Individual PPO Health Insurance on the Cigna Network — Ages 18–64

Yes, you can access PPO health coverage on the Cigna network without being employed by a traditional employer. This plan — Patriot Ultra Cigna PPO — works differently than an ACA marketplace plan: it's a self-funded ERISA health plan, and eligibility is provided through fractional ownership rather than a traditional job. Below, licensed broker Clifford Grekin explains exactly how the plan works, who qualifies, and how it compares to ACA marketplace coverage — so you can make an informed decision before you apply.

Clifford Grekin is a licensed health insurance broker/general agent who can help you compare available options. Call 631-963-6020 or email broker@nysmallgroupplans.com to speak with a licensed professional.

What Exactly Is This PPO Plan?

How Is This Different From an ACA Marketplace Plan?

This is not an ACA marketplace plan, and it is not "ACA-compliant major medical" in the regulatory sense of that term. It is a self-funded ERISA health plan — a category of coverage that federal law treats differently from individual-market insurance. Self-funded ERISA plans are specifically exempt from ACA individual-market requirements such as guaranteed issue (accepting all applicants regardless of health status). That's a structural feature of how ERISA plans work, not a shortcoming specific to this plan.

Eligibility for this plan works through fractional ownership: applicants become a fractional owner, which makes them eligible to participate in that entity's self-funded health plan on the Cigna PPO network. Because it isn't guaranteed issue, applicants complete a health questionnaire, and those with major pre-existing conditions such as cancer, diabetes, or recent surgery are not accepted.

Available Nationwide

This PPO plan is available to eligible individuals in all 50 states, including Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. Because the plan uses the national Cigna PPO network, coverage generally travels with you if you relocate or need care while traveling — see "Does PPO insurance cover me outside my home state?" below.

Frequently Asked Questions

Can an individual buy PPO health insurance?

Yes. This PPO plan on the Cigna network is available to individuals directly, without a traditional employer. Eligibility works through fractional ownership in the sponsoring entity, plus a health questionnaire, rather than through a job or the ACA marketplace.

Can I get a PPO without an employer?

Yes. You don't need a traditional employer or business to apply. Eligibility comes from becoming a fractional owner of the plan's sponsoring corporation/union, which qualifies you to participate in its self-funded health plan.

Can I buy PPO insurance if I'm self-employed?

Yes. Self-employed individuals can apply the same way as any other applicant — through the fractional ownership eligibility structure and health questionnaire. There are no additional requirements specific to self-employment.

Can a retired person under 65 buy PPO health insurance?

Yes. Applicants ages 18–64 are eligible, and pricing is the same at every age within that range — there's no additional cost for being closer to 65. Acceptance still depends on the health questionnaire.

Are PPO plans available in New York?

Yes, this plan is available to eligible individuals in New York. Because self-funded ERISA plans are regulated differently than New York's individual insurance market,

Can I buy PPO insurance outside Obamacare?

Yes. This plan is not sold through the ACA marketplace — it's a self-funded ERISA plan accessed through fractional ownership eligibility. It is not restricted to the ACA's annual Open Enrollment Period, but unlike ACA marketplace plans, it is not guaranteed issue.

Do I have to wait for open enrollment?

No. You can apply year-round; there is no restriction to an annual open enrollment window.

Does PPO insurance cover me outside my home state?

Yes. Because the plan uses the national Cigna PPO network, you can generally receive in-network care from participating Cigna providers in any of the 50 states, not just your home state.

Does PPO insurance cover out-of-network doctors?

Yes. Out-of-network care is covered, subject to the plan's deductible and coinsurance, which are higher than in-network cost-sharing.

Are pre-existing conditions covered?

If you're accepted into the plan, pre-existing conditions are covered the same as any other condition. However, applicants with major pre-existing conditions — such as cancer, diabetes, or recent surgery — are generally not accepted, since this plan uses medical underwriting rather than guaranteed issue.

This page is for general informational purposes and does not constitute a description of any specific insurance contract. This plan is a self-funded ERISA health plan, not ACA marketplace or individual-market major medical insurance. Plan details, availability, and pricing vary by plan option and eligibility. Contact 631-963-6020 to speak with a licensed broker and review the official plan documents before enrolling.