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Contact Information
Benefit Administrator

Jill Age
Phone: 757-227-6097
Fax: 757-963-8600

Kim King
Phone: 757-227-6127

Alayna Gregoire
Phone: 757-227-6146

Ask Jill

Cigna Medical Plan - HRA 1500/20%

The information below is a brief summary of your Cigna HRA 1500/20% benefits and is designed to show your cost when a service is utilized.

For more information check out the expanded Summary of Benefits Brochure for this plan and additional carrier information.

Part of the medical plan calls for you to better understand your health by participating in the new Employee Wellness Plan. With this plan an employee can earn up to 750 incentive points/dollars to be used as your deductible.

 Physician Services
 
In Network
Out-of-Network
Primary Care Office Visits 20% AD 60% AC AD
Specialist Office Visits 20% AD 60% AC AD

 Laboratory, X-rays and Diagnostic Tests
 
In Network
Out-of-Network
Routine Diagnostic Lab & X-rays 20% AD 60% AC AD
Complex Diagnostic Lab & X-rays 20% AD 60% AC AD

 Hospital Services
 
In Network
Out-of-Network
Inpatient Hospitalization 20% AD 60% AC AD
Outpatient Surgery/Services 20% AD 60% AC AD

Prescription Drug Coverage  
Prescription Drug Coverage $4/$30/$45 AD

Deductibles  
 
In Network
Out-of-Network
Annual Deductible $1,500/$3,000 $3,000/$6,000

 Out-of-pocket Maximum
 
In Network
Out-of-Network
Out-of-pocket Maximum $4,000/$8,000 $8,000/$16,000

Preventive Benefits  
 
In Network
Out-of-Network
Preventive Care Covered 100% Covered 100%

Well Baby  
 
In Network
Out-of-Network
Well Baby Covered 100% Covered 100%

Emergency Services  
 
In Network
Out-of-Network
Emergency Care 20% AD 60% AC AD
Urgent Care 20% AD 60% AC AD

This chart is only a summary. Please see the evidence of coverage benefit booklet or disclosure form for the selected plan for a thorough description of its benefits, limitations, exclusions and conditions of coverage.