Cigna Connect HSA 7000 Plan Details for 2021- HealthPocket

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Applicant Info
Applicant
Date of birth
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Gender
male
female
Income
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Zip Code	85364 (edit)
Applicant	5/20/1987 Male (edit)

Insurance Type	ACA (Obamacare)
Plan Name	Cigna Connect HSA 7000
Plan ID	hhs-97667AZ0110026
Plan Year	2021
Insurance Provider	Cigna
Metal Level	Expanded Bronze
Plan Type	HMO
Deductible	$7,000
Out-of-Pocket Maximum	$7,000
Plan Highlights

Costs for Medical Care
Primary Care Visit to Treat an Injury or Illness	No Charge after deductible
Specialist Visit	No Charge after deductible
Laboratory Outpatient and Professional Services	No Charge after deductible
X-rays and Diagnostic Imaging	No Charge after deductible
Diagnostic Imaging such as MRIs, CT, and PET scans	No Charge after deductible
Deductible - Family	$14000 per group
Out-of-Pocket Maximum - Family	$14000 per group

Prescription drug coverage
Generic Drugs	No Charge after deductible
Preferred Brand Drugs	No Charge after deductible
Non-Preferred Brand Drugs	No Charge after deductible
Specialty Drugs	No Charge after deductible

Access to doctors and hospitals
Provider directory URL	http://www.cigna.com/ifp-providers
Does this plan have access to a national provider network?	No
Is a referral required to see a Specialist?	Not Covered
Does this plan cover services outside plan service area?	Yes - Emergency Only
Does this plan cover services outside the country?	Yes - Emergency Only

Hospital services
Emergency Room Services	No Charge after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	No Charge after deductible
Inpatient Physician and Surgical Services	No Charge after deductible
Emergency Transportation or Ambulance Service	No Charge after deductible

Maternity
Prenatal and Postnatal Care	No Charge after deductible
Delivery and all inpatient services for maternity care	No Charge after deductible

Mental Health
Mental/Behavioral Health Outpatient Services	No Charge after deductible
Mental/Behavioral Health Inpatient Services	No Charge after deductible
Substance use disorder outpatient services	No Charge after deductible
Substance use disorder inpatient services	No Charge after deductible

Medical Management Programs
Does this plan offer disease managment programs?	Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy
Does this plan offer a wellness program?	Not Covered

Vision Coverage
Routine Eye Exam for Children	Included
Eye Glasses for Children	Included
Routine Eye Exam for Adults	Not Covered

Child Dental Coverage
Child Dental Coverage - Routine Dental Care	Not Covered
Child Dental Coverage - Basic Dental Care	Not Covered
Child Dental Coverage - Orthodontia	Not Covered
Child Dental Coverage - Major Dental Care	Not Covered

Adult Dental Coverage
Adult Dental Coverage - Routine Dental Care	Not Covered
Adult Dental Coverage - Basic Dental Care	Not Covered
Adult Dental Coverage - Orthodontia	Not Covered
Adult Dental Coverage - Major Dental Care	Not Covered

Exclusions and Limitations
More Included Benefits	Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Skilled Nursing Facility Bariatric Surgery Hearing Aids Private-Duty Nursing Imaging (CT/PET Scans, MRIs) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Outpatient Rehabilitation Services Habilitation Services Durable Medical Equipment Hospice Services Chiropractic Care Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Tier 2 Generic Drugs Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
More Limited Benefits	Home Health Care Services
More Excluded Benefits	Acupuncture Cosmetic Surgery Infertility Treatment Weight Loss Programs Dental Check-Up for Children Routine Foot Care Abortion for Which Public Funding is Prohibited Long-Term/Custodial Nursing Home Care

+ See All Coverage Details

Premium	Plan Name	Deductible
from $298	Medica Pinnacle Bronze Copay ($0 Virtual Care + Online Wellness)	$7,200.00	Select
from $316	Oscar Bronze Classic ($3 Prescription List + Free 24/7 Virtual	$7,000.00	Select
from $320	UHC Bronze-X Value+ Saver ($3 Rx + 3 Free Primary Care & 6 Free Virtual Visits)	$7,000.00	Select
from $332	Cigna Connect 7000	$7,000.00	Select
from $355	Ambetter Essential Care 2 HSA (2021) + Vision + Adult Dental	$6,900.00	Select

Last Name

Location/Distance

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Rajesh, Khona

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Shawn, Hermenau

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Sw Rehab

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Nicolas, Santos

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Nnabuikem, Anaba

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Kailey, Rote

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Joseph, Sanchez

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Michael, Mccullagh

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Zachary, Parkinson

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Shanti Anesthesiology, Pllc

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Nafisah, Naqvi

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Stephanie, Clark

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Lee, Barnwell

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Kemell Health Llc

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Rajesh Khona, M.D.

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Phone Number
(602) 273-6770
Office Locations
2400 S Avenue A
Yuma, AZ 85364

2400 S Avenue A Yuma AZ, 85364

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ZIP Code
County
Applicant Info
Applicant
Date of birth
//
Gender
male
female
Income
$

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HealthPocket.com is a free information source. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. While on our site, if you click on a plan or link, you may be directed to one of our partners who offers health insurance products. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.