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Cigna Healthcare:
1-877-646-0792

College Group ID: 2970

Benefits At a Glance

Medical Benefits	Level 2	Level 1
Doctor's Office Visits* copay plan pays	$10 100%	$15 100%
Non ER Care in ER Room* deductible plan pays maximum amount paid by plan	$100/occurrence 50% $500/year	$100/occurrence 50% $500/year
Outpatient Care deductible plan pays maximum amount paid by plan	$100/year 80% $1,500/year	$50/year 80% $1,000/year
*Prescription Benefit¶** deductible – Generic deductible – Brand maximum amount paid by plan	discount program included§ $15/prescription $25/prescription $300/year	discount program included§
Daily In-Hospital Benefit deductible plan pays maximum amount paid by plan	$250/day up to 100 days $0 100% $25,000/year	$100/day up to 100 days $0 100% $10,000/year
In-Hospital Surgery deductible plan pays maximum amount paid by plan	$0 100% $1,500/occurrence	not included
Maternity Benefit deductible plan pays maximum amount paid by plan	$0 100% $1,500/occurrence	not included
Accident Coverage deductible plan pays number of occurrences maximum per occurrence maximum amount paid by plan	$100/occurrence 80% 2/year $5,000 $10,000/year	$50/occurrence 80% 2/year $2,500 $5,000/year
Accidental Death Benefit plan pays	$15,000	$10,000
CIGNA 24-Hour EAPSM health information line audio library of health topics EAP consultation	unlimited unlimited up to 3/year	unlimited unlimited up to 3/year
Online Tools locate doctors in our network compare doctors by price track status of claims	included	included
Starbridge Select utilizes the CIGNA BridgeSM Network that provides discounts on outpatient and inpatient services. * The total amount Starbridge Select pays will count toward your Outpatient Care maximum. § The prescription discount program is not insurance. ¶ This benefit reimburses 100% of the prescription charge after deductible has been met. The benefits above are provided by policy form SBCII-GMP-02. All yearly benefits are paid per coverage year.

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