Cigna Ultra 3000 PPO
Cigna PPO Network
Cigna Ultra 3000 PPO — Deductible: $3,000 / $6,000; Max Out of Pocket: $9,200 / $18,400; Office Copays: $30 / $60; Coinsurance: 30% after deductible; Rx Coverage: $15 / $65 / $100.
Monthly premiums
- Member
- $1,074.00/mo
- Member & Children
- $1,744.00/mo
- Member & Spouse
- $1,963.00/mo
- Member & Family
- $2,591.00/mo
Plan details
- Deductible (Individual)
- $3,000
- Deductible (Family)
- $6,000
- Out-of-Pocket Max (Individual)
- $9,200
- Out-of-Pocket Max (Family)
- $18,400
- Coinsurance (In-Network)
- 30%
- Primary Care Copay
- $30
- Specialist Copay
- $60
- Urgent Care Copay
- $60
Benefits
Deductible
$3,000 / $6,000
Individual / Family (in-network)
Max Out of Pocket
$9,200 / $18,400
Individual / Family (in-network)
Office Copays
$30 / $60
PCP / Specialist
Coinsurance
30% after deductible
Out-of-network: 40%
Rx Coverage
$15 / $65 / $100
Generic / Preferred / Non-Preferred (30-day)
X-Ray & Bloodwork
$30 copay
In-network
Advanced Imaging
30% after deductible
CT / MRI / PET
Emergency Room
30% after deductible
Urgent Care
$60 copay
In-network
Mental Health
30% after deductible
In-network
Network
Cigna PPO — National
No referrals required
Plan documents
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