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CLIENT SUMMARY OF BENEFITS  Connecticut General Life Insurance Co.   For ­ Arlington County Government  Network Open Access Copay Plan   
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Document Date: 2014-03-19 15:51:16


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City

Service You / /

Company

Case Management / Programs Cigna Behavioral Advantage Inpatient / Cigna / Connecticut General Life Insurance Co. / /

Currency

USD / /

Facility

Other Health Care Facilities Outpatient Services Benefit In Network In Network Hospice / Delivery Facility / Rehabilitation Hospital / Inpatient Hospital / Travel Lifetime Maximum Lifesource Facility / Hospice Care Program / Outpatient Facility / Skilled Nursing Facility / Sub Acute Facility / /

IndustryTerm

Contraceptive devices / transportation / partial hospitalization services / medical and surgical services / surgical services / lab services / radiological imaging copays / care for diabetes / Allergy Treatment / non emergency transportation / substance abuse services / /

MedicalCondition

Infertility / peripheral vascular disease / Allergy Treatment/Injections / diabetes / injury / obesity / clinically severe obesity / pulmonary rehabilitation / /

MedicalTreatment

occupational therapy / cognitive therapy / Immunizations / vasectomy / artificial insemination / Acupuncture / counseling / speech therapy / Surgery / surgical treatment / Organ Transplants / physical therapy / Bariatric Surgery / in vitro fertilization / /

Organization

In Network In Network In Network In Network In Network Lab / Inpatient Hospital / Birthing Center / Critical Care Unit / Intensive Care Unit / Rehabilitation Hospital / Physician's Office / Environmental Protection Agency / /

Person

Semi Private / Radiologist / /

Position

Elective and non elective Specialist / Care Physician / Network Physician Services / anesthesiologist / etc. / physician / physician in the office / Surgeon / Care Physician Office / Pathologist / ER Physician / /

Technology

MRI / /

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