Out-of-Network Plan Benefits
If you seek treatment from a provider who does not participate
in the network, then deductibles and coinsurance
will apply. The deductible applies to medical service but
not to behavioral health service. The cost of the service for
which you will be responsible under the coinsurance rates
is indicated in the Premier Plan Chart. Generally you will
pay 40% of the reasonable and customary cost of medical
service and 50% of the negotiated cost of behavioral
service plus any excess fee over the Reasonable and
Customary fees. Your out-of-pocket liability for
deductibles and coinsurance (but not excess fees) is
limited separately for medical and behavioral health
services as indicated in the Premier Plan Chart.
If you must use the services of a medical provider that
does not participate in the CIGNA Healthcare Network,
show that provider your MILA Identification Card, which
identifies you as a participant in a CIGNA Healthcare
Open Access Plus Network program. That ID card also
contains the logo for groups of medical providers that
do not participate in the CIGNA Healthcare Open Access
Plus Network but that will provide services at a discounted
charge. You must show the provider this card in order to
qualify for any Out-of-Network discount he or she might
offer. The number of providers offering the Plan a discount
was expanded in 2007. If the provider offers you a discount,
both you and MILA will benefit from the reduction
in the cost of the service.
