2026 Cigna Health Plan Benefit Summary HDHP 3500

01/01/2026 ASO Open Access Plus HDHPQ - HDHPQ 3500 Proclaim - 37302326 - V 33 - 10/20/25 05:17 PM ET 1 of 17 ©Cigna 2025 BENEFIT SUMMARY Administered by - Cigna Health and Life Insurance Co. For - Inotiv, Inc. Open Access Plus HDHPQ Plan HDHPQ 3500 Effective - 01/01/2026 Selection of a Primary Care Provider - your plan may require or allow the designation of a primary care provider. You have the right to designate any primary care provider who participates in the network and who is available to accept you or your family members. If your plan requires designation of a primary care provider, Cigna may designate one for you until you make this designation. For information on how to select a primary care provider, and for a list of the participating primary care providers, visit www.mycigna.com or contact customer service at the phone number listed on the back of your ID card. For children, you may designate a pediatrician as the primary care provider. Direct Access to Obstetricians and Gynecologists - You do not need prior authorization from the plan or from any other person (including a primary care provider) in order to obtain access to obstetrical or gynecological care from a health care professional in our network who specializes in obstetrics or gynecology. The health care professional, however, may be required to comply with certain procedures, including obtaining prior authorization for certain services, following a pre-approved treatment plan, or procedures for making referrals. For a list of participating health care professionals who specialize in obstetrics or gynecology, visit www.mycigna.com or contact customer service at the phone number listed on the back of your ID card. Plan Highlights In-Network Out-of-Network Lifetime Maximum Unlimited Unlimited Plan Year Accumulation Your plan’s deductibles, out-of-pockets and benefit level limits accumulate on a calendar year basis unless otherwise stated. In addition, all plan maximums and service-specific maximums (dollar and occurrence) cross-accumulate between in- and out-of-network unless otherwise noted. Plan Coinsurance Plan pays 80% Plan pays 50% Maximum Reimbursable Charge Not Applicable 110% Plan Deductible Individual - Employee Only: $3,500 Individual - within a Family: $3,500 Family Maximum: $7,000 Individual - Employee Only: $6,000 Individual - within a Family: $6,000 Family Maximum: $12,000  Only the amount you pay for in-network covered expenses counts towards your in-network deductible. Only the amount you pay for out-of-network covered expenses counts towards your out-of-network deductible.  Plan deductible always applies before any benefit copay/deductible or coinsurance.  Plan deductible does not apply to in-network preventive services.  Family members meet only their individual deductible and then their claims will be covered under the plan coinsurance; if the family deductible has been met prior to their individual deductible being met, their claims will be paid at the plan coinsurance.  This plan includes a combined Medical/Pharmacy plan deductible.  In-Network Generic and Preferred Brand preventive drugs and products included in the Preventive Plus Package will not be subject to deductible. This may apply to drugs for: Asthma, Cholesterol Lowering, Depression, Diabetes (including diabetic supplies and continuous glucose monitor supplies), Heart Disease and Stroke, High Blood Pressure, Osteoporosis, Smoking Cessation, Prenatal Vitamins, Prescription Vitamins. Note: Services where plan deductible applies are noted with a caret (^).