What's Changing for 2016?
The network for 2015 is Open Access Plus. The network for 2016 is LocalPlus. If you are currently enrolled in Cigna and do not make a change during the annual enrollment period, you will automatically be enrolled in Cigna LocalPlus and your provider(s) may not be participating in this plan. NOTE: CHI Memorial Health Care System/facilities is NOT in the Cigna LocalPlus network. Services at any Memorial Health Care System/facilities will be considered out-of-network.
Partnership PPO and Standard PPO
In many ways, the Partnership PPO and Standard PPO are identical. They cover the same types of services, treatments and products. However, there's an important difference between the two options: If you choose the Partnership PPO, you must commit to a partnership promise, and the state will reward you with lower monthly premiums; lower annual deductible; lower pharmacy copays; lower coinsurance; lower out-of-pocket maximum.
Cigna issues an insurance card to each member with their name on it. Members may request additional cards by phoning (800) 244-6224 or by logging onto the Cigna website and printing a temporary card.
CVS Caremark is the pharmacy benefits manager. Call the CVS Caremark Call Center, open 24/7, at (877) 522-8679 to order a replacement card and for instructions on how to print a temporary card from the Caremark Website. You will be able to use your temporary card until your new card arrives.
Filling a prescription
Use a network pharmacy when filling prescriptions with up to a 30-day supply. The network includes more than 1,600 pharmacies across the state and chain pharmacies such as CVS, Kroger, Publix, RiteAid, Sam's, Target, Walgreens, and Walmart. Many local, independent pharmacies are also in the network.
Use the CVS Caremark Mail Service Pharmacy to fill your 90-day supply prescription or receive a 90-day supply from a participating retail pharmacy store. The mail-at-retail network will be different from the 30-day retail network.
In Network vs. Out of Network Providers
You can see any doctor or go to any health care facility you want. However, if you use an in-network provider, you will always pay less. That’s because an in-network provider agrees to provide services to our members at discounted rates. Broad networks of doctors and hospitals will continue to be available. That’s because an in-network provider agrees to provide services to members at discounted rates. Non-network health care providers can bill you for any difference between actual charges and the approved amount.
Services requiring copays are not subject to a deductible and do not apply to the annual out-of-pocket coinsurance maximum. Services requiring copays include preventive care (well-baby, well-child visits); adult annual physical; annual well-woman exam; immunizations as recommended by the CDC; primary care and specialist office visits; urgent care facilities; emergency room visit; x-ray and lab; prescriptions.
Some services require that you pay coinsurance after you meet a deductible. Coinsurance is a percentage of the total cost. Typical coinsurance charges include hospital stays; home care; ambulance services; advanced X-ray, scans, imaging; rehabilitation and therapy services.
A deductible is the amount you pay out of your pocket before the plan pays for hospital charges and other services that require coinsurance. It does not apply to services with a copay. Payments toward the deductible count toward the annual out-of-pocket maximum.
Out-of-Pocket Coinsurance Maximum
An out-of-pocket coinsurance maximum is the most you will pay for your deductible and coinsurance each year. It does not include your copays. Once you reach your out-of-pocket maximum, the plan pays 100 percent of covered medical expenses.