CIGNA POS Open Access

Freedom to Choose the Care Needed

CIGNA Point of Service (POS) Open Access plans offers access to our broad networks, but lets members make their own health care choices. For example:

• 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. With the open access option, a member is not required to select a PCP for in network care. A member can visit any in network provider.
• Choose out-of-network providers. The choice to see whomever needed; 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 you receive until an 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.
• During an emergency or urgent care situation, the member also may receive approval to use out-of-network services.

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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.

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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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 some mild pains you feel in your chest. Your PCP orders X-rays to make sure it's not more serious, then prescribes medication to ease the pain.

Out-of-network Care Offers More Choice, Higher Costs

You are feeling pains in your lower legs and choose 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 you may have to file claim forms for reimbursement.

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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 Advantages

FAQ

• Do I have to choose a PCP?


• What is the difference between in-network and out-of-network coverage?
  
• Do I have to choose between in-network and out-of-network coverage now?


• What if I go to an out-of-network doctor, and he or she sends me to a participating hospital? Will I pay in-network or out-of-network charges for the hospitalization?


• How do I file a claim? How long does it take to be reimbursed?


• Am I covered for emergency care?

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

What is the difference between in-network and out-of-network coverage?
When you use in-network coverage, you may visit any CIGNA HealthCare preferred provider, and your out-of-pocket costs are lowest.
With out-of-network benefits, you can see any doctor you wish and still be covered for treatment of illness or injury, but your out-of-pocket expenses will be higher.

Do I have to choose between in-network and out-of-network now?
No. Each time you seek medical care, you choose your doctor, whether he or she is a preferred provider or an out-of-network provider.

What if I go to an out-of-network doctor, and he or she sends me to a participating hospital? Will I pay in-network or out-of-network charges for the hospitalization?
You may be admitted to a participating hospital by either an in-network or out-of-network doctor. CIGNA HealthCare will cover authorized medical services provided by the participating hospital at your in-network level.

How do I file a claim? How long does it take to be reimbursed?
Every time you use out-of-network services, you may need to submit a claim form. To get a claim form, see your benefits manager or visit myCIGNA.com. Submit your completed claim form to the address on your CIGNA HealthCare ID card. Once you file your completed claim form, claims are generally paid within 10 to 15 working days. However, if questions about your claim arise, payment may be delayed.

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. Emergencies are covered 24 hours a day, seven days a week, no matter where you are.

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