Preferred Provider Organization (PPO)

Plan Highlights

  • Selecting a primary care physician isn't required
  • Referrals to see a specialist aren't required
  • Must obtain precertification for in-network services when required
  • In-network and out-of-network coverage
  • ID card shows most patient payment responsibilities and precertification requirements

Self-directed Health Care

Cigna Preferred Provider Organization (PPO) plans allow your patients covered by these plans to visit any health care professional. Patients aren't required to choose a primary care physician (PCP) to coordinate their care and treatment. They also don't need a referral to see a specialist.

Your patients may have one of these Cigna PPO plans:

  • PPO - patients have both in-network and out-of-network coverage. You're responsible for filing the claim form and obtaining precertification for all in-network services that require precertification.
  • EPO - patients have in-network benefits only, except in emergency and urgent care situations. You're responsible for obtaining precertification for all in-network services that require precertification.

Patients in these Cigna administered plans may be responsible for:

  • Deductibles for inpatient and outpatient facility charges
  • Coinsurance and/or deductibles for facility and physician charges

See the member ID card for the list of payment responsibilities.
Coinsurance/deductible should not be collected at the time of service unless you have accessed the Cigna Cost of Care Estimator® to obtain an estimate of the patient's costs and provide a copy of the Explanation of Estimate to the patient.

In addition to their Cigna administered PPO plan, patients may also have a Cigna Choice Fund®. They can use this employer- or employee-funded account to pay for qualified health care expenses.

Please contact us for more information about Cigna PPO plans, or about how to become a participating Cigna health care professional.