Orlando Harmon
Cigna is an American multinational for-profit managed healthcare and insurance company that offers a range of health insurance plans. These plans typically involve paying a premium, usually monthly, and may include deductibles, copays, and coinsurance. Coinsurance refers to the sharing of medical costs between the insured and the insurance carrier, and a 20% coinsurance means that the insured pays 20% of the cost of their covered medical bills. For example, if an individual has a $2000 hospital bill and a 20% coinsurance, they would pay $400 (20% of $2000) out-of-pocket, while their health insurance plan would cover the remaining $1600.
| Characteristics | Values |
|---|---|
| Coinsurance | 20% |
| What you pay | 20% of the cost of your covered medical bills |
| What Cigna pays | 80% of the cost of your covered medical bills |
| Out-of-pocket maximum | $6,350 |
| Deductible | $3,000 |
| Annual check-up | Covered 100% |
| Flu shot | Covered 100% |
| Childhood vaccinations | Covered 100% |
| In-network doctors and specialists | Reduced rate |
| Hospitalization | Covered after deductible is met |
| Emergency Room | No requirement to go to an in-network ER in an emergency |
| Lab work | Lower costs for in-network labs |
| Exclusions | Alternative medicine, cosmetic surgery, weight-loss surgery, vein surgery, elective surgeries, unapproved medical care |
| Availability | Products and services vary by location and plan type |
| Payment methods | Credit and debit cards, bank wire transfer |
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What You'll Learn
Coinsurance and deductibles
A deductible is the amount you pay each year for eligible medical services or medications before your health plan begins to share in the cost of covered services. For example, if you have a $2,000 yearly deductible, you'll need to pay the first $2,000 of your total eligible medical costs before your plan helps to pay. After you've paid your deductible, you continue to pay your monthly premium, but the medical costs are covered (aside from any copay or coinsurance charges).
Coinsurance is a portion of the medical cost you pay after your deductible has been met. Coinsurance is a way of saying that you and your insurance carrier each pay a share of eligible costs that add up to 100 percent. The higher your coinsurance percentage, the higher your share of the cost. For example, if you have an 80/20 coinsurance plan, your health plan will pay 80% of your covered medical expenses, and you'll be responsible for the remaining 20%.
Your employer may offer you a health plan as part of your job, or you can buy one directly through a health insurance company, like Cigna Healthcare. Health insurance plans may cover a wide range of medical care and services, including preventive and non-preventive care, emergency care, behavioural health, and sometimes vision and hearing.
Preventive visits, such as annual check-ups and certain vaccinations, are typically covered 100% by health insurance plans. Non-preventive doctor visits, hospitalization, emergency room visits, and lab work may be covered by your health plan once you've met your deductible. You will pay less if you go to a hospital or doctor that is in your plan's network.
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Monthly premiums
Cigna is a multinational for-profit managed healthcare and insurance company that provides health insurance plans to help lower the amount you would otherwise have to pay for medical care. Typically, you pay a premium, usually monthly, to have a health plan. This premium is a fee for having the health plan.
The monthly premium you pay is separate from your deductible. A deductible is the amount you pay each year for eligible medical services or medications before your health plan begins to share in the cost of covered services. For example, if you have a $2,000 yearly deductible, you'll need to pay the first $2,000 of your total eligible medical costs before your plan helps to pay. After you pay your deductible, you continue to pay your monthly premium, but the medical costs are covered (aside from any copay or coinsurance charges).
Copays are a small fee you pay at the time of the doctor's visit. Copay costs are predetermined based on your health insurance plan, and you can view this amount on your ID card.
Coinsurance is a portion of the medical cost you pay after your deductible has been met. Coinsurance is a way of saying that you and your insurance carrier each pay a share of eligible costs that add up to 100%. The higher your coinsurance percentage, the higher your share of the cost. For example, if you have an 80/20 coinsurance plan, you pay 20% of the cost of your covered medical bills, and your health insurance plan pays the other 80%.
Cigna offers a range of health insurance plans, including Medicare Advantage, Medicare Supplement Insurance, and Medicare Part D prescription plans. Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group, including Cigna Health and Life Insurance Company, Cigna Healthcare of Arizona, Inc., Cigna HealthCare of Georgia, Inc., and more.
Cigna also offers international health insurance plans, including Cigna Silver, Cigna Gold, and Cigna Platinum. These plans are customizable, allowing customers to choose and pay for only the coverage they need. Cigna accepts payments through credit and debit cards or by bank wire transfer if paid annually. Customers who pay quarterly or annually have lower premiums than those who pay monthly.
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In-network vs out-of-network
Cigna offers a range of health insurance plans, including Preferred Provider Organization (PPO) plans and Open Access Plus (OAP) plans. These plans can be obtained through an employer or purchased individually. Cigna's health insurance plans typically involve a monthly premium, a deductible, and coinsurance.
