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BENEFITS SUMMARY

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 all medical services. 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 charges for all medical services plus 100% of any excess fee over the reasonable and customary (R&C) amounts.

If you must use the services of a medical provider that does not participate in the Cigna Healthcare Network, show that provider your MILA/Cigna Identification Card, which identifies you as a participant in a Cigna Healthcare Open Access Plus Network. Your ID card also contains the logo for groups of medical providers that do not participate in the Cigna Healthcare Open Access Plus Network but do provide services at a discounted charge. You must show the provider your card in order to qualify for any Out-of-Network discount he or she might offer. If the provider offers you a discount, both you and MILA will benefit from the reduction in the cost of the service.

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