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Dual network: HIP HMO in NY · Cigna PPO outside NY (no referral)Dual network: HIP HMO in NY · Cigna PPO outside NY (no referral)

175 HIP HMO 3K

Dual network: HIP HMO in NY · Cigna PPO outside NY (no referral)

Gated HMO in New York — $3,000/$6,000 deductible, $30 office copay, $60 specialist after deductible, 3-tier Rx ($25/$50/$100 after a $100 Rx deductible), $500 inpatient copay. $7,150/$14,300 out-of-pocket max. Outside New York you use the Cigna PPO network — no referral needed, even though the plan is an HMO.

Monthly premiums

Member
$1,499.00/mo
Member & Family
$3,474.00/mo

Lowest-cost Local 175 HIP plan — $3,000 deductible, $30 PCP copay before the deductible, full 3-tier Rx

Plan details

Deductible (Individual)
$3,000
Deductible (Family)
$6,000
Out-of-Pocket Max (Individual)
$7,150
Out-of-Pocket Max (Family)
$14,300
Coinsurance (In-Network)
0%
Primary Care Copay
$30
Specialist Copay
$60
Urgent Care Copay
$75
ER Copay
$150

Benefits

  • Deductible

    $3,000 / $6,000

    OON: Not Covered; separate $100 / $200 Rx deductible

  • Max Out of Pocket

    $7,150 / $14,300

    In-network; accumulates plan year

  • Copay

    $30 / $60 / $75

    PCP (no ded) / Specialist / Urgent Care after ded

  • Coinsurance

    0%

    Copays after deductible

  • Emergency Room

    $150 copay

    After deductible; waived if admitted

  • Rx Coverage

    $25 / $50 / $100

    3-tier after the Rx deductible; 90-day mail order

  • Pregnancy

    Covered

    $30 visits (no ded); $1,000 delivery facility copay

  • Mental Health

    Covered

    $30 outpatient (no ded); $500 inpatient after ded

  • Hospital Admission

    $500 per admission

    After deductible; preauthorization required

  • Referrals

    Required

    Gated HMO — care through your PCP

  • Dependents

    To Age 26

  • Coverage

    HIP HMO in NY

    Cigna PPO outside New York — no referral

  • Work Requirement

    Work Required

Plan documents

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