CIGNA Open Access Plus

Freedom of Choice

CIGNA Open Access Plus plans offers choice and convenience – access to our broad national provider network, while offering health care choices. For example:

• Members have the option to choose a Primary Care Physician (PCP) to serve as a personal physician and help coordinate health needs.
• No referrals are necessary to see specialists in the network. Members Just choose the participating doctor prefered and make an appointment.
• The option to see any licensed physician choosen within or outside of the Open Access Plus network - though benefits are higher when care is received from a provider in the Open Access Plus network.
• Emergency care is covered 24 hours a day, no matter where the member receive it. You may go to any emergency facility, anywhere.

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Where to Find the Care You Need

Here is a summary of your plan's services and how to arrange for care.

Routine Medical Care (such as physical exams, mild fever and pains, chronic pain and, headaches, colds and flu).

• Call a PCP within the network during office hours and he or she will provide you with medical advice and/or schedule an office visit for you.

Specialty Care (such as orthopedic or heart disease)

• Make an appointment with a specialist within the network for an initial assessment, and if needed, he or she will provide medical advice and treatment.

Hospital Care (such as inpatient care and surgery, or outpatient surgery)

• For non-emergency care, call a network PCP and he or she will work with you to coordinate all your hospital care.

Urgent Medical Care (such as fever, sprains or strains, eye or ear infections, or severe sore throat)

• Call a network PCP and he or she will assess your situation and if necessary, give you advice on where to seek immediate care.

Emergency Care (such as poisoning, chest pains, broken bones, uncontrolled bleeding, loss of consciousness or sudden paralysis)

• Go to the nearest emergency facility or call 911. Call a network PCP or CIGNA HealthCare as soon as reasonably possible, so that someone can coordinate your follow-up care.

If you have a question about your health, call a network physician. And for questions about your health plan or coverage, call the toll-free number on your CIGNA HealthCare ID card.

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How Open Access Plus Might Work for You

You visit an out-of-network orthopedic specialist and it is determined that you will require outpatient surgery. You undergo day surgery at a participating facility, which also include X-Rays and Laboratory services. Your benefit plan covers:

*Covered expense may be reduced to the Maximum Reimbursable Charge specified in the Plan. This example assumes charges are typical of the amount that other doctors in the geographic area charge for the same service.

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Special Programs

Members of CIGNA HealthCare plans may also have access to valuable Health and Wellness Programs:

• Well Informed — a personalized health improvement program designed to let CIGNA HealthCare members and their doctors know about opportunities to maintain or improve the member's health.
• 24-hour health information — call the CIGNA HealthCare 24-Hour Health Information Line^SM any time to speak with a registered nurse or listen to our audio library for health-related information.
• Support for chronic conditions — manage your asthma, diabetes, heart condition, low back pain, or chronic obstructive pulmonary disease with help from CIGNA Well Aware for Better Health^®.
• Member discounts — save up to 60% on products and services-from acupuncture to weight management-with our Healthy Rewards^® discount program. Note: not all programs are available in all states.
• Quality transplant care — access care from nationally recognized facilities in the CIGNA LIFESOURCE Transplant Network^®.
• CIGNA HealthCare Healthy Babies^® — give your child a healthy beginning with information and support from the CIGNA HealthCare Healthy Babies^® program.
• CIGNA Healthy Pregnancies, Healthy Babies^SM — the CIGNA Healthy Pregnancies, Healthy Babies^® program offers a full scope of educational and care management services to members who are pregnant or considering pregnancy.
• Cancer prevention and education — the Comprehensive Oncology Program^® addresses cancer prevention and education, as well as active management of members diagnosed with cancer.
• High Touch Personal Assistance — with CIGNA Health Advisor^SM, CIGNA Health Advisors proactively identify and reach out to members who are at risk for significant health issues but are not appropriate candidates for chronic or acute disease or case management programs.
• Lose weight and improve your health — when you enroll in the CIGNA Healthy Steps to Weight Loss^SM, you won't be starting a diet. Instead, this program helps you change your behaviors permanently. You'll learn healthier eating habits and how to incorporate exercise into your schedule – helping you to feel better, look better and improve your overall health.

