Page 16 - MPCU Open Enrollment Presentation

Medical HMO - Cigna

Cigna
Select and Full HMO

Calendar Year Deductible None

Calendar Year Out-of-Pocket Maximum

- Individual / Family $3,000 / $6,000

Office Visits

- PCP $25 Copay

- Specialist $25 Copay
- Urgent Care $35 Copay

- Virtual Visit $25 Copay

- Chiropractic (limit 20 days) $25 Copay

Lab & X-Ray $0 (MRI, CT, PET $50)

Hospitalization
- Inpatient $500/admit

- Outpatient $250/visit

Emergency Room (Waived if Admitted) $100/visit