myCigna Copay Assure Silver

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
myCigna Copay Assure Silver
Plan ID
55409TX0020008
Plan Year
2014
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
Metal Level
Silver
Plan Type
PPO
Deductible
$0
Out-of-Pocket Maximum
$6,350
Plan Highlights

Cost & Coverage

Estimated Monthly Base Rate
Estimated monthly premium starts at $322.71
Deductible
Individual: $0
Family: $0
In-Network Out-of-Pocket Limit
Individual: $6350
Family: $12700
What is included in the in-network out-of-pocket limit?
Deductible + Coinsurance + Co-pay
Is this plan Health Savings Account (HSA) eligible?
No
How can I find a doctor in this plan's network?
Plan Type
PPO

Health Services Options

Service
In Network
Out of Network
Primary care physician office visit
$30 Copay
50% Coinsurance after deductible
Specialist
$60 Copay
50% Coinsurance after deductible
Diagnostic Test (X-ray, blood work)
40% Coinsurance
50% Coinsurance after deductible
Outpatient Facility Fee
$2000 Copay
50% Coinsurance after deductible
Outpatient Physician/Surgeon Fee
30% Coinsurance
50% Coinsurance after deductible
Hospital facility fee
$2000 Copay
50% Coinsurance after deductible
Hospital physician/surgeon fee
30% Coinsurance
50% Coinsurance after deductible
Emergency Room
$500 Copay
$500 Copay

Drug Services

Generic Drugs
Coverage: $25 Copay
Preferred Brand Drugs
Coverage: $60 Copay
Specialty Drugs
Coverage: 40% Coinsurance
What drugs are covered in the formulary?

Mental Health or Substance Abuse Services

Service
In Network
Out of Network
Mental/behavioral health outpatient services
$60 Copay
50% Coinsurance after deductible
Mental/behavioral health inpatient services
$2000 Copay
50% Coinsurance after deductible
Substance use disorder inpatient services
$2000 Copay
50% Coinsurance after deductible
Substance use disorder outpatient services
$60 Copay
50% Coinsurance after deductible

Maternity Services

Service
In Network
Out of Network
Prenatal/postnatal care
30% Coinsurance
50% Coinsurance after deductible
Delivery and all inpatient services for maternity care
$2000 Copay
50% Coinsurance after deductible

Coverage Options Summary

Included Benefits
  • Chiropractic
  • Durable medical equipment
  • Emergency Transportation
  • Eye glasses children
  • Habilitation
  • Home health care
  • Hospice
  • Imaging (CT/PET scans, MRIs)
  • Inpatient rehabilitation
  • Non-preferred brand drugs
  • Skilled nursing care
  • Other practitioner office visit
  • Outpatient rehabilitation
  • Preventive care, screening, immunization
  • Routine eye exam children
  • Urgent Care
Excluded Benefits
  • Acupuncture
  • Bariatric surgery
  • Cosmetic surgery
  • Dental care adult
  • Dental check up children
  • Eye exam adult
  • Infertility treatment
  • Long Term Care
  • Non-emergency care outside U.S.
  • Private duty nursing
  • Routine foot care
  • Routine hearing tests
  • Weight loss program
Limited Benefits
  • Hearing Aid

What To Know

  • This is an ACA (Obamacare) compliant health plan.
  • This plan is eligible for a tax credit subsidy

Physician Directory

List of doctors that accepts myCigna Copay Assure Silver Obamacare Plan in Texas

/
RAMIREZ, AMADO
1440 GEORGE DIETER DR STE C
EL PASO, TX 79936
TERESA R PINAROC MD PA
11548 VISTA DEL SOL DR
EL PASO, TX 79936
HERNANDEZ, ARTURO
11680 PEBBLE HILLS BLVD
EL PASO, TX 79936
MENDOZA-CASTILLO, RODIN
1860 DEAN MARTIN DR
EL PASO, TX 79936
MARQUEZ, FRANCISCO
11621 PELLICANO DR
EL PASO, TX 79936
SEBESTA, MICHAEL
3100 N LEE TREVINO DR STE G
EL PASO, TX 79936
HERNANDEZ, ARTURO
2931 GEORGE DIETER DR
EL PASO, TX 79936
ENZ, JASON
1416 GEORGE DIETER DR
EL PASO, TX 79936
PATTERSON, JOHN
11680 PEBBLE HILLS BLVD
EL PASO, TX 79936
LIANO, RUBEN
11450 ROJAS DR STE D1
EL PASO, TX 79936
MALDONADO, YVONNE
11965 PELLICANO DR
EL PASO, TX 79936
SRINGAM, YADAH
11965 PELLICANO DR
EL PASO, TX 79936
BAKER, NANNI
11965 PELLICANO DR
EL PASO, TX 79936
YTEM, JOSE
11544 VISTA DEL SOL DRIVE
EL PASO, TX 79936
SAMONTE, MIGUEL
11544 VISTA DEL SOL
EL PASO, TX 79936
BLANCAS, MOSES
1721 N LEE TREVINO DR STE B
EL PASO, TX 79936
WONG, KA
1400 GEORGE DIETER DR
EL PASO, TX 79936
GERALDE, NICOLO
2028 PASEO DEL PRADO DR
EL PASO, TX 79936
HOFFER, THOMAS
2400 TRAWOOD DR
EL PASO, TX 79936
REED, TERESA
1400 GEORGE DIETER DR
EL PASO, TX 79936
BELOCURA, JONNALYN
11345 MONTWOOD DR
EL PASO, TX 79936
RESIGNATO, PAUL
1722 N ZARAGOZA RD
EL PASO, TX 79936
KHATEEB, MAZIN
3235 TRAWOOD DR.
EL PASO, TX 79936
ZAYAS, RAUL
11880 VISTA DEL SOL DR
EL PASO, TX 79936
NUTIS, MARIO
2400 TRAWOOD DR
EL PASO, TX 79936
Details
AMADO RAMIREZ, M.D.
Phone Number
(915) 594-7777
Office Locations
1440 GEORGE DIETER DR STE C
EL PASO, TX 79936
1440 GEORGE DIETER DR STE C EL PASO TX, 79936

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