SureFit

 

SureFit Plan1

SureFit Network1

Out-of-Network

Office Visit

 

 

Primary Care Physician

Deductible + 0%

No Coverage

Specialist

Deductible + 0%

No Coverage

Consigilio Wellness Center

$10

 

Deductible

 

 

Individual

$2,700

N/A

Individual + More

$5,400

$2,700/person

N/A

Coinsurance

0%

No Coverage

Out-of-Pocket Maximum

 

 

Individual

(includes deductible)

$2,700

N/A

Individual + More

(includes deductible)

$5,400

$2,700/person

N/A

 

 

 

 

SureFit Plan-Your Responsibility2

Prescription Drug Highlights

Preventive

Non-Preventive

Retail In-Network3

(34 day supply)

 

 

Generic

$0

Deductible + 0%

Preferred Brand

$0

Deductible + 0%

Non-Preferred Brand

$0

Deductible + 0%

Mail Order In-Network

(90 day supply)

 

 

Generic

$0

Deductible + 0%

Preferred Brand

$0

Deductible + 0%

Non-Preferred Brand

$0

Deductible + 0%

1 A regional network of physicians located in Kansas City.  Please visit www.cigna.com for a list of participating providers in your area..

2There is no coverage for prescriptions obtained from an out-of-network mail order pharmacy for the SureFit and Consumer Driven plans.

3Prescriptions obtained at a non-network retail pharmacy are subject to the deductible + 50% coinsurance for all plans.