Cigna HealthCare of North Carolina - Connect Silver 3500 Summary of Benefits and Coverage 2025

Sep 22, 2026

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Summary of Benefits and Coverage (SBC) for Cigna HealthCare of North Carolina, Inc. outlines how the Connect Silver 3500 plan shares costs for covered services during 01/01/2025–12/31/2025. The document specifies overall deductibles ($3,500 individual / $7,000 family), the annual out-of-pocket limits ($9,100 individual / $18,200 family), and key exclusions from out-of-pocket calculations. It also explains network-provider savings, referral rules for specialists, and example copayment/coinsurance responsibilities for common medical events and prescription drug coverage.

LanguageEnglish

CategoryForms

FormatPDF

Pages8

Reading Time3 min

AccessFree to download

Plan Overview

Coverage Period and Plan Type

Cost Sharing Basics

Overall Deductible

Out-of-Pocket Limit

Network Provider Rules

Covered Services Examples

Office Visits and Preventive Care

Diagnostic Tests and Imaging

Prescription Drug Coverage

Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/2025 – 12/31/2025 Cigna HealthCare of North Carolina, Inc.: Connect Silver 3500 Indiv Med Deductible Coverage for: Individual & Family | Plan Type: HMO | The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium) will be provided separately.
This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, call 1-866-494-2111 or visit us [at](at www.cigna.com/ifp-documents. For general definitions of common)[ ](at www.cigna.com/ifp-documents. For general definitions of common)[www.cigna.com/ifp-documents.](at www.cigna.com/ifp-documents. For general definitions of common)[ ](at www.cigna.com/ifp-documents. For general definitions of common)[For general definitions of common](at www.cigna.com/ifp-documents. For general definitions of common) terms, such as allowed amount, balance billing, coinsurance, copayment, deductible, provider, or other underlined terms, see the Glossary. You can view the Glossary at [https://www.healthcare.gov/sbc-glossary/](https://www.healthcare.gov/sbc-glossary/ or call)[ or call](https://www.healthcare.gov/sbc-glossary/ or call) 1-866-494-2111 to request a copy.
| | | | --- | --- | --- | | Important Questions | Answers | Why This Matters: | | What is the overall deductible? | $3,500 person/ $7,000 family | Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan, each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible. | | Are there services covered before you meet your deductible? | Yes. Preventive care, office visits, Prescription drugs, Urgent care visits subject to acopayment, and eye
exam/glasses for children are covered before you meet your deductible. | This plan covers some items and services even if you haven’t yet met the deductible amount, but a copayment or coinsurance may apply. For example, this plan covers certain preventive services without cost sharing and before you meet your deductible. See a list of covered preventive services at [https://www.healthcare.gov/coverage/preventive-care-benefits/](https://www.healthcare.gov/coverage/preventive-care-benefits/) . | | Are there other deductibles for specific services? | No. | You don’t have to meet deductibles for specific services. | | What is the out-ofpocket limit for this plan? | $9,100 person/ $18,200 family | The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan, they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met. | | What is not included in the out-of-pocket limit? | Premiums, balance-billing charges, penalties for failure to obtain preauthorization for services and health care this plan doesn’t cover. | Even though you pay these expenses, they don’t count toward the out-of-pocket limit. | | Important Questions | Answers | Why This Matters: | | --- | --- | --- | | Will you pay less if you use a network provider? | [Yes. See](Yes. See www.cigna.com/ifp)[ ](Yes. See www.cigna.com/ifp)[www.cigna.com/ifp](Yes. See www.cigna.com/ifp)providers or call 1-866-494- 2111 for a list of network providers. | This plan uses a provider network. You will pay less if you use a provider in the plan’s network. You will pay the most if you use an out-of-network provider, and you might receive a bill from a provider for the difference between the provider’s charge and what your plan pays (balance billing) . Be aware, your network provider

FAQs

What are the overall deductible amounts for this plan in 2025?

The overall deductible is $3,500 for an individual and $7,000 for a family. You generally pay covered costs from providers up to the deductible before the plan begins to pay.

Are any services covered before meeting the deductible?

Yes. Preventive care, office visits, prescription drugs, urgent care visits subject to a copayment, and children’s eye exam/glasses are covered before meeting the deductible.

How does using a network provider affect what you pay?

You typically pay less when you use a provider in the plan’s network. You pay the most when you use an out-of-network provider, and balance billing may apply for the difference between the provider’s charge and what the plan pays.

Sep 22, 2026

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