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Page 1 b Limitations may be different for Arizona residents. Cigna dental care – Patient charge schedule 09 series – standard copays Listed on the following pages of this Patient Charge Schedule at a Glance are charges to be paid directly to you by the member for specific procedures. 08 Series – Split Copays Cigna Dental Care – Patient Charge Schedules Listed on the following pages of this Patient Charge Schedule are charges to be paid directly to you by the member for specific procedures. When services are rendered by a Network General Dentist, the member is responsible for paying the charges listed in the “GD” column.
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Cigna Fundamental Medicare (HMO) H4513-009 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Cigna available to residents in Texas. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The Cigna Fundamental Medicare (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $3,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,900 out of pocket. This can be a extremely nice safety net.
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Cigna Fundamental Medicare (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
Cigna works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Cigna Fundamental Medicare (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Cigna and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Cigna except hospice care. Carte memoire. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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Sat 9am-9pm EST
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2021 Cigna Medicare Advantage Plan Costs
Name: | |
---|---|
Plan ID: | H4513-009 |
Provider: | Cigna |
Year: | 2021 |
Type: | Local HMO * |
Monthly Premium C+D: | $0 |
Part C Premium: | |
MOOP: | $3,900 |
Similar Plan: | H4513-026 |
Cigna Dental Copay Schedule
2021 Cigna Fundamental Medicare (HMO) Summary of Benefits
Additional Benefits
No |
---|
Comprehensive Dental
Diagnostic services | Not covered |
---|---|
Endodontics | Not covered |
Extractions | $0 copay |
Non-routine services | Not covered |
Periodontics | $0 copay |
Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay |
Restorative services | $0 copay |
Deductible
$0 |
---|
Diagnostic Tests and Procedures
Diagnostic radiology services (e.g., MRI) | $0-200 copay |
---|---|
Diagnostic tests and procedures | $0-150 copay |
Lab services | $0 copay |
Outpatient x-rays | $0 copay |
Doctor Visits
Primary | $0 copay |
---|---|
Specialist | $30 copay per visit |
Emergency care/Urgent Care
Cigna Copay Basic
Emergency | $90 copay per visit (always covered) |
---|---|
Urgent care | $30 copay per visit (always covered) |
Foot Care (podiatry services)
Foot exams and treatment | $30 copay |
---|---|
Routine foot care | Not covered |
Ground Ambulance
$200 copay |
---|
Hearing
Fitting/evaluation | $0 copay |
---|---|
Hearing aids - inner ear | $0 copay |
Hearing aids - outer ear | $0 copay |
Hearing aids - over the ear | $0 copay |
Hearing exam | $0-30 copay |
Inpatient Hospital Coverage
$600 per stay |
---|
Medical Equipment/Supplies
Diabetes supplies | 0-10% coinsurance per item |
---|---|
Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
Cigna Dental Hmo Copay
Medicare Part B Drugs
Chemotherapy | 20% coinsurance |
---|---|
Other Part B drugs | 20% coinsurance |
Mental Health Services
Inpatient hospital - psychiatric | $150 per day for days 1 through 7 $0 per day for days 8 through 90 |
---|---|
Outpatient group therapy visit | $0 copay |
Outpatient group therapy visit with a psychiatrist | $0 copay |
Outpatient individual therapy visit | $0 copay |
Outpatient individual therapy visit with a psychiatrist | $0 copay |
MOOP
$3,900 In-network |
---|
Option
Yes, contact plan for further details |
---|
Optional supplemental benefits
No |
---|
Outpatient Hospital Coverage
$0-250 copay per visit |
---|
Preventive Care
$0 copay |
---|
![Cigna Dental Copay Cigna Dental Copay](/uploads/1/1/9/6/119677428/698349442.jpg)
Preventive Dental
Cleaning | $0 copay |
---|---|
Dental x-ray(s) | $0 copay |
Fluoride treatment | Not covered |
Oral exam | $0 copay |
Rehabilitation Services
Occupational therapy visit | $30 copay |
---|---|
Physical therapy and speech and language therapy visit | $30 copay |
Skilled Nursing Facility
$0 per day for days 1 through 20 $184 per day for days 21 through 100 |
---|
Transportation
$0 copay |
---|
Vision
Contact lenses | $0 copay |
---|---|
Eyeglass frames | $0 copay |
Eyeglass lenses | $0 copay |
Eyeglasses (frames and lenses) | $0 copay |
Other | Not covered |
Routine eye exam | $0 copay |
Upgrades | $0 copay |
