Cigna is a global healthcare business that serves over 180 million people in over 30 countries around the world. Cigna insurance provides coverage for a host of medical needs, including the treatment of mental health and substance abuse disorder.1
This page will give a brief overview of the addiction treatment coverage many Americans with Cigna health insurance can expect to receive.
Please note: While American Addiction Centers (AAC) strives to provide you with the most updated information on each carriers’ addiction insurance coverage, policy changes and errors do occur. This is meant to be a brief overview of how Cigna insurance covers addiction treatment and not a comprehensive guide. Please check with your insurance carrier directly or call 1-888-744-0069 to confirm coverage levels.
Cigna Insurance Coverage Levels and Coverage Plans
There are several tiers and options when you choose Cigna health insurance benefits. Available plans and the coverage these policies provide may vary based on:
- The state you live in. Cigna provides coverage in:2
- North Carolina
- Your employer. When you choose Cigna insurance through your employer, you typically choose from the following options:3
- LocalPlus plans. These plans are cost-effective options that limit coverage to services provided in your locality or any LocalPlus Network area.
- Health Maintenance Organization (HMO) plans. HMO plans typically limit your coverage to medical professionals who contract with Cigna.
- Exclusive Provider Organization (EPO) plans. These plans provide a larger network of physicians and hospitals, though using services outside this network is usually not covered except in emergencies or special circumstances.
- Preferred Provider Organization (PPO) plans. PPO plans allow you to receive treatment outside of the Cigna-recommended network; however, taking this route usually results in a higher deductible or co-insurance percentage. You may also have to submit these claims yourself.
- Open Access Plus (OAP) plans. These plans allow you to choose a primary care provider (PCP) and do not require a referral for in-network professionals. Out-of-network coverage is not provided except in emergencies.
- Whether you have a government-funded plan (such as Medicare or Medicaid). There are minimum government-mandated levels of coverage, but Cigna offers options to add additional benefits; for example, Medicare Advantage plans and prescription drug plans.4 Medicaid coverage may vary substantially between states.5
- Indemnity or Cigna SureFit customizable plans.3
Before delving into the specifics, here are some terms that are important to understand:
- Deductible: This is the annual amount you must pay before Cigna will begin covering expenses.6
- Copayment: Once you reach your deductible, you’ll still have to pay a small amount each time you visit the doctor or need medication (e.g., $20 each time you see the physician).7 In some instances, your deductible may not apply to your copayment amount.
- Co-insurance: This is the percentage of the total cost you’ll pay when you need treatment (e.g. 20% of the cost of a stay at the hospital.8
- Out-of-pocket limit/maximum: This is the maximum amount you’ll have to spend per year. It includes deductibles, copayment, and co-insurance. Once you hit this amount, insurance covers the rest.9 Often, this will be the total amount you end up owing for inpatient or outpatient treatment.
It’s important to reach out to your provider to verify your coverage before you enter any form of rehabilitation treatment.
Does Cigna Insurance Cover Inpatient Rehab?
Cigna health insurance will cover inpatient rehabilitation in most cases (though this may change depending on your specific plan and circumstances). Here’s an example of the way inpatient costs are broken down, taking the Cigna Connect Flex Bronze 6700 EPO plan for one person as an example. If you need inpatient treatment for a mental health, behavioral health, or substance abuse problem at a Cigna network facility, you would pay:10
- Your $6,700 deductible.
- No copayment.
- 40% co-insurance (up until you reach your out-of-pocket limit of $7,900).
If you require prescription medication, you would also be required to make a copayment every 30 or 90 days depending on whether you opt for retail or home delivery. This co-pay may vary between $10 and $1,800 depending on the type of drug (generic, brand name, or specialty drug). Deductible does not apply to prescription drug coverage.10
This Cigna health plan does not include any limitations or exceptions when it comes to inpatient treatment.10 Some other plans may impose limits on the maximum length of your stay in the facility or the number of visits you can make in a year that would be covered.
If you opt to receive treatment outside the network with this plan, Cigna would not cover any of the expenses.10
Does Cigna Insurance Cover Outpatient Rehab?
Cigna insurance benefits also apply to outpatient treatment. Using the same plan as our example from above, if you opt for outpatient rehabilitation at a Cigna network facility, you would pay:10
- The $6,700 deductible.
- No copayment.
- 40% co-insurance (until you reach your out-of-pocket maximum of $7,900).
The Cigna Connect Flex Bronze 6700 EPO health plan does not include any limitations or exceptions when it comes to substance abuse or mental health services (e.g. number of visits, total cost, etc.).10 This may not be the case with other plans.
Prescription medication is an important part of rehabilitation treatment. Copayment for prescription drugs with this plan ranges between $10 and $1,800 depending on the type of drugs and whether they are delivered or picked up from a pharmacy. This co-pay must be paid when the prescription is refilled. The deductible does not apply, though your copayments will count toward your out-of-pocket maximum.10
If you opt to receive outpatient treatment outside the Cigna network with this particular EPO plan, Cigna would not cover any of the expenses.10
Does Cigna Cover Mental Health?
Mental health, behavioral health, and substance abuse services are all covered under Cigna health insurance.11, 12 Using the Cigna Connect Flex Bronze 6700 EPO plan as our example again, the coverage provided and the costs for inpatient and outpatient services for individuals requiring mental health treatment are the same as what is outlined in the previous two sections.10
Checking Your Insurance Benefits
There are several ways to check your Cigna insurance benefits. You can:
- Check your insurance paperwork that was supplied when you were hired by your employer.
- Call the customer service line.
- Log into the myCigna website or App. If you have not registered already, do so by providing your:
- Name and date of birth.
- Zip code.
- Social security number (SSN) or Cigna ID number (found on the front of your benefit ID card).
In most cases, Cigna insurance provides coverage for addiction and mental health services, provided you have an insurance plan through your employer or a government-funded plan such as Medicare or Medicaid; however, this may not be the case with certain customizable plans.
- Cigna. (2020). Company profile.
- Cigna. (2020). Shop and compare 2021 Cigna Medicare insurance plans.
- Cigna (2020). Medicaid plans.
- Healthcare.gov. (n.d.). Deductible.
- Healthcare.gov. (n.d.). Copayment.
- Healthcare.gov. (n.d.). Coinsurance.
- Healthcare.gov. (n.d.). Out-of-pocket maximum/limit.
- Cigna. (2019). Summary of benefits and coverage: What this plan covers & what you pay for covered services.
- Cigna. (2020). Mental health benefits.
- Cigna. (2020). Substance use.