10/7/2020
Coverage | myCigna
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Medical, Behavioral Health, and Pharmacy Coverage Details
Plan: Open Access Plus
Group ID: 3213484
Coverage is active for: Dephanie +1
View the main features of your plan
Coverage from 01/01/2020 - Present (Change)
View coverage details for:
William Jo (Spouse/Partner)
In-Network
How Your Plan Works
William jo is here
1
2
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You pay the deductible
You and the plan share
costs
You pay nothing
When you visit a provider, you pay all
costs* for services, until the
deductible is met.
Eligible in-network preventive care
is covered 100%
Deductible Remaining:
$
After the deductible is met, you and
the plan share the costs for covered
services.
View covered services and your share
of cost.
When you or your family reach the
out-of-pocket maximum, the plan
pays 100% for covered services.
Out-of-Pocket Maximum Remaining:
$3,300.00

See more
500 00

See less
William jo needs to meet either the
individual or the family deductible,
not both.
William jo’s Deductible: $500.00
Met: $0.00
Remaining: $500.00
Family Deductible: $1,000.00
Met: $43.25
Remaining: $956.75
About Deductibles
A separate deductible for your
prescriptions may apply. Contact us
for details.
*Your deductible is waived for certain
services.
Covered Services and Your Share of Costs
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Your plan requires that some services be approved to be covered.
Learn about precerti cations
Check the status of a precerti cation
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Preventive Care
Wellness Exams | Vaccinations | Preventive Screenings
Provider Visits
Primary Care Physician (PCP) | Specialist
Prescriptions
See Prescriptions details
Blood Tests and Other Lab Work
Lab Services
X-ray and Radiology
X-ray and Radiology | Advanced Radiology
Surgeries & Medical Services/Procedures
Outpatient Hospital | Outpatient Professional Services | Inpatient Hospital | Inpatient Professional Services | Weight-Red…
Immediate Care
Urgent Care Visit | Emergency Room Visit | Ambulance
Physical Therapies
Short-Term Rehabilitation
Home Health Care and Skilled Nursing Facility
Home Health Care | Skilled Nursing Facility
Alternative Medicine
Chiropractic Care
Behavioral Health
Mental Health O ce Visit | Mental Health Outpatient | Mental Health Inpatient | Substance Abuse O ce Visit | Substanc…
Maternity
Breast-feeding Equipment
Medical Equipment and Prosthetics
Medical Equipment | Hearing Aids | External Prosthetic Appliances
The information on this page provides highlights of coverage only. It is not a contract. Coverage is subject to your plan terms, including exclusions and limitations. If there areTalk
any
di erences between the information on this page and your o cial plan documents, the terms of the plan documents will control.
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