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Cigna Simple Choice 7500

53882IL0040045
Expanded Bronze
HMO

Cigna Simple Choice 7500 is an Expanded Bronze HMO plan by Cigna Healthcare.

IMPORTANT: You are viewing the 2023 version of Cigna Simple Choice 7500 53882IL0040045. You can enroll in this plan if you qualify for special enrollment until the end of 2023.

Locations

Cigna Simple Choice 7500 is offered in the following counties.

Plan Overview

This is a plan overview for 2023 version of Cigna Simple Choice 7500 53882IL0040045.
Insurer: Cigna Healthcare
Network Type: HMO
Metal Type: Expanded Bronze
HSA Eligible?: No
Plan ID: 53882IL0040045

Cost-Sharing Overview

Cigna Simple Choice 7500 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 7500?

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 7500 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: Yes
Specialist Requiring Referral: All Specialist
Plan Exclusions:
Child Only Option?: Allows Adult and Child-Only

Network Details

The following network details will help you understand what Cigna Simple Choice 7500 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 7500 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% Includes Mental Health Office Visits and Substance Use Disorder Office Visits. Refer to the policy for more information about Virtual Care Services
Specialist Visit
Covered
$100.00 100.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
Covered
$100.00 100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Covered
50.00% Coinsurance after deductible 100.00%
Outpatient Surgery Physician/Surgical Services
Covered
50.00% Coinsurance after deductible 100.00%
Hospice Services
Covered
50.00% Coinsurance after deductible 100.00% Includes Respite care.
Routine Dental Services (Adult)
Infertility Treatment
Covered
50.00% Coinsurance after deductible 100.00% Benefit depends on type of service provided
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Covered
50.00% Coinsurance after deductible 100.00%
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
50.00% Coinsurance after deductible 100.00%
Emergency Room Services
Covered
50.00% Coinsurance after deductible 50.00% 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
50.00% Coinsurance after deductible 50.00% 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
50.00% Coinsurance after deductible 100.00%
Inpatient Physician and Surgical Services
Covered
50.00% Coinsurance after deductible 100.00%
Bariatric Surgery
Covered
50.00% Coinsurance after deductible 100.00% Benefit depends on type of service provided
Cosmetic Surgery
Covered
50.00% Coinsurance after deductible 100.00% Cosmetic surgery for the correction of congenital deformities or for conditions resulting from accidental injuries, scars, tumors or disease is covered.
Skilled Nursing Facility
Covered
50.00% Coinsurance after deductible 100.00%
Prenatal and Postnatal Care
Covered
50.00% Coinsurance after deductible 100.00%
Delivery and All Inpatient Services for Maternity Care
Covered
50.00% Coinsurance after deductible 100.00%
Mental/Behavioral Health Outpatient Services
Covered
$50.00 100.00% This benefit applies to Mental Health Office Visits. All other Mental Health Outpatient Services are covered at the Outpatient professional services benefit. Please refer to the SBC for more information.
Mental/Behavioral Health Inpatient Services
Covered
50.00% Coinsurance after deductible 100.00%
Substance Abuse Disorder Outpatient Services
Covered
$50.00 100.00% This benefit applies to Substance Abuse Office Visits. All other Substance Abuse Outpatient Services are covered at the Outpatient professional services benefit. Please refer to the SBC for more information.
Substance Abuse Disorder Inpatient Services
Covered
50.00% Coinsurance after deductible 100.00%
Generic Drugs
Covered
$25.00 100.00% Up to a 30 day supply at any designated pharmacy, or up to a 90 day supply at any 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
$50.00 Copay after deductible 100.00% Up to a 30 day supply at any designated pharmacy, or up to a 90 day supply at any designated 90 day retail pharmacy. You pay a copayment after deductible for each 30 day supply. Formulary Diabetic Supplies are covered at no charge. Refer to the prescription drug list for more information.
Non-Preferred Brand Drugs
