175 HIP HMO 3K
Dual network: HIP HMO in NY · Cigna PPO outside NY (no referral)
Gated HMO in New York — $3,000/$6,000 deductible, $30 office copay, $60 specialist after deductible, 3-tier Rx ($25/$50/$100 after a $100 Rx deductible), $500 inpatient copay. $7,150/$14,300 out-of-pocket max. Outside New York you use the Cigna PPO network — no referral needed, even though the plan is an HMO.
Monthly premiums
- Member
- $1,499.00/mo
- Member & Family
- $3,474.00/mo
Lowest-cost Local 175 HIP plan — $3,000 deductible, $30 PCP copay before the deductible, full 3-tier Rx
Plan details
- Deductible (Individual)
- $3,000
- Deductible (Family)
- $6,000
- Out-of-Pocket Max (Individual)
- $7,150
- Out-of-Pocket Max (Family)
- $14,300
- Coinsurance (In-Network)
- 0%
- Primary Care Copay
- $30
- Specialist Copay
- $60
- Urgent Care Copay
- $75
- ER Copay
- $150
Benefits
Deductible
$3,000 / $6,000
OON: Not Covered; separate $100 / $200 Rx deductible
Max Out of Pocket
$7,150 / $14,300
In-network; accumulates plan year
Copay
$30 / $60 / $75
PCP (no ded) / Specialist / Urgent Care after ded
Coinsurance
0%
Copays after deductible
Emergency Room
$150 copay
After deductible; waived if admitted
Rx Coverage
$25 / $50 / $100
3-tier after the Rx deductible; 90-day mail order
Pregnancy
Covered
$30 visits (no ded); $1,000 delivery facility copay
Mental Health
Covered
$30 outpatient (no ded); $500 inpatient after ded
Hospital Admission
$500 per admission
After deductible; preauthorization required
Referrals
Required
Gated HMO — care through your PCP
Dependents
To Age 26
Coverage
HIP HMO in NY
Cigna PPO outside New York — no referral
Work Requirement
Work Required
Plan documents
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