From: COH - Broadcast Message
Sent: Friday, April 22, 2011 11:04 AM
To: COH - All Employees
Subject: Open Enrollment Fast Facts #7: Out-of-pocket maximums



You’re protected with out-of-pocket maximums

Each medical plan requires you to pay part of the cost at time of service, whether a copayment, deductible or coinsurance. However, when you reach your plan’s out-of-pocket maximum, you’ll no longer have to pay anything for certain covered services. Your plan will pay 100 percent of the cost of those services for the rest of the benefit year.


Here’s how it works:

Each plan has two out-of-pocket maximum levels, one for an individual and one for the family.  One family member can reach the individual out-of-pocket maximum for the benefits year and not have to pay at the time of service, while other family members will still have to pay at time of service. If some combination of family members reaches the family out-of-pocket maximum for the benefits year, the family out-of-pocket is considered met.  No one covered person will pay more than the individual maximum.


The maximums:

CIGNA KelseyCare

    • $1,500 individual maximum for inpatient facility, outpatient facility and advanced radiological copayments. 
    •  $3,000 Family maximum for inpatient facility, outpatient facility and advanced radiological copayments. 
    • Only inpatient facility, outpatient facility and advanced radiological copayments count toward the out-of-pocket maximum. Other copayments, including physician office visits and prescriptions medications, are not included when figuring the out-of-pocket maximum for this plan. 


CIGNA Open Access

    • $3,000 in coinsurance payments for an individual.
    • $6,000 in coinsurance payments for a family.
    • Doctor’s visit copayments, deductibles, and prescription copayments or coinsurance are not included when figuring the maximum for this plan.


Consumer-Driven Health Plan 

    • In network:
      • Employee: $5,000.
      • Family: $10,000.
    • Out of network:
      • Employee: $10,000.
      • Family: $20,000.
    • All deductibles and coinsurance for covered services count toward the out-of-pocket maximum.
    • In-network covered services count toward the in-network out-of-pocket maximum only.  
    • Out-of-network covered services count toward the in-network and out-of-network out-of-pocket maximums.


See examples for each plan.


Your Open Enrollment Tools

·        CIGNA pre-enrollment hotline : 800-997-1406

· : Username is Houston 2011 and the password is CIGNA


·        Open Enrollment lab : 611 Walker, 4th floor, weekdays from 8 a.m. – 5 p.m. until Wed., April 20.