Cigna insurance plans offer many different types of coverage, which include:1
- Health insurance for individuals and families.
- Dental plans.
- Medicare plans.
- Supplemental Insurance.
- International health insurance.
- Behavioral health.
Cigna health plans can be broken down into several different categories. However, the specifics of Cigna insurance plans may vary based on:
- Employer (if you opted for health insurance through your employer).
- State of residence.
- Whether you qualify for government-funded healthcare. The two main types of government healthcare are:
- Medicaid, which mostly applies to low-income individuals.2
- Medicare, which is usually for seniors or people with certain specific health conditions.3
- Whether you chose your plan through the Affordable Care Act (ACA) marketplace (as opposed to your employer).
Like many other health insurance companies, Cigna insurance plans fit into several main categories:4
- Health Maintenance Organization (HMO). An HMO plan is an option for people who don’t mind limiting themselves to providers within the Cigna network. HMO plans cover services exclusively provided by physicians and facilities that contract with the health insurance company directly.
- Exclusive Provider Organization (EPO). EPO plans give customers more flexibility when it comes to choosing a physician or facility for healthcare needs. However, many services may not be covered if they are outside the Cigna network.
- Preferred Provider Organization (PPO). PPO plans allow customers to choose from a much wider variety of healthcare providers. However, going outside the network typically results in a much higher out-of-pocket cost for services.
Cigna also provides other options:
- Open Access Plus (OAP). OAP plans are similar to PPO plans, except the network of providers contracted directly is larger. Like with a PPO plan, OAP plans allow you to go outside this network for a higher cost.5
- This is an affordable route that allows you to choose from a limited network of healthcare services. You can opt to have your plan include out-of-network services (for a higher cost) or choose to limit yourself to the network for a lower premium.6
Cigna Out-of-Pocket Coverage
Out-of-pocket coverage means that after you meet your yearly out-of-pocket maximum, insurance will cover any costs above the maximum amount set by your plan. Out-of-pocket costs can include copayments, deductibles, and coinsurance.
Some plans are required to meet standards set by the Affordable Care Act (ACA), which calls for out-of-pocket maximums. If you have a plan through the ACA, be sure to check your coverage for the specific out-of-pocket maximum.7
Mental health and substance abuse coverage is a part of Cigna medical plans acquired through an employer and does not have a separate deductible to be met.8 If you buy your own health plan, there may be different premiums and rules regarding out-of-pocket maximums, such as not being able to apply your deductible to the out-of-pocket maximum.7
It’s always important to check the details of your plan to confirm coverage. There may be some expenses that don’t count toward your out-of-pocket maximum, including:7
- Cosmetic procedures and alternative medicine.
- Costs above the allowed amount. If your plan sets an amount for a specific service, and costs exceed that amount, your plan may not cover that cost or apply it to out-of-pocket maximum.
- Out-of-network care and services.
- Plan premiums for individual health plans (not through employer).
- Most preventive care like flu shots, well-visits, routine screenings etc.
- Plan deductibles for certain plans.
Cigna Out-of-State Rehab Coverage
Out-of-state rehab coverage may depend on your specific Cigna health plan and which treatment providers are considered in-network or out-of-network. Make sure to check your plan details for information about receiving addiction treatment that’s out of your plan’s local service area.