Wellness Programs (e.g. fitness nursing hotline)
Covered |
---|
Reviews for Cigna Fundamental Medicare (HMO) H4513
2019 Overall Rating |
---|
Part C Summary Rating |
Part D Summary Rating |
Staying Healthy: Screenings, Tests, Vaccines |
Managing Chronic (Long Term) Conditions |
Member Experience with Health Plan |
Complaints and Changes in Plans Performance |
Health Plan Customer Service |
Drug Plan Customer Service |
Complaints and Changes in the Drug Plan |
Member Experience with the Drug Plan |
Drug Safety and Accuracy of Drug Pricing |
Staying Healthy, Screening, Testing, & Vaccines
Total Preventative Rating |
---|
Breast Cancer Screening |
Colorectal Cancer Screening |
Annual Flu Vaccine |
Improving Physical |
Improving Mental Health |
Monitoring Physical Activity |
Adult BMI Assessment |
Managing Chronic And Long Term Care for Older Adults
Total Rating |
---|
SNP Care Management |
Medication Review |
Functional Status Assessment |
Pain Screening |
Osteoporosis Management |
Diabetes Care - Eye Exam |
Diabetes Care - Kidney Disease |
Diabetes Care - Blood Sugar |
Rheumatoid Arthritis |
Reducing Risk of Falling |
Improving Bladder Control |
Medication Reconciliation |
Statin Therapy |
Member Experience with Health Plan
Total Experience Rating |
---|
Getting Needed Care |
Customer Service |
Health Care Quality |
Rating of Health Plan |
Care Coordination |
Member Complaints and Changes in Cigna Fundamental Medicare (HMO) Plans Performance
Total Rating |
---|
Complaints about Health Plan |
Members Leaving the Plan |
Health Plan Quality Improvement |
Timely Decisions About Appeals |
Health Plan Customer Service Rating for Cigna Fundamental Medicare (HMO)
Total Customer Service Rating |
---|
Reviewing Appeals Decisions |
Call Center, TTY, Foreign Language |
Cigna Fundamental Medicare (HMO) Drug Plan Customer Service Ratings
Total Rating |
---|
Call Center, TTY, Foreign Language |
Appeals Auto |
Appeals Upheld |
Ratings For Member Complaints and Changes in the Drug Plans Performance
Total Rating |
---|
Complaints about the Drug Plan |
Members Choosing to Leave the Plan |
Drug Plan Quality Improvement |
Member Experience with the Drug Plan
Total Rating |
---|
Rating of Drug Plan |
Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
Total Rating |
---|
MPF Price Accuracy |
Drug Adherence for Diabetes Medications |
Drug Adherence for Hypertension (RAS antagonists) |
Drug Adherence for Cholesterol (Statins) |
MTM Program Completion Rate for CMR |
Statin with Diabetes |
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Cigna Fundamental Medicare (HMO)
![Dental Dental](/uploads/1/1/9/6/119677428/498188825.jpg)
(Click county to compare all available Advantage plans)
State: | Texas |
---|---|
County: | Angelina,Brazoria,Cameron,Chambers,Fort Bend, Galveston,Hardin,Harris,Hidalgo, Jasper,Jefferson,Liberty,Montgomery, Nacogdoches,Newton,Orange,Polk, San Jacinto,Tyler,Walker,Waller, Webb,Willacy, |
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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Rv042 vpn client to gateway. Employer sponsored 800 series and plans under sanction are excluded.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Rv042 vpn client to gateway. Employer sponsored 800 series and plans under sanction are excluded.
CIGNA DENTAL INSURANCE PLANS ARE NOT MAJOR MEDICAL OR COMPREHENSIVE HEALTH INSURANCE POLICIES AND DO NOT PROVIDE THE MINIMUM ESSENTIAL COVERAGE NECESSARY TO AVOID PENALTY UNDER THE AFFORDABLE CARE ACT OF 2010 (ACA).
Dental plans are insured by Cigna Health and Life Insurance Company with network management services provided by Cigna Dental Health, Inc. Rates may vary based on age, family size, geographic location (residential zip code) and plan design. Some dental plans apply waiting periods to covered basic, major and orthodontic dental care services. Waiting periods do not apply in RI. Some covered services are determined by age. Dental insurance policies have exclusions, limitations, reduction of benefits and terms under which a policy may be continued in force or discontinued.
For costs and additional details about coverage, contact Cigna at 900 Cottage Grove Rd, Hartford, CT 06152 or call 866.GET.Cigna. (866.438.2446).
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company and Cigna Dental Health, Inc. In Texas, the Dental plan is known as 'Cigna Dental Choice' and this plan uses the national Cigna DPPO network. The Cigna name, logo and other Cigna marks are owned by Cigna Intellectual Property, Inc.
This ad is not intended for residents of New Mexico.
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Privacy © 2018 Cigna. Some content provided under license.
Privacy © 2018 Cigna. Some content provided under license.