Covered
$100.00 Copay after deductible 100.00% Up to a 30 day supply at any designated pharmacy, or up to a 90 day supply at any designated 90 day retail pharmacy. You pay a copayment after deductible for each 30 day supply.
Specialty Drugs
Covered
$500.00 Copay after deductible 100.00% Including other high cost drugs. Up to a 30-day supply at any designated pharmacy or up to a 90-day supply at at any designated 90 day retail pharmacy. You pay a copayment after deductible for each 30 day supply.
Outpatient Rehabilitation Services
Covered
50.00% Coinsurance after deductible 100.00% Cardiac rehab limited to a maximum of 36 Outpatient treatment sessions within a 6 month period. Physical, Occupational and Speech Therapies are Unlimited.
Habilitation Services
Covered
$50.00 100.00% Includes unlimited Physical, Speech and Occupational Therapies.
Chiropractic Care
Covered
50.00% Coinsurance after deductible 100.00%25 Visit(s) per Year Includes an additional 15 visits per year for Naprapathic Services.
Durable Medical Equipment
Covered
50.00% Coinsurance after deductible 100.00%
Hearing Aids
Covered
50.00% Coinsurance after deductible 100.00%1 Item(s) per 2 Years Hearing aids for adults and children, 1 per ear every 24 months. Includes bone anchored hearing aids (BAHAs) with no maximum.
Imaging (CT/PET Scans, MRIs)
Covered
50.00% Coinsurance after deductible 100.00%
Preventive Care/Screening/Immunization
Covered
No Charge 100.00%
Routine Foot Care
Covered
50.00% Coinsurance after deductible 100.00% Services associated with foot care for diabetes and peripheral vascular disease are covered when Medically Necessary as part of another Covered Service.
Acupuncture
Weight Loss Programs
Routine Eye Exam for Children
Covered
No Charge 100.00%1 Exam(s) per Year Children up to age 19, through the end of their birth month.
Eye Glasses for Children
Covered
No Charge 100.00%1 Item(s) per Year Children up to age 19, through the end of their birth month. Limit 1 pair of glasses (lenses and frames from pediatric selection) per 12 month period. One pair of contact lenses – in lieu of lenses and frames benefit, (may not receive contact lenses and frames in same benefit year).
Dental Check-Up for Children
Not Covered
Rehabilitative Speech Therapy
Covered
$50.00 100.00% Unlimited Speech Therapy.
Rehabilitative Occupational and Rehabilitative Physical Therapy
Covered
$50.00 100.00% Physical, Occupational and Speech Therapy- Unlimited. Includes medically necessary preventive physical therapy for members diagnosed with multiple sclerosis.
Well Baby Visits and Care
Covered
No Charge 100.00%
Laboratory Outpatient and Professional Services
Covered
50.00% Coinsurance after deductible 100.00% Some laboratory tests for Diabetes are covered at no charge. Refer to the policy for more information regarding Diabetes.
X-rays and Diagnostic Imaging
Covered
50.00% 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
Covered
50.00% Coinsurance after deductible 100.00%
Transplant
Covered
50.00% Coinsurance after deductible 100.00% LifeSource Facility Travel Maximum: $10,000 per insured person, per transplant and a maximum reimbursement of $50 for lodging per person, per day.
Accidental Dental
Covered
50.00% Coinsurance after deductible 100.00% Limited to treatment for accidental injury to natural teeth within six months of the accidental injury.
Dialysis
Covered
50.00% Coinsurance after deductible 100.00% Benefit depends on place of treatment
Allergy Testing
Covered
50.00% Coinsurance after deductible 100.00%
Chemotherapy
Covered
50.00% Coinsurance after deductible 100.00%
Radiation
Covered
50.00% Coinsurance after deductible 100.00%
Diabetes Education
Covered
No Charge 100.00%
Prosthetic Devices
Covered
50.00% Coinsurance after deductible 100.00%
Infusion Therapy
Covered
50.00% Coinsurance after deductible 100.00%
Treatment for Temporomandibular Joint Disorders
Covered
50.00% Coinsurance after deductible 100.00%
Nutritional Counseling
Covered
50.00% Coinsurance after deductible 100.00%
Reconstructive Surgery
Covered
50.00% 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 7500 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 7500 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 7500?

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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