Cigna Simple Choice 2000

73033SC0010021
Gold
HMO

Cigna Simple Choice 2000 is a Gold HMO plan by Cigna Healthcare of South Carolina.

IMPORTANT: You are viewing the 2023 version of Cigna Simple Choice 2000 73033SC0010021. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

Cigna Simple Choice 2000 is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Cigna Simple Choice 2000 73033SC0010021.
Insurer: Cigna Healthcare of South Carolina
Network Type: HMO
Metal Type: Gold
HSA Eligible?: No
Plan ID: 73033SC0010021

Cost-Sharing Overview

Cigna Simple Choice 2000 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 Simple Choice 2000?

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 Simple Choice 2000 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 Simple Choice 2000 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 Simple Choice 2000 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
$30.00 100.00% 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
$60.00 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$60.00 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
25.00% Coinsurance after deductible 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
25.00% Coinsurance after deductible 100.00%
Hospice Services
Covered
25.00% Coinsurance after deductible 100.00%6 Months per Episode
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
$45.00 $45.00 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
25.00% Coinsurance after deductible 100.00%60 Visit(s) per Year
Emergency Room Services
Covered
25.00% Coinsurance after deductible 25.00% 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
25.00% Coinsurance after deductible 25.00% 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.
Inpatient Hospital Services (e.g., Hospital Stay)
Covered
25.00% Coinsurance after deductible 100.00%
Inpatient Physician and Surgical Services
Covered
25.00% Coinsurance after deductible 100.00%
Bariatric Surgery
Cosmetic Surgery
Skilled Nursing Facility
Covered
25.00% Coinsurance after deductible 100.00%60 Days per Year
Prenatal and Postnatal Care
Covered
25.00% Coinsurance after deductible 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
25.00% Coinsurance after deductible 100.00%
Mental/Behavioral Health Outpatient Services
Covered
$30.00 100.00% This benefit applies to Mental Health Office Visits. All other Mental Health Outpatient Services are covered at the Outpatient professional services benmefit. Please refer to the SBC for more information.
Mental/Behavioral Health Inpatient Services
Covered
25.00% Coinsurance after deductible 100.00%
Substance Abuse Disorder Outpatient Services
Covered
$30.00 100.00% This benefit applies to Substance Abuse Office visits. All other Sustance Abuse Outpatient services are covered at the Outpatient professional services benefit level. Please refer to the SBC for more information.
Substance Abuse Disorder Inpatient Services
Covered
25.00% Coinsurance after deductible 100.00%
Generic Drugs
Covered
$15.00 100.00% You pay a copayment for each 30 day supply. Up to a 30-day supply at a participating pharmacy or up to a 90-day supply at a Designated 90-day Pharmacy. Formulary Diabetic Supplies are covered at no charge. Refer to the prescription drug list for more information.
Preferred Brand Drugs
Covered
$30.00 100.00% You pay a copayment for each 30 day supply. Up to a 30-day supply at a participating pharmacy or up to a 90-day supply at a Designated 90-day Pharmacy. Formulary Diabetic Supplies are covered at no charge. Refer to the prescription drug list for more information.
Non-Preferred Brand Drugs
Covered
$60.00 100.00% You pay a copayment for each 30 day supply. Up to a 30-day supply at a participating pharmacy or up to a 90-day supply at a Designated 90-day Pharmacy.
Specialty Drugs
Covered
$250.00 100.00% Including other high cost drugs. You pay a copayment for each 30 day supply. Up to a 30-day supply at a participating pharmacy or up to a 30-day supply at a Designated 90-day Pharmacy.
Outpatient Rehabilitation Services
Covered
25.00% Coinsurance after deductible 100.00% Cardiac and Pulmonary Rehabilitation Therapy unlimited visits. Physical Therapy, Occupational Therapy, Speech Therapy limited to 30 combined visits per year.
Habilitation Services
Covered
$30.00 100.00% Physical Therapy, Occupational Therapy, Speech Therapy limited to 30 combined visits per year.
Chiropractic Care
Covered
25.00% Coinsurance after deductible 100.00% Limited to 30 visits per year.
Durable Medical Equipment
Covered
25.00% Coinsurance after deductible 100.00%
Hearing Aids
Imaging (CT/PET Scans, MRIs)
Covered
25.00% Coinsurance after deductible 100.00%
Preventive Care/Screening/Immunization
Covered
0.00% 100.00% Routine physicals and other preventive services.
Routine Foot Care
Acupuncture
Weight Loss Programs
Not Covered
Routine Eye Exam for Children
Covered
No Charge 100.00% Limited to 1 visit per 12 month period.
Eye Glasses for Children
Covered
No Charge 100.00% Limited to 1 pair of glasses (lenses and frames from pediatric selection) per 12 month period.
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$30.00 100.00%30 Visit(s) per Year
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$30.00 100.00% Physical Therapy, Occupational Therapy, Speech Therapy limited to 30 combined visits per year.
Well Baby Visits and Care
Covered
No Charge 100.00%
Laboratory Outpatient and Professional Services
Covered
25.00% Coinsurance after deductible 100.00% Refer to the policy for more information regarding Diabetes.
X-rays and Diagnostic Imaging
Covered
25.00% 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
25.00% Coinsurance after deductible 100.00%
Accidental Dental
Covered
25.00% Coinsurance after deductible 100.00%
Dialysis
Covered
25.00% Coinsurance after deductible 100.00% Benefit depends on place of treatment.
Allergy Testing
Covered
25.00% Coinsurance after deductible 100.00%
Chemotherapy
Covered
25.00% Coinsurance after deductible 100.00%
Radiation
Covered
25.00% Coinsurance after deductible 100.00%
Diabetes Education
Covered
No Charge 100.00%
Prosthetic Devices
Covered
25.00% Coinsurance after deductible 100.00%
Infusion Therapy
Covered
25.00% Coinsurance after deductible 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
25.00% Coinsurance after deductible 100.00%
Nutritional Counseling
Covered
25.00% Coinsurance after deductible 100.00%
Reconstructive Surgery
Covered
25.00% Coinsurance after deductible 100.00%
Gender Affirming Care

Free Preventive Services

There is no copayment or coinsurance for any of the following Cigna Simple Choice 2000 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 Simple Choice 2000 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 Simple Choice 2000?

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

Table of Contents