Cigna Connect 1900 Enhanced Diabetes Care - 76763KS0010029 Health Insurance Plan

Cigna Health and Life Insurance Company health insurance plan with the Plan ID 76763KS0010029. The plan is called Cigna Connect 1900 Enhanced Diabetes Care.

Based on the data of Health Plan Issuer, this plan has an actuarial value of 78.55% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 21.45% 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 79.13% (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 20.87% 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 76763KS0010029
Health Insurance Plan Year 2023
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 76763KS0010029-00
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 - 76763KS0010029-00

Standard On Exchange Plan - 76763KS0010029-01

Open to Indians below 300% FPL - 76763KS0010029-02

Open to Indians above 300% FPL - 76763KS0010029-03

Last Plan Update Date Mon, 19 Dec 2022 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Benefits of Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan, 76763KS0010029-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental
YES

20.00% Coinsurance after deductible

100.00%
Acupuncture
NO
Allergy Testing
YES

20.00% Coinsurance after deductible

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult
NO
Basic Dental Care - Child
NO
Chemotherapy
YES

20.00% Coinsurance after deductible

100.00%
Chiropractic Care
YES

20.00% Coinsurance after deductible

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care
YES

20.00% Coinsurance after deductible

100.00%
Dental Check-Up for Children
NO
Diabetes Education
YES

No Charge

100.00%
Dialysis

Benefit depends on place of treatment

YES

20.00% Coinsurance after deductible

100.00%
Durable Medical Equipment
YES

20.00% Coinsurance after deductible

100.00%
Emergency Room Services

Out-of-network: You pay the same level as In-network if it is an emergency as defined in your plan, otherwise Not covered.

YES

40.00% Coinsurance after deductible

40.00% Coinsurance after deductible
Emergency Transportation/Ambulance

Out-of-network: You pay the same level as In-network if it is an emergency as defined in your plan, otherwise Not covered.

YES

20.00% Coinsurance after deductible

20.00% Coinsurance after deductible
Eye Glasses for Children

Children are covered through the end of the month in which they turn 19 years of age. Limited to three pairs of pediatric collection frames and lenses every calendar year. Coverage for the second and third pair of glasses is dependent on a change in the member?s refractive state or to replace broken, damaged or lost glasses. Standard Frames must include a minimum one-year warranty. Therapeutic contact lenses are limited to a one year supply in lieu of frame and lenses.

YES

No Charge

100.00%
Gender Affirming Care
NO
Generic Drugs

Cost sharing shown applies to Tier 1-Preferred Generic Drugs only. See Summary of Benefits and the policy or service agreement for more information on an additional category, Tier 2 Generic Drugs, which may apply a higher cost share. Up to a 34-day supply at any Participating Pharmacy or up to a 90-day supply at a Designated 90 day Retail Pharmacy. You pay a copayment for each 34-day supply. Formulary Diabetic Supplies are covered at no charge. Refer to the prescription drug list for more information.

YES

$2.00

100.00%
Habilitation Services

Includes Physical, Occupational and Speech therapies.

YES

20.00% Coinsurance after deductible

100.00%
Hearing Aids

Hearing Aid Devices - Not Covered (Except BAHA) Hearing Aid Exam/Evaluation - Covered at the same benefit level as Bone Anchored Hearing Aids Bone Anchored Hearing Aids - Covered-No maximum

YES

20.00% Coinsurance after deductible

100.00%
Home Health Care Services

Includes up to three (3) home care education visits per calendar year

YES

20.00% Coinsurance after deductible

100.00%
Hospice Services
YES

20.00% Coinsurance after deductible

100.00%
Imaging (CT/PET Scans, MRIs)
YES

20.00% Coinsurance after deductible

100.00%
Infertility Treatment

Limited to coverage for diagnosis and treatment of cause of infertility. Covered services include office visits, laboratory tests, and radiological studies to diagnose the cause of infertility.

YES

20.00% Coinsurance after deductible

100.00%
Infusion Therapy
YES

20.00% Coinsurance after deductible

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)
YES

20.00% Coinsurance after deductible

100.00%
Inpatient Physician and Surgical Services
YES

20.00% Coinsurance after deductible

100.00%
Laboratory Outpatient and Professional Services

Refer to the policy for more information regarding Diabetes.

YES

20.00% Coinsurance after deductible

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult
NO
Major Dental Care - Child
NO
Mental/Behavioral Health Inpatient Services
YES

20.00% Coinsurance after deductible

100.00%
Mental/Behavioral Health Outpatient Services

This benefit applies to All Other Outpatient Services excluding Office Visits. Please refer to the Specialist Office Visit benefit and to the SBC for more information.

YES

20.00% Coinsurance after deductible

100.00%
Non-Preferred Brand Drugs

Up to a 34-day supply at any Participating Pharmacy or up to a 90-day supply at a Designated 90 day Retail Pharmacy.

YES

50.00% Coinsurance after deductible

100.00%
Nutritional Counseling
NO
Orthodontia - Adult
NO
Orthodontia - Child
NO
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

$50.00

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
YES

20.00% Coinsurance after deductible

100.00%
Outpatient Rehabilitation Services

Includes Physical, Occupational and Speech therapies. Speech therapy is limited to one service per day up to 90 daily services per year.

YES

20.00% Coinsurance after deductible

100.00%
Outpatient Surgery Physician/Surgical Services
YES

20.00% Coinsurance after deductible

100.00%
Preferred Brand Drugs

Up to a 34-day supply at any Participating Pharmacy or up to a 90-day supply at a Designated 90 day Retail Pharmacy. You pay a copayment for each 34-day supply.

