|
|
CIGNA Point of Service Organization (POS)
|
|
Choose a Provider – and Choose Your Costs
CIGNA Point of Service (POS) plans offers choice where to get care.
Choose In-network providers
One of the best ways to control costs and get the most from a POS plan is to choose an in-network Primary Care Physician (PCP) to coordinate care. He or she can treat for a wide variety of conditions, provide important preventive care checkups and tests, and make referrals to participating specialists and facilities.
Choose out-of-network providers
Members have the choice to see whomever they want; however, when care is received from a doctor or facility that is not in the CIGNA HealthCare network, out-of-pocket costs will be higher. The member must pay the entire cost of any care receive until the annual deductible is met. Once the deductible is paid, your coverage begins and the member pays a percentage of the cost (coinsurance) of subsequent care.
Next (How It Works) >
Where to Find the Care You Need
Here is a summary of your plan 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 in our out of 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.
Next (Cost Example) >
In-network Care Offers Higher Benefits, Lower Costs
You rely on your CIGNA HealthCare PCP as your overall care coordinator, and make an appointment regarding pains you are feeling in your lower legs. Your PCP refers you to lab and X-ray facilities for additional tests before referring you to an orthopedic specialist.
| Cost Example for In-network Care: |
|
|
| PCP office visit/exam fee |
$85 |
|
| Your Copayment |
$20 |
|
| Lab |
No cost to you |
|
| X-rays |
No cost to you |
|
| No deductible applies |
|
|
| You pay |
$20 |
|
Out-of-network Care Offers More Choice, Higher Costs
You are feeling pains in your lower legs and chooses to make an appointment with an orthopedic specialist who is not in the CIGNA HealthCare network. She orders lab and X-ray services. Because you are outside the CIGNA HealthCare network, you're covered, but at a lower level, which means your out-of-pocket costs may be higher. In addition, you are responsible for all authorizations and may have to file claim forms for reimbursement.
| Cost Example |
|
|
| Office visit/exam fee |
$125 |
|
| Lab fee |
$50 |
|
| X-ray fee |
$150
$325 |
|
| If you haven't met the $500 deductible |
|
|
| The plan pays |
$0 |
|
| You pay |
$325 |
|
| If you have met the $500 deductible |
|
|
| The plan pays 70% coinsurance |
$227.50 |
|
| You pay 30% coinsurance |
$97.50 |
|
Next (Special Programs) >
Special Programs
Health and wellness 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 LineSM 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 BabiesSM — 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 AdvisorSM, 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 LossSM, 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.
Next (Employer Advantages - Benefits) >
Employer Advantages
Flexible HMO and Network Open Access plan designs include benefits for employees and employers alike:
- Pharmacy and behavioral-care benefits;
- No out-of-pocket costs for immunizations or maternity care after the initial visit, and lower out-of-pocket costs for urgent care;
- Our Network Savings Program – provides discounts for services provided by certain out-of-network physicians, hospitals and other facilities;
- Consolidated billing, accounting, reporting and banking; and
- Standard health and wellness features, with optional features available at an additional cost.
Next (Support) >
We've designed a flexible communication program to help your employees understand their plan and make better health care purchase decisions.
Pre-enrollment
- customized Intranet articles
- newsletter articles
- e-mail notices
- presentation scripts
- posters
- payroll stuffers
- "train the trainers" presentation
Open enrollment
- enrollment kits
- toll-free help line
- benefit fair
- kiosk (at an additional cost)
- on-site enrollers, workshops and seminars
Post-enrollment
- handbook
- ID card
- monthly e-mail copy
- customized Intranet services with online forms and detailed information about your company's plan
- customized, secure employee portal, myCIGNA.com, with extensive, reliable health information from Web MD®, physician and hospital ratings, side-by-side drug comparisons and health records and trackers
Your implementation manager will help you every step of the way with communication strategies and materials that best suit you and your employees.
Next (Options) >
Funding Options
Choose from multiple funding options:
Fully Insured
- Full premium paid monthly
- Predetermined and guaranteed rates
- Predictable, easy-to-budget expenses
- Protection from high claim costs
Fully Insured - Participating
- Full premium paid monthly
- Predetermined and guaranteed rates
- Predictable, easy-to-budget expenses
- Protection from high claim costs
- Year-end settlement
- Can earn cash back at year end if claims are low
Minimum Premium
- Lower premium paid monthly
- Claims funded through bank account with a monthly claim cap
- Protection from high claim costs
- Year-end settlement
- Improved cash flow
- Lower expenses and premium taxes
Administrative Services Only
- No monthly premium or premium taxes paid, just an administrative fee
- Exempt from most state regulations and mandates on coverage levels
- Stop Loss coverage available
- Maximizes cash flow
- Freedom to design your health benefits
- Financial protection against unanticipated, catastrophic claims
Health and Wellness Programs
Members of CIGNA HealthCare plans may also have access to valuable Health and Wellness programs and support.
- 24-hour health information — call the CIGNA HealthCare 24-Hour Health Information LineSM 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 our Healthy Babies program.
- CIGNA Healthy Pregnancies, Healthy BabiesSM — the CIGNA Healthy Pregnancies, Healthy BabiesSM 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 AdvisorSM, 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.
- Award Prgrams To Fit Your Needs — through the Healthy Awards Account® you can offer your employees health and well-being programs that are specific to your culture and needs.
- Lose weight and improve your health — when you enroll in the CIGNA Healthy Steps to Weight LossSM, 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.
Next (FAQ) >
FAQ
Do I have to choose a PCP?
Yes. Your PCP will give you and your dependents a valuable resource and a personal health advocate. You can choose a PCP from our broad network of participating general and family practice physicians, internists and pediatricians.
Can I change my PCP?
Yes. You and your covered dependents can change you PCP for any reason. Simply select another participating PCP from the CIGNA HealthCare Provider Directory.
Can I see a doctor who does not participate in the CIGNA HealthCare network?
You have the option to visit any doctor; however, when you receive care from a doctor or facility that is not in the CIGNA HealthCare network, your out-of-pocket costs will be higher. You may be required to pay for your care at the time of service and file a claim for reimbursement.
What if my doctor is not on your list?
That means your doctor does not participate in the CIGNA HealthCare network. To receive your maximum benefit, you should select a PCP from CIGNA HealthCare Provider Directory. 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.
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 as your PCP.
What if I am in the middle of treatment and my doctor is not in the network?
You should still select a PCP who can review your medical history and work with you to complete your treatment. You also have the option to receive care from your doctor using your out-of-network benefits. You may also be eligible for Transition of Care benefits.
Do I need a referral to see a specialist?
Your PCP must provide you with a referral to see a participating specialist in order for your care to be covered at the in-network benefits level. You can see a participating OB/GYN for covered services without a referral from your PCP. Of course, you also can see a non-participating specialist without a referral, but you will be responsible for the higher out-of-pocket costs and all authorizations.
What if I see a specialist regularly for ongoing treatment? Do I need a referral for each visit?
When you see a participating specialist, you're authorized to receive only the specific services approved by the referral and those services may or may not include regular visits.
Am I covered for emergency care?
Emergencies are covered 24 hours a day, seven days a week, no matter where you are. So, whenever there is an emergency, seek medical help immediately. Then you will need to contact your PCP as soon as possible for further assistance and follow-up care, including necessary authorizations for care or hospitalization, if necessary. 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.
Next (Features & Benefits) >
|