In-network refers to doctors, facilities, and pharmacies that are part of Cigna's network. These providers have agreed to accept a discounted rate for covered services, which can help lower your healthcare expenses. Out-of-network providers, on the other hand, have not agreed to a discounted rate, and using their services can result in higher out-of-pocket costs.
When you receive care from in-network providers, you benefit from reduced rates as part of the network. This means that once you have met your deductible, your insurance plan will pay its share of the cost, and you will be responsible for a smaller portion. For example, if your plan has an 80/20 coinsurance structure, the insurance plan will cover 80% of the cost, while you pay the remaining 20%.
Using in-network doctors and hospitals can significantly lower your out-of-pocket expenses. Even if your plan includes out-of-network benefits, your deductible amount will typically be lower if you use in-network providers. Additionally, emergency and urgent care services, as defined by your plan, are usually covered at the in-network level, giving you more flexibility in emergency situations.
It is important to understand the difference between in-network and out-of-network providers to avoid unexpected medical bills. By choosing in-network providers, you can save money and better manage your healthcare expenses.
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Preventative care
Cigna Healthcare offers a range of health insurance plans that may cover preventative care. These plans often include preventive and non-preventive care, emergency care, behavioral health, and sometimes vision and hearing. The specific services covered and the extent of coverage can vary depending on the plan chosen. For example, some plans may require a copay, which is a small fee paid at the time of the doctor's visit.
Coinsurance is a term used to describe the sharing of medical costs between the insured and the insurance carrier. After paying the deductible, the insured pays a percentage of the remaining medical costs, while the health insurance plan covers the rest. For instance, with an 80/20 coinsurance plan, the insured pays 20% of the cost of their covered medical bills, while the insurance plan pays the remaining 80%.
It is important to note that preventative care services may vary depending on the healthcare provider and the specific insurance plan. Additionally, alternative medicine, cosmetic surgery, weight-loss surgery, vein surgery, and elective surgeries are typically not covered by health insurance plans.
Cigna Healthcare provides tools and support to healthcare providers to help them deliver better care to their patients. This includes making it easier for providers to prescribe medications and manage medication therapy for their patients.
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Non-covered services
Cigna health insurance plans can help cover a wide range of medical care and services. However, there are some services that are typically not covered by health insurance. These non-covered services can vary depending on the specific plan. Here are some examples of services that may not be covered:
Alternative Medicine
Services such as massage, acupuncture, and herbal healing are often not covered by health insurance plans. These are considered alternative or complementary therapies and are not always considered medically necessary.
Cosmetic Surgery
Procedures such as plastic surgery, laser skin removal, liposuction, and rhinoplasty (nose job) are typically not covered by insurance. These are considered elective or cosmetic surgeries and are not medically necessary.
Weight-Loss Surgery
Gastric bypass and bariatric surgery may not be covered, depending on the specific plan. Some insurance plans may cover these procedures if they are deemed medically necessary, but this requires careful review and approval by a doctor.
Vein Surgery
Laser surgery to correct spider veins is often considered cosmetic and may not be covered by insurance. However, if a doctor can provide a medical justification and prove its medical necessity, it may be covered.
Elective Surgeries
Surgeries that are not deemed medically necessary and for which a doctor cannot provide a valid medical reason may not be covered by insurance. Surgeries that are considered purely elective or optional are typically the responsibility of the individual.
Unapproved Medical Care
If prior authorization or approval is not obtained for specific care or services, the insurance plan may deny coverage. It is important for individuals to understand the requirements and pre-authorization procedures outlined in their insurance plans to avoid unexpected costs.
It is important to note that Cigna health insurance plans can vary in their coverage and exclusions. Individuals should carefully review their specific plan documents or contact a Cigna Healthcare representative to understand the details of their coverage, including non-covered services.
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Frequently asked questions
Coinsurance is the portion of medical costs you pay after meeting your deductible. For example, if you have an 80/20 coinsurance plan, you pay 20% of the cost of your covered medical bills, and your insurance plan pays the remaining 80%.
A deductible is the amount you pay each year for eligible medical services or medications before your insurance plan starts to share in the cost of covered services. For example, if you have a $2,000 yearly deductible, you need to pay the first $2,000 of your total eligible medical costs before your plan helps to pay.
A premium is a fee for having a health plan, usually paid monthly. A deductible is separate from the monthly premium, and you continue to pay your premium even after meeting your deductible.
Let's say you have a $3,000 annual deductible and a 20% coinsurance with a $6,350 out-of-pocket maximum. If you require surgery and hospitalization, you first pay the $3,000 deductible. Then, your coinsurance kicks in, and you pay 20% of the remaining expenses until you reach your out-of-pocket maximum of $3,350. After that, your plan covers 100% of eligible medical expenses for that year.
The amount you pay out-of-pocket depends on factors such as whether you've met your deductible, your coinsurance percentage, whether you're using in-network providers, and the specific benefits covered by your plan.
