Cigna Global Health Medical Plan

2021 Plan Year Information

Expatriate and International Coverage

If you are a US benefits-eligible expatriate or US benefits-eligible international employee, you may elect medical, dental and vision coverage. Cigna Global Health Benefits is the provider of medical and dental benefits and Vision Service Plan is the provider of vision benefits.

Cigna Global Health Medical Plan

If you are a U.S. benefits-eligible expatriate or U.S. benefits-eligible international employee, you may elect medical coverage under the Cigna Global Health Medical Plan, which includes Cigna prescription drug benefits.

Cigna Global Health Medical Plan
Note

The figures in the chart below reflect what the Plan pays, with the exception of deductibles and out-of-pocket maximums.

Individual Deductible

In-Network:
$500

Out-of-network:
$1,500

Family Annual Deductible

In-Network:
$1,500

Out-of-network:
$4,500

Preventive Care

In-Network:
100% of R&C; deductible waived

Out-of-network:
100% of R&C; deductible waived

Office Visits (non-preventive)

In-Network:
80% of R&C, after annual deductible

Out-of-network:
80% of R&C, after annual deductible; 60% of R&C, after annual deductible, for U.S. out-of-network services

Maternity

In-Network:
80% of R&C, after annual deductible

Out-of-network:
80% of R&C, after annual deductible

Fertility Coverage (includes cryopreservation, artificial insemination, IVF, GIFT and ZIFT)

In-Network:
80% of R&C, after annual deductible; lifetime maximums; combined $30,000 for medical and prescription drugs

Out-of-network:
80% of R&C, after annual deductible; lifetime maximums; combined $30,000 for medical and prescription drugs

Individual Out-of-Pocket Maximum

In-Network:
$4,000

Out-of-network:
$4,000

Family Out-of-Pocket Maximum

In-Network:
$10,000

Out-of-network:
$10,000

Out-of-Network Charges for Medical Services

Out-of-network reimbursements and maximums are based on reasonable and customary (R&C) charges as determined by the health plan administrator. You are responsible for any charges above the reasonable and customary amount charged by your provider.

Preventive vs. Non-Preventive Care

Preventive care covered by the Cigna Global Health Medical Plan includes routine exams, screenings and immunizations. Non-preventive care includes services such as office visits.

Cigna Global Health Benefits ID Cards

You will receive one ID card for medical and dental coverage. Should you require additional ID cards or misplace yours, contact Cigna Global Health Benefits.

Prescription drugs purchased outside the U.S.Prescription drugs purchased inside the U.S.:
Participating Retail Pharmacy or Mail Order		Prescription drugs purchased inside the U.S.:
Non-Participating Pharmacy
Generics

Covered at 20%

20% coinsurance per prescription order or refill

40% coinsurance per prescription order or refill

Brand Name Drugs

Covered at 20%

20% coinsurance per prescription order or refill

40% coinsurance per prescription order or refill

Cigna Global Health Plan Prescription Drug Special Circumstances

In some circumstances, if your physician agrees to write a prescription for a 365-day supply of medication, members can present their ID card and obtain a year’s worth of prescription medication prior to assignment or departure from the U.S.

Cigna Global Health Plan Prescription Drug Deductible and Out-of-Pocket Maximum

On the Cigna Global Health Plan, your prescription drug copays do not count toward your deductible. However, your prescription drug copays do count toward the individual and family out-of-pocket maximums for the whole medical plan.

FSAs

Flexible Spending Accounts (FSAs) allow you to set aside before-tax money to use for certain eligible expenses not covered by your health plans or to pay for certain dependent day care expenses. Using an FSA can save you from 20% to 40% depending on your tax bracket.

The Firm offers three types of FSAs: a Health Care FSA, a Limited Purpose FSA* and a Dependent Day Care FSA. The Health Care and Dependent Day Care FSAs are administered by UnitedHealthcare (UHC). The Limited Purpose FSA is administered by Your Savings Account.

*The Limited Purpose FSA is only available to employees enrolled in Medical Plan Option C and can only be used for eligible dental and vision expenses.

Medical Contributions

You and the Firm share the cost of medical coverage. Your contributions are deducted from your pay on a before-tax basis. If you or your spouse/domestic partner is a user of tobacco products and certify as such during Annual Enrollment, your annual contributions to the medical plan will increase by $500 per tobacco user.

Select the information that applies to your situation to see your contributions.

My location is:

Choose one

My benefits eligible earnings are:

Generally, your W-2 earnings.
To see your actual BEE, log on to the Benefit Center website.

Choose one

I want to see costs for:

Choose one

I want to see coverage for:

Select all that apply

If you are covering a domestic partner or the children of a domestic partner, the final determination of the tax status of a dependent is made by the IRS. As a result, there is no guarantee that the IRS will not impose a tax on the value of coverage.

The wizard shows estimates only; you’ll see exact amounts based on your eligible earnings when you enroll.