Cigna Connect 6800 Enhanced Diabetes Care

76589TX0010016
Expanded Bronze
HMO

Cigna Connect 6800 Enhanced Diabetes Care is an Expanded Bronze HMO plan by Cigna Healthcare.

IMPORTANT: You are viewing the 2023 version of Cigna Connect 6800 Enhanced Diabetes Care 76589TX0010016. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

Cigna Connect 6800 Enhanced Diabetes Care is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Cigna Connect 6800 Enhanced Diabetes Care 76589TX0010016.
Insurer: Cigna Healthcare
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: No
Plan ID: 76589TX0010016

Cost-Sharing Overview

Cigna Connect 6800 Enhanced Diabetes Care 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 6800 Enhanced Diabetes Care?

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 6800 Enhanced Diabetes Care 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 6800 Enhanced Diabetes Care 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 6800 Enhanced Diabetes Care includes the following benefits at the cost sharing rates listed below.

Service In-Network
Copay / Coinsurance
Out-of-Network
Copay / Coinsurance
Limits and Explanation
Primary Care Visit to Treat an Injury or Illness
Covered
$50.00 100.00% Refer to the policy for more information about Virtual Care Services. Includes Mental Health Office Visits and Substance Use Disorder Office Visits.
Specialist Visit
Covered
$90.00 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$90.00 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
40.00% Coinsurance after deductible 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
40.00% Coinsurance after deductible 100.00%
Hospice Services
Covered
40.00% Coinsurance after deductible 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
$75.00 $75.00 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
40.00% Coinsurance after deductible 100.00%60 Visit(s) per Year
Emergency Room Services
Covered
40.00% Coinsurance after deductible 40.00% Coinsurance after deductible 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
40.00% Coinsurance after deductible 40.00% Coinsurance after deductible Coverage for Medically Necessary transport to the nearest facility capable of handling the Emergency Medical Condition. 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
40.00% Coinsurance after deductible 100.00%
Inpatient Physician and Surgical Services
Covered
40.00% Coinsurance after deductible 100.00%
Bariatric Surgery
Cosmetic Surgery
Skilled Nursing Facility
Covered
40.00% Coinsurance after deductible 100.00%25 Days per Year
Prenatal and Postnatal Care
Covered
40.00% Coinsurance after deductible 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
40.00% Coinsurance after deductible 100.00%
Mental/Behavioral Health Outpatient Services
Covered
40.00% Coinsurance after deductible 100.00% This benefit applies to All Other Outpatient Services excluding Office Visits. Please refer to the Primary Care Office Visit benefit and to the SBC for more information
Mental/Behavioral Health Inpatient Services
Covered
40.00% Coinsurance after deductible 100.00%
Substance Abuse Disorder Outpatient Services
Covered
40.00% Coinsurance after deductible 100.00% This benefit applies to All Other Outpatient Services excluding Office Visits. Please refer to the Primary Care Office Visit benefit and to the SBC for more information
Substance Abuse Disorder Inpatient Services
Covered
40.00% Coinsurance after deductible 100.00%
Generic Drugs
Covered
$3.00 100.00% 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 a Designated 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
40.00% Coinsurance after deductible 100.00% Up to a 30-day supply at any Participating Pharmacy or up to a 90-day supply at a Designated 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% Coinsurance after deductible 100.00% Up to a 30-day supply at any Participating Pharmacy or up to a 90-day supply at a Designated 90 day Retail Pharmacy.
Specialty Drugs
Covered
50.00% Coinsurance after deductible 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 a Designated 90 day Retail Pharmacy.
Outpatient Rehabilitation Services
Covered
40.00% Coinsurance after deductible 100.00% Maximum of 35 visits per Insured Person per Calendar Year for Physical Therapy, Occupational Therapy, and Chiropractic Treatment combined.
Habilitation Services
Covered
40.00% Coinsurance after deductible 100.00% Maximum of 35 visits per Insured Person per Calendar Year for Physical Therapy and Occupational Therapy.
Chiropractic Care
Covered
40.00% Coinsurance after deductible 100.00% Maximum of 35 visits per Insured Person per Calendar Year for Physical Therapy, Occupational Therapy, and Chiropractic Treatment combined.
Durable Medical Equipment
Covered
40.00% Coinsurance after deductible 100.00%
Hearing Aids
Covered
40.00% Coinsurance after deductible 100.00% Hearing Aid Devices – Limited to one hearing aid, per hearing impaired ear, every 3 years.
Imaging (CT/PET Scans, MRIs)
Covered
40.00% Coinsurance after deductible 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 Exam(s) per Year Limited to one exam per year
Eye Glasses for Children
Covered
No Charge 100.00%1 Item(s) per Year Limited to one pair of eyeglasses and lenses per year. One pair or single purchase of a supply of contact lenses in lieu of lenses and frames.
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
40.00% Coinsurance after deductible 100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
40.00% Coinsurance after deductible 100.00% Maximum of 35 visits per Insured Person per Calendar Year for Physical Therapy, Occupational Therapy, and Chiropractic Treatment combined. Maximum does not apply to services for treatment of Autism Spectrum Disorders.
Well Baby Visits and Care
Covered
No Charge 100.00%
Laboratory Outpatient and Professional Services
Covered
40.00% Coinsurance after deductible 100.00% Refer to the policy for more information regarding Diabetes.
X-rays and Diagnostic Imaging
Covered
40.00% Coinsurance after deductible 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
40.00% Coinsurance after deductible 100.00% Lifesource Transplant Network travel maximum of $10,000 per insured person, per transplant
Accidental Dental
Covered
40.00% Coinsurance after deductible 100.00%
Dialysis
Covered
40.00% Coinsurance after deductible 100.00% Benefit depends on place of treatment.
Allergy Testing
Covered
40.00% Coinsurance after deductible 100.00%
Chemotherapy
Covered
40.00% Coinsurance after deductible 100.00%
Radiation
Covered
40.00% Coinsurance after deductible 100.00%
Diabetes Education
Covered
No Charge 100.00% Routine Foot Care and Nutritional Counseling covered based on Medical Necessity
Prosthetic Devices
Covered
40.00% Coinsurance after deductible 100.00%
Infusion Therapy
Covered
40.00% Coinsurance after deductible 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
40.00% Coinsurance after deductible 100.00%
Nutritional Counseling
Reconstructive Surgery
Covered
40.00% Coinsurance after deductible 100.00%
Gender Affirming Care
Tier 2 Generic Drugs
Covered
$30.00 100.00% Up to a 30-day supply at any Participating Pharmacy or up to a 90-day supply at a Designated 90 day Retail Pharmacy. You pay a copayment for each 30-day supply.

Free Preventive Services

There is no copayment or coinsurance for any of the following Cigna Connect 6800 Enhanced Diabetes Care 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 6800 Enhanced Diabetes Care 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 6800 Enhanced Diabetes Care?

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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