Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) - 76763KS0010011 Health Insurance Plan

Cigna Health and Life Insurance Company health insurance plan with the Plan ID 76763KS0010011. The plan is called Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 76.50% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 23.50% of the costs of all covered benefits (according to the Issuer).

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 77.58% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 22.42% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Health Insurance Plan ID 76763KS0010011
Health Insurance Plan Year 2022
State Kansas
Health Insurance Issuer Cigna Health and Life Insurance Company
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 76763KS0010011-00
Provider Network(s) ['KSN002']
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Wed, 27 Mar 2024 12:10 GMT).

Providers Kansas All US States
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A
Available Variants of the Health Plan

Standard Off Exchange Plan - 76763KS0010011-00

Standard On Exchange Plan - 76763KS0010011-01

Open to Indians below 300% FPL - 76763KS0010011-02

Open to Indians above 300% FPL - 76763KS0010011-03

Last Plan Update Date Thu, 12 Aug 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 76763KS0010011-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.77577157
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2022
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Gold Off Exchange Plan
Dental Only Plan No
Disease Management Programs Offered Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy
EHB Percent of Total Premium 1
First Tier Utilization 100%
Formulary ID KSF012
Formulary URL URL
HIOS Product ID 76763KS001
Import Date 8/12/2021 20:00
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer Actuarial Value 76.50%
Issuer ID 76763
Issuer Marketplace Marketing Name Cigna Healthcare
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Gold
Multiple In Network Tiers No
National Network No
Network ID KSN002
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Only
Plan Brochure URL
Plan Effective Date 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 76763KS0010011-00
Plan Marketing Name Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth)
Plan Type EPO
Plan Variant Marketing Name Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $4,500
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $1,250
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $700
SBC Scenario, Having Diabetes, Deductible $900
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $300
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,250
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID KSS002
Source Name SERFF
Plan ID 76763KS0010011
State Code KS
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual Not Applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual Not Applicable
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 40.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $2500 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $1250 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $1,250
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group per group not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person per person not applicable
Combined Medical and Drug EHB Deductible, Out of Network, Individual Not Applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $15800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $7900 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $7,900
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group per group not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person per person not applicable
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual Not Applicable
Unique Plan Design Yes
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, 76763KS0010011

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth), 76763KS0010011 Health Insurance Plan, 76763KS0010011

  • Does Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, 76763KS0010011 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (76763KS0010011) Health Insurance Plan, Variant (76763KS0010011-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy

    Does (76763KS0010011) Health Insurance Plan, Variant (76763KS0010011-00) have Out Of Country Coverage?

    Yes. Details: Emergency Only

    Does (76763KS0010011) Health Insurance Plan, Variant (76763KS0010011-00) have Out of Service Area Coverage?

    Yes. Details: Emergency Only

    Does (76763KS0010011) Health Insurance Plan, Variant (76763KS0010011-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Heart Disease, Diabetes, High Blood Pressure & High Cholesterol, Pregnancy

    Does Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, Variant (76763KS0010011-00) offer Disease Management Programs for Asthma?

    Yes, the Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 76763KS0010011-00 offers Disease Management Program for Asthma.

    Does Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, Variant (76763KS0010011-00) offer Disease Management Programs for Heart disease?

    Yes, the Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 76763KS0010011-00 offers Disease Management Program for Heart disease.

    Does Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, Variant (76763KS0010011-00) offer Disease Management Programs for Diabetes?

    Yes, the Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 76763KS0010011-00 offers Disease Management Program for Diabetes.

    Does Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, Variant (76763KS0010011-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 76763KS0010011-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, Variant (76763KS0010011-00) offer Disease Management Programs for Pregnancy?

    Yes, the Cigna Connect 1250 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 76763KS0010011-00 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Wed, 27 Mar 2024 12:10 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API