Health Plan at-a-glance: 
        Hospital benefits
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The Health Plan provides coverage for inpatient services from network hospitals and non-network hospitals, subject to copayment and coinsurance. To maximize your benefits and reduce out-of-pocket costs, choose hospitals and other health care providers within the AFTRA Health Plan’s preferred provider organization (PPO) network.

Network hospital Coverage
  • Copayment
$100 per inpatient admission.
  • Inpatient/outpatient benefit
90% of first $10,000 in covered expenses (excluding the $100 copayment) for each individual's pre-authorized¹ inpatient admissions and/or outpatient services per year; 100% thereafter. 
  • Coinsurance
10% of first $10,000 in covered expenses for each individual's pre-authorized inpatient admissions and/or outpatient services per year.
  • Annual out-of-pocket limit
$1,000 (plus $100 copayment per inpatient admission2).
Non-network hospital
  • Copayment
$100 per inpatient admission.
  • Inpatient/outpatient benefit
60% of first $7,000 in covered expenses (excluding the $100 copayment) for each individual's pre-authorized¹ inpatient admissions and/or outpatient services per year; 100% of covered expenses thereafter. 
  • Coinsurance
40% of first $7,000 in covered expenses for each individual's pre-authorized inpatient admissions and/or outpatient services per year.
  • Annual out-of-pocket limit
$2,800 (plus a $100 copayment per inpatient admission).
 
 
¹ All inpatient hospital admissions must be pre-authorized by CIGNA, except in the case of emergency admissions which must be authorized within 72 hours of the admission.

2 Exception: If you are hospitalized for a single uninterrupted hospitalization spanning two calendar years, you will only be responsible for satisfying the annual network or non-network out-of-pocket maximum once.

Refer to the 2011 Health Plan SPD and relevant Benefits Updates  for additional information and details. The information provided above is summarized and is not a complete description of the actual terms and provisions of the Health Plan documents. If any conflict arises between this information and the Plan documents, or if any point is not discussed above or is only partially discussed, the Plan documents will govern in all cases.