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CIGNA

Customer Service call toll free at 1-800-997-1617, 24 hours a day, 7 days a week.
Pharmacy Benefits are administered by CVS Caremark. Phone toll-free at 1-877-522-TNRX (8679).

Did you receive your CIGNA insurance card?
CIGNA issues an insurance card to each member with their name on it. Members may request additional cards by phoning 1-800-244-6224 or by logging onto the CIGNA website and printing a temporary card.

Did you receive your Caremark card?
CVS Caremark is the pharmacy benefits manager. Call the CVS Caremark Call Center, open 24/7, at 1-877-522-8679 to order a replacement card and for instructions on how to print a temporary card from the Caremark Website. You will be able to use your temporary card until your new card arrives.


Partnership PPO and Standard PPO

In many ways, the Partnership PPO and Standard PPO are identical. They cover the same types of services, treatments and products. However, there's an important difference between the two options: If you choose the Partnership PPO, you must commit to a partnership promise, and the state will reward you with lower monthly premiums; lower annual deductible; lower pharmacy copays; lower coinsurance; lower out-of-pocket maximum.



Services requiring Copays (A flat dollar amount)
For the following services, you will not need to meet your deductible. These costs do not apply to your annual out-of-pocket maximum.

      Partnership PPO Partnership PPO Standard PPO Standard PPO
      In-Network Out-of-Network In-Network Out-of-Network
    Preventive Care Well-baby; well-child visits;

    Adult annual physical; Annual well-woman exam; immunizations as recommended by CDC

    No charge $45 co-pay No charge $50 co-pay
    Primary Care Office Visit * $25 co-pay $45 co-pay $30 co-pay $50 co-pay
    Specialist Office Visit* $40 co-pay $65 co-pay $45 co-pay $70 co-pay
    Convenience Clinics/Urgent Care Facilities $30 co-pay $30 co-pay $35 co-pay $35 co-pay
    ER Visit (waived if admitted) $80 co-pay $80 co-pay $100 co-pay $100 co-pay
    X-Ray and Lab 100% covered after office co-pay 100% covered after office co-pay up to MAC 100% covered after office co-pay 100% covered after office co-pay up to MAC
    Chiropractor Visits Visits 1-20: $25
    Visits 21 and up: $40
    Visits 1-20: $45
    Visits 21 and up: $65
    Visits 1-20: $30
    Visits 21 and up: $45
    Visits 1-20: $50
    Visits 21 and up: $70
    Mental Health (Outpatient, including psychiatry and substance abuse)* $25 co-pay $45 co-pay $30 co-pay $50 co-pay
    Pharmacy: 30-day supply from pharmacy in the 30-day network** $5 co-pay for generic; $30 co-pay for preferred brand; $80 co-pay for non-preferred brand. Co-pay, plus any amount exceeding MAC $10 co-pay for generic; $40 co-pay for preferred brand; $90 co-pay for non-preferred brand. Co-pay, plus any amount exceeding MAC.
    Pharmacy: 90-day supply available from 90-day network pharmacy or mail order*** $10 co-pay for generic; $60 co-pay for preferred brand; $160 co-pay for non-preferred brand. Co-pay, plus any amount exceeding MAC. $20 co-pay for generic; $80 co-pay for preferred brand; $180 co-pay for non-preferred brand. Co-pay, plus any amount exceeding MAC.
    Pharmacy: 90 day supply for certain maintenance medications from 90-day network pharmacy or mail order*** $5 copay generic; $30 copay preferred brand; $160 copay non-preferred. Copay plus amount exceeding MAC. $10 copay generic; $10 copay preferred brand; $180 copay non-preferred. Copay plus amount exceeding MAC.

    * Out-of-pocket maximum, per individual, applies to in-network office visits for primary care, specialist care and mental health and substance abuse treatment: $900 Partnership PPO, $1,100 Standard PPO
    ** 30-day supply from pharmacy in 30-day network
    Use a network pharmacy when filling prescriptions with up to a 30-day supply. The network includes more than 1,600 pharmacies across the state and chain pharmacies such as CVS, Kroger, Publix, RiteAid, Sam's, Target, Walgreens, and Walmart. Many local, independent pharmacies are also in the network.
    *** 90-day supply from pharmacy in 90-day network or mail order
    Use the CVS Caremark Mail Service Pharmacy to fill your 90-day supply prescription or receive a 90-day supply from a participating retail pharmacy store. The mail-at-retail network will be different from the 30-day retail network.

Coinsurance (a percentage of the total cost)
For the following services, you must meet your deductible before the plan will begin to pay benefits. These costs apply to your annual out-of-pocket maximum.

      Partnership PPO Partnership PPO Standard PPO Standard PPO
      In-Network Out-of-Network In-Network Out-of-Network
    Hospital/Facility Services
    Inpatient Care; Outpatient Surgery
    10% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance
    Home Care 10% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance
    Ambulance (air and ground) 10% coinsurance 10% coinsurance 20% coinsurance 20% coinsurance
    Advanced X-ray, Scans, Imaging 10% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance
    Rehabilitation and Therapy Services 10% coinsurance 40% coinsurance 20% coinsurance 40% coinsurance

Annual Deductible (The amount you pay out of your pocket before the plan pays for hospital charges and other services that require co-insurance. It does not apply to services with a copay.) Payments toward the deductible count toward the annual out-of-pocket maximum.

      Partnership PPO Partnership PPO Standard PPO Standard PPO
      In-Network Out-of-Network In-Network Out-of-Network
    Employee Only $350 $700 $700 $1,400
    Employee+Child(ren) $550 $1,100 $1,100 $2,200
    Employee+Spouse $700 $1,400 $1,400 $2,800
    Employee+Spouse+Child(ren) $900 $1,800 $1,800 $3,600

Annual Out-of-Pocket Coinsurance Maximum (The most you will pay for your deductible and coinsurance each year. It does not include your copays. Once you reach your out-of-pocket maximum, the plan pays 100 percent of covered medical expenses.)

      Partnership PPO Partnership PPO Standard PPO Standard PPO
      In-Network Out-of-Network In-Network Out-of-Network
    Employee Only $1,350 $2,700 $1,700 $3,400
    Employee+Child(ren) $2,150 $4,300 $2,800 $5,600
    Employee+Spouse $2,700 $5,400 $3,400 $6,800
    Employee+Spouse+Child(ren) $3,500 $7,000 $4,500 $9,000