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Employer Benefits

FAQ

• Do I have to choose a PCP?
• What if my doctor is not on your list?
• Do I need a referral to see a specialist?
• What is the difference between in-network coverage and out-of-network coverage?
• Do I have to choose between in-network and out-of-network coverage now?
• How do I find participating doctors?
• What if I go to an out-of-network physician who sends me to a network hospital? Will I pay in-network or out-of-network charges for my hospitalization?
• What is utilization review?
• Who is responsible for obtaining precertification?
• What if my doctor keeps me in the hospital longer than my precertification allows?
• Can my current doctor be added to your network?
• What if my doctor is on the list, but his/her office is shown as "accepting current patients only"? Can I still choose my doctor?
• Am I covered for emergency care?

Do I have to choose a PCP?
You are not required to choose a primary care physi­cian. However, a primary care physician gives you and your dependents a valuable resource and a personal health advocate.

What if my doctor is not on your list?
That means your doctor does not participate in the Open Access Plus/CareLink network. To receive your maximum benefit, you should select a doctor from the list of participating Open Access Plus/CareLink providers. Participating providers must meet standards to become a part of the network. You can continue seeing your current doctor, even if he or she is not a participating provider. However, in that case, you will pay higher out-of-pocket costs, and your care will be covered at the out-of-network benefits level.

Do I need a referral to see a specialist?
Though you may want your personal doctor's advice and assistance in arranging care with a participating specialist, you do not need a referral to see a participating specialist. If you choose to see an out-of-network specialist, the health care services you receive will be covered at the out-of-network ben­efits level.

What is the difference between in-network coverage and out-of-network coverage?
When you visit an Open Access Plus/CareLink participating doctor, you will have lower out-of-pocket costs. That's because these providers have agreed to charge lower fees, and your plan's benefits cover a larger share of the charges.
With out-of-network benefits, you can see any doctor you wish and still be covered for treatment of any illness or injury. Keep in mind, however, that your out-of-pocket costs will be higher if you choose a doctor who doesn't participate in the Open Access Plus/CareLink network.

Do I have to choose between in-network and out-of-network coverage now?
No. Each time you seek medical care, you can choose your doctor – either in- or out-of-network.

How do I find participating doctors?
Search for participating Open Access Plus/CareLink doctors in the Provider Directory or visit the online directory at www.cigna.com and select Open Access Plus/CareLink.

What if I go to an out-of-network physician who sends me to a network hospital? Will I pay in-network or out-of-network charges for my hospitalization?
CIGNA HealthCare will cover authorized medical services provided by a Open Access Plus/CareLink participating hospital at your in-network benefits level – whether you were sent there by an in- or out-of-network doctor.

What is utilization review?
Utilization review is a process that helps determine if the services you receive are a covered benefit. CIGNA HealthCare performs utilization review, including hospital pre-admission certification, continued stay review and case management.Requests for non-emergency hospital stays other than maternity stays must be approved in advance.
Precertification is not required for a maternity stay of 48 hours for vaginal deliveries, or 96 hours for caesarean sections. Depending on your benefits plan, you may be eligible for additional benefits. Any maternity hospital stay beyond the initial 48 or 96 hours must be approved. Please call the toll-free number on your CIGNA HealthCare ID card for details.

Who is responsible for obtaining precertification?
Your doctor will help you decide which procedures require hospital care and which can be handled on an outpatient basis.
If your doctor participates in the Open Access Plus/CareLink network, he or she will arrange for precerti­fication. If you use an out-of-network doctor, you are responsible for making the arrangements.

What if my doctor keeps me in the hospital longer than my precertification allows?
CIGNA HealthCare will contact your hospital the day before you are scheduled to be discharged. If your physician has extended your stay, then the additional days will be reviewed for coverage. CIGNA HealthCare will continue to review your hospital stay for coverage until you are discharged. If you remain in the hospital for services that are not covered, your out-of-pocket costs may be higher.

Can my current doctor be added to your network?
If your current doctor meets our credentialling standards and is interested in becoming a participating provider, he or she can call our Provider Relations Department to get more information on joining the Open Access Plus/CareLink network.

What if my doctor is on the list, but his/her office is shown as "accepting current patients only"? Can I still choose my doctor?
If you are an existing patient of a participating doctor, you may select him or her to provide your care.

Am I covered for emergency care?
Whenever there is an emergency, seek medical help immediately. An emergency is an accident or sudden illness that a person with average knowledge of medical science believes needs to be treated right away or it could result in serious medical complications or permanent disability.

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