for more information on an additional category, Tier 2-Generic Drugs, which may apply a higher cost share. Up to a 30 day supply at any participating pharmacy, or up to a 90 day supply at any participating 90 day retail pharmacy. You pay a copayment for each 30 day supply. Formulary Diabetic Supplies are covered at no charge. Refer to the prescription drug list for more information.
Preferred Brand Drugs
Covered
50.00% 100.00% Up to a 30 day supply at any participating pharmacy, or up to a 90 day supply at any participating 90 day retail pharmacy. Formulary Diabetic Supplies are covered at no charge. Refer to the prescription drug list for more information.
Non-Preferred Brand Drugs
Covered
50.00% 100.00% Up to a 30 day supply at any participating pharmacy, or up to a 90 day supply at any participating 90 day retail pharmacy.
Specialty Drugs
Covered
50.00% 100.00% Including other high cost drugs. Up to a 30 day supply at any participating pharmacy, or up to a 30 day supply at any participating 90 day retail pharmacy.
Outpatient Rehabilitation Services
Covered
50.00% 100.00% Physical Therapy limited to 20 visits per year; Occupational Therapy limited to 20 visits per year; Speech Therapy limited to 20 visits per year.
Habilitation Services
Covered
50.00% 100.00% Physical Therapy limited to 20 visits per year; Occupational Therapy limited to 20 visits per year; Speech Therapy limited to 20 visits per year.
Chiropractic Care
Covered
50.00% 100.00%20 Visit(s) per Year
Durable Medical Equipment
Covered
50.00% 100.00%
Hearing Aids
Covered
50.00% 100.00% Hearing Aid Devices – 1 Hearing Aid per ear, every 3 years Hearing Aid Exam/Evaluation – Only services necessary to select, fit and adjust the hearing aid are included in this benefit. Bone Anchored Hearing Aids – Not Covered
Imaging (CT/PET Scans, MRIs)
Covered
50.00% 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge 100.00%
Routine Foot Care
Acupuncture
Weight Loss Programs
Routine Eye Exam for Children
Covered
No Charge 100.00%1 Visit(s) per Year Up to age 19.
Eye Glasses for Children
Covered
No Charge 100.00%1 Item(s) per Year Up to age 19. One pair of glasses (lenses and frames from the pediatric selection) per year. May receive one pair of contact lenses, including professional services, in lieu of lenses and frame benefit. May not receive contact lenses and frames/lenses in same benefit year.
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
50.00% 100.00%20 Visit(s) per Year Same limits and coverage apply for habilitative services.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
50.00% 100.00% Limited to 20 visits per year for Occupational therapy and 20 visits per year for Physical therapy; same visits and coverage apply to habilitative services.
Well Baby Visits and Care
Covered
No Charge 100.00%
Laboratory Outpatient and Professional Services
Covered
50.00% 100.00% Refer to the policy for more information regarding Diabetes.
X-rays and Diagnostic Imaging
Covered
50.00% 100.00%
Basic Dental Care – Child
Not Covered
Orthodontia – Child
Not Covered
Major Dental Care – Child
Not Covered
Basic Dental Care – Adult
Orthodontia – Adult
Major Dental Care – Adult
Abortion for Which Public Funding is Prohibited
Transplant
Covered
50.00% 100.00% Lifesource Transplant Network travel benefit maximum of $10,000 per insured person per transplant. Coverage for travel expenses not available for services outside of the Lifesource Transplant Network.
Accidental Dental
Covered
50.00% 100.00%
Dialysis
Covered
50.00% 100.00% Benefit depends on place of treatment.
Allergy Testing
Covered
50.00% 100.00%
Chemotherapy
Covered
50.00% 100.00%
Radiation
Covered
50.00% 100.00%
Diabetes Education
Covered
No Charge 100.00%
Prosthetic Devices
Covered
50.00% 100.00%

Free Preventive Services

There is no copayment or coinsurance for any of the following Cigna Connect 0B preventive services. This is true even if you haven’t met your yearly deductible.

Please note, these services are free only when delivered by a doctor or other provider in your plan’s network.

Additional Resources

Below are additional resources for Cigna Connect 0B including the Summary of Benefits & Coverage (SBC), plan brochure, formulary link, and a link to the website to pay your monthly premium after you enroll.

Summary of Benefits: Summary of Benefits Link
Plan Brochure: Plan Brochure Link
Formulary: Formulary Link
Premium Payment Website: Premium Payment Link
Ready to sign up for Cigna Connect 0B?

Click or call to enroll online, get a quote, or find out if you qualify for assistance.
Get Help from a licensed agent. 1-877-668-0904

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