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AMERISTEAD HEALTH

Cigna Healthcare PPO Network · Administered by Marpai

Seven major-medical plan levels — HSA 8700, Bronze, HSA 6000, Silver, Gold, Platinum and Diamond — all on the Cigna PPO network. Full deductible, coinsurance, copay and sample premium tables below, pulled from the agent portal and plan comparison sheet.

Plan Comparison Sample Premiums Underwriting Agent Tools

Plan Comparison — All 7 Levels

All plans run on the Cigna Healthcare PPO network and are administered by Marpai. Deductible and out-of-pocket figures below are per person; family amounts are double the individual figure unless noted. Confirm current figures against the plan's Summary of Benefits before quoting — rates and cost-shares vary by state.

HSA 8700 Bronze HSA 6000 Silver Gold Platinum Diamond

Plan Feature	HSA 8700	Bronze	HSA 6000	Silver	Gold	Platinum	Diamond
Deductible — In-Network (Ind / Fam)
In-Network	$8,700 / $17,400	$8,000 / $16,000	$6,000 / $12,000	$5,000 / $10,000	$3,000 / $6,000	$250 / $500	$0 / $0
Out-of-Network	$8,700 / $17,400	$16,000 / $32,000	$9,000 / $18,000	$10,000 / $20,000	$6,000 / $12,000	$500 / $1,000	$6,000 / $12,000
Out-of-Pocket Maximum (Ind / Fam)
In-Network	$8,700 / $17,400	$8,700 / $17,400	$7,000 / $14,000	$8,700 / $17,400	$6,000 / $12,000	$1,250 / $2,500	$6,000 / $12,000
Out-of-Network	$8,700 / $17,400	$17,400 / $34,800	$14,000 / $28,000	$17,400 / $34,800	$12,000 / $24,000	$3,750 / $7,500	$12,000 / $24,000
Office Visit Copay / Coinsurance
Primary Care	30% after ded.	$50 copay	30% after ded.	$40 copay	$35 copay	$25 copay	$25 copay
Specialist	30% after ded.	$120 copay	30% after ded.	$80 copay	$55 copay	$45 copay	$50 copay
Urgent Care	30% after ded.	$100 copay	30% after ded.	$60 copay	$55 copay	$45 copay	$50 copay
Emergency Room	30% after ded.	No charge	30% after ded.	30% after ded.	$500 copay	20% after ded.	30% after ded.
Other Services (30% after deductible on most plans)
Labs / X-Ray	30% after deductible on all plans except where noted above
Diagnostic MRI / PET / CT / EKG	30% after deductible (20% on Platinum)
Outpatient Surgical / Hospital Admission	30% after deductible (20% on Platinum, 80/20 on Gold)
Maternity	30% after deductible on all plans
Prescription Drugs
Preventive Rx	$0 on all plans
Generic / Brand / Non-Preferred Brand	$0 / $35 / $75 on Silver, Gold, Platinum & Diamond — PBM-managed formulary on HSA and Bronze plans
Specialty Rx	PBM management required on every plan — see Rx Formulary link below

HSA 8700 and HSA 6000 are HSA-compatible high-deductible plans — no first-dollar copays, everything (including office visits) runs through the deductible/coinsurance until the out-of-pocket max is met. Diamond is a $0 in-network deductible copay plan. Per the current Diamond Summary of Benefits, out-of-network care carries a $6,000 / $12,000 deductible and a $12,000 / $24,000 out-of-pocket max — confirm out-of-network details against the SOB before quoting a client who travels or splits time between states.

Sample Monthly Premiums

Representative rates by coverage tier, per the current plan comparison sheet. Actual premium is age- and state-rated — always run a real quote before presenting a number to a client.

Coverage Tier	HSA 8700	Bronze	HSA 6000	Silver	Gold	Platinum	Diamond
Employee Only	Run quote	$544	$640	$674	$941	$1,003	$873
Employee + Spouse	Run quote	$856	$753	$1,012	$1,067	$1,493	$1,372
Employee + Child(ren)	Run quote	$753	$889	$945	$1,309	$1,563	$1,243
Employee + Family	Run quote	$1,134	$1,340	$1,413	$1,981	$2,993	$1,687

Underwriting & Eligibility

Medically Underwritten

Every Ameristead Health plan is individually medically underwritten on the Cigna medical questionnaire — agents cannot bind coverage, and acceptance/rating decisions are made after full application review. Walk clients through the medical questions before quoting so there are no surprises at underwriting.

Cigna Medical Questions (PDF) →

Qualifying Life Event

Clients enrolling outside their normal window need a documented Qualifying Life Event. Use the QLE form to capture and submit the event with the application.

Ameristead QLE Form (PDF) →

Plan documents, per-plan Summary of Benefits, and full policy language are available from each plan's page in the agent portal (see Agent Tools below) — always confirm the current Summary of Benefits for the client's state before you quote or enroll.

Agent Tools

Where to quote, enroll, and pull current plan documents as an Ameristead Health agent.

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Agent Enrollment Portal

Per-plan Info, Brochure, Cost calculator and Enrollment links for all 7 Ameristead Health plans.

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Ameristead Training FAQ

Product training and frequently asked questions straight from Ameristead Health.

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Rx Formulary

Current prescription drug formulary and PBM tiering for all Ameristead Health plans.

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Ameristead Health Plan Document

Full policy language and plan document for Ameristead Health coverage.

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Underwriting Tool

SAIL Underwriting Census

Blank census template (powered by Gradient AI) for submitting a group's employee census for underwriting — one file per group, required fields: name, gender, DOB, ZIP, relationship and coverage tier.

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Network

Cigna Healthcare Provider Directory

Confirm a client's doctors and facilities are in-network before quoting — linked from each plan's Information tab in the agent portal.

Network
Cigna Healthcare PPO

Administered by
Marpai

Underwriting
Medically underwritten — Cigna medical questions apply

Coverage
Varies by state — confirm before quoting