- There are two deductible thresholds: $2000 for single & $4000 for family (more than one )
- Preventative services (physicals, mammograms, etc.) are covered at 100% with no cost to insured unless they become diagnostic, in which case they are not.*
- Insured will be responsible for Cigna negotiated price for these services as long as we stay in network.
- Until you reach the deductible threshold, all bills (in & out of network medical services and prescriptions) are paid by the insured person, not the BOE.
- Negotiated prices will count towards the $2000/$4000 deductible threshold.
- Insured are responsible for entire out of network costs until $2000/$4000 deductible threshold is met.
- Out of network doctor visits will be credited towards deductible threshold at the maximum reimbursable charge (MRC).
- Once the 2000/$4000 deductible threshold is met, all in-network medical services will be covered by BOE.
- After the deductible threshold is met, insured are still responsible for:
- 20% of out of network fees and BOE will pay 80% amaximum reimbursable charge (MRC) for that service. Providers may still balance bill for the difference between what they charged and the MRC. How it works
- The limit for out of network medical is based on 20% of MRC for services, $2000 single and $4000 family above the basic $2000/$4000 deductible threshold.
- Insured will still have to pay for prescriptions but will follow the $10/$30/$45 formula until a further $1000/$2000 expenditure limit is reached.
Example: if a family plan member spends $4000 in a combination of in and out of network visits, blood tests and prescriptions (paid at full negotiated price) they would not be charged for any further in-network services.
They would still have to pay the $10/$30/$45 co-pay for prescriptions until they had spent a further $2000 on prescriptions & would have to pay for out of network medical services at 20% of MRC for a further $4000.
Maximum possible they could expend in an insurance year from Sept to Aug would be $10,000 for family or $5,000 for single.
* Example: if you are at a physical and the doctor notices that you have some strange spot and sends you for more tests, the original physical will be charged as a diagnostic session and will be counted towards the deductible.