Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) - 74483MO0040015 Health Insurance Plan

Cigna Health and Life Insurance Company health insurance plan with the Plan ID 74483MO0040015. The plan is called Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth).

Based on the data of Health Plan Issuer, this plan has an actuarial value of 66.22% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 33.78% 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 67.94% (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 32.06% 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 74483MO0040015
Health Insurance Plan Year 2022
State Missouri
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 74483MO0040015-00
Provider Network(s) ['MON002']
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 Missouri 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 - 74483MO0040015-00

Standard On Exchange Plan - 74483MO0040015-01

Open to Indians below 300% FPL - 74483MO0040015-02

Open to Indians above 300% FPL - 74483MO0040015-03

73% AV Silver Plan - 74483MO0040015-04

87% AV Silver Plan - 74483MO0040015-05

94% AV Silver Plan - 74483MO0040015-06

Last Plan Update Date Tue, 07 Dec 2021 00:00 GMT
Last Import Date Wed, 27 Mar 2024 12:10 GMT

Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 74483MO0040015-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.679388669
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 Silver 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 MOF007
Formulary URL URL
HIOS Product ID 74483MO004
Import Date 12/7/2021 1:01
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 66.22%
Issuer ID 74483
Issuer Marketplace Marketing Name Cigna Healthcare
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Silver
Multiple In Network Tiers No
National Network No
Network ID MON002
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 1/1/2022
Plan Expiration Date 12/31/2022
Plan ID (Standard Component ID with Variant) 74483MO0040015-00
Plan Marketing Name Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth)
Plan Type EPO
Plan Variant Marketing Name Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $2,800
SBC Scenario, Having a Baby, Copayment $10
SBC Scenario, Having a Baby, Deductible $5,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $0
SBC Scenario, Having Diabetes, Copayment $800
SBC Scenario, Having Diabetes, Deductible $900
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $0
SBC Scenario, Treatment of a Simple Fracture, Copayment $300
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,700
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID MOS003
Source Name HIOS
Plan ID 74483MO0040015
State Code MO
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 $11000 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $5500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $5,500
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 $17400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $8700 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $8,700
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 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, 74483MO0040015

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

Frequently Asked Questions(FAQ) about Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth), 74483MO0040015 Health Insurance Plan, 74483MO0040015

  • Does Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, 74483MO0040015 support Mail Ordering?

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

  • Does (74483MO0040015) Health Insurance Plan, Variant (74483MO0040015-00) offer Disease Management Programs?

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

    Does (74483MO0040015) Health Insurance Plan, Variant (74483MO0040015-00) have Out Of Country Coverage?

    Yes. Details: Emergency Services Only

    Does (74483MO0040015) Health Insurance Plan, Variant (74483MO0040015-00) have Out of Service Area Coverage?

    Yes. Details: Emergency Services Only

    Does (74483MO0040015) Health Insurance Plan, Variant (74483MO0040015-00) 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 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, Variant (74483MO0040015-00) offer Disease Management Programs for Asthma?

    Yes, the Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 74483MO0040015-00 offers Disease Management Program for Asthma.

    Does Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, Variant (74483MO0040015-00) offer Disease Management Programs for Heart disease?

    Yes, the Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 74483MO0040015-00 offers Disease Management Program for Heart disease.

    Does Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, Variant (74483MO0040015-00) offer Disease Management Programs for Diabetes?

    Yes, the Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 74483MO0040015-00 offers Disease Management Program for Diabetes.

    Does Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, Variant (74483MO0040015-00) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 74483MO0040015-00 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan, Variant (74483MO0040015-00) offer Disease Management Programs for Pregnancy?

    Yes, the Cigna Connect 5500 ($3 Tier 1 Rx, $0 Telehealth) Health Insurance Plan Variant 74483MO0040015-00 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