YES

$50.00

100.00%
Prenatal and Postnatal Care
YES

20.00% Coinsurance after deductible

100.00%
Preventive Care/Screening/Immunization
YES

No Charge

100.00%
Primary Care Visit to Treat an Injury or Illness

Refer to the policy for more information about Virtual Care Services.

YES

$15.00

100.00%
Private-Duty Nursing
YES

20.00% Coinsurance after deductible

100.00%
Prosthetic Devices
YES

20.00% Coinsurance after deductible

100.00%
Radiation
YES

20.00% Coinsurance after deductible

100.00%
Reconstructive Surgery
YES

20.00% Coinsurance after deductible

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy
YES

20.00% Coinsurance after deductible

100.00%
Rehabilitative Speech Therapy

Speech therapy is limited to one service per day up to 90 daily services per year.

YES

20.00% Coinsurance after deductible

100.00%
Routine Dental Services (Adult)
NO
Routine Eye Exam (Adult)
NO
Routine Eye Exam for Children

Children are covered through the end of the month in which they turn 19 years of age.

YES

No Charge

100.00%
Routine Foot Care

Limited to coverage when systemic conditions such as metabolic, neurologic, or peripheral vascular disease exists and results in medically significant circulatory deficits or decreased sensation to the foot. Refer to the policy for more information regarding Diabetes.

YES

20.00% Coinsurance after deductible

100.00%
Skilled Nursing Facility
YES

20.00% Coinsurance after deductible

100.00%
Specialist Visit

Includes Mental Health Office Visits and Substance Use Disorder Office Visits.

YES

$50.00

100.00%
Specialty Drugs

Including other high cost drugs. Up to a 34-day supply at any Participating Pharmacy or up to a 34-day supply at a Designated 90 day Retail Pharmacy.

YES

50.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Inpatient Services
YES

20.00% Coinsurance after deductible

100.00%
Substance Abuse Disorder Outpatient Services

This benefit applies to All Other Outpatient Services excluding Office Visits. Please refer to the Specialist Office Visit benefit and to the SBC for more information.

YES

20.00% Coinsurance after deductible

100.00%
Tier 2 Generic Drugs

Up to a 34-day supply at any Participating Pharmacy or up to a 90-day supply at a Designated 90 day Retail Pharmacy. You pay a copayment for each 34-day supply.

YES

$10.00

100.00%
Transplant

Lifesource Transplant Network travel maximum of $10,000 per insured person, per transplant

YES

20.00% Coinsurance after deductible

100.00%
Treatment for Temporomandibular Joint Disorders
YES

20.00% Coinsurance after deductible

100.00%
Urgent Care Centers or Facilities

Out-of-network: You pay the same level as In-network if it is an emergency as defined in your plan, otherwise Not covered.

YES

$30.00

$30.00
Weight Loss Programs
NO
Well Baby Visits and Care
YES

No Charge

100.00%
X-rays and Diagnostic Imaging
YES

20.00% Coinsurance after deductible

100.00%

Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan Variant 76763KS0010029-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.791269392
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2023
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Gold Off Exchange Plan
Dental Only Plan No
Design Type Not Applicable
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 KSF010
Formulary URL URL
HIOS Product ID 76763KS001
Import Date 12/19/2022 20:01
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 78.55%
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 Services Only
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Emergency Services Only
Plan Brochure URL
Plan Effective Date 1/1/2023
Plan Expiration Date 12/31/2023
Plan ID (Standard Component ID with Variant) 76763KS0010029-00
Plan Marketing Name Cigna Connect 1900 Enhanced Diabetes Care
Plan Type EPO
Plan Variant Marketing Name Cigna Connect 1900 Enhanced Diabetes Care
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,100
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $1,900
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $300
SBC Scenario, Having Diabetes, Deductible $900
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $30
SBC Scenario, Treatment of a Simple Fracture, Copayment $200
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,900
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID KSS002
Source Name SERFF
Plan ID 76763KS0010029
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 20.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $3800 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $1900 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $1,900
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 $18200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9100 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,100
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 1900 Enhanced Diabetes Care Health Insurance Plan, 76763KS0010029

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

Frequently Asked Questions(FAQ) about Cigna Connect 1900 Enhanced Diabetes Care, 76763KS0010029 Health Insurance Plan, 76763KS0010029

  • Does Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan, 76763KS0010029 support Mail Ordering?

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

  • Does (76763KS0010029) Health Insurance Plan, Variant (76763KS0010029-00) offer Disease Management Programs?

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

    Does (76763KS0010029) Health Insurance Plan, Variant (76763KS0010029-00) have Out Of Country Coverage?

    Yes. Details: Emergency Services Only

    Does (76763KS0010029) Health Insurance Plan, Variant (76763KS0010029-00) have Out of Service Area Coverage?

    Yes. Details: Emergency Services Only

    Does (76763KS0010029) Health Insurance Plan, Variant (76763KS0010029-00) 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 1900 Enhanced Diabetes Care Health Insurance Plan, Variant (76763KS0010029-00) offer Disease Management Programs for Asthma?

    Yes, the Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan Variant 76763KS0010029-00 offers Disease Management Program for Asthma.

    Does Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan, Variant (76763KS0010029-00) offer Disease Management Programs for Heart disease?

    Yes, the Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan Variant 76763KS0010029-00 offers Disease Management Program for Heart disease.

    Does Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan, Variant (76763KS0010029-00) offer Disease Management Programs for Diabetes?

    Yes, the Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan Variant 76763KS0010029-00 offers Disease Management Program for Diabetes.

    Does Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan, Variant (76763KS0010029-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan Variant 76763KS0010029-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan, Variant (76763KS0010029-00) offer Disease Management Programs for Pregnancy?

    Yes, the Cigna Connect 1900 Enhanced Diabetes Care Health Insurance Plan Variant 76763KS0010029-00 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