Your Cigna Plans - Open Access Plus (OAP) and Health Savings Account (HSA)
Educational Service Center of Cuyahoga County
Effective July 1, 2013
2Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Cigna
Open Access Plus
(OAP)
balancing choice and convenience
3Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Open Access Plus Plan Medical Plan
Choice and Convenience
• Your option to select a Primary Care Physician; however we encourage you to have a relationship with a doctor
• Save the most when you visit in-network doctors and facilities
• Freedom to visit any licensed provider with no referrals
• Access to a nationwide network of doctors and hospitals
a perfect balance
CHOICE CONVENIENCE
4Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Open Access Plus Copay Medical PlanIn Network Out-of-Pocket Costs
TYPE OF SERVICE Copayment/Coinsurance In-Network
• Deductible: $300 Single / $600 Family• Out of Pocket Maximum: $1,000 Single / $2,000 Family• (plan deductible does count towards OOP maximum – copays do not count)• Primary Care Physician visit: $25 copay• Specialist visit: $25 copay• Preventive Care Visits No charge • In-patient hospital care: 10% charges after deductible• Out-patient hospital care: 10% charges after deductible• Emergency Room Copay: $100 copay, then no charge
(waived if admitted) • Urgent Care Copay: $25 copay, then no charge
5Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
WHAT IS A HEALTH SAVINGS ACCOUNT (HSA) PLAN?
• A tax-advantaged health plan that provides coverage for current medical/pharmacy expenses with the option to save for future health expenses
• Combines a Qualified Medical Plan (medical/pharmacy coverage) with a Health Savings Account
• You, your employer or both can contribute to the Health Savings Account• Money put in the Health Savings Account is generally not taxable*• You have investment options
+ =Qualified Medical Plan
Tax-advantagedHSA Plan
Health Savings Account
* HSA contributions and earnings are not subject to Federal taxes and not subject to state taxes in most states. A few states do not allow pretax treatment of contributions or earnings. Please consult your personal tax advisor or contact your plan administrator for information about your state.
6Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
HSA(Employer
contribution)$1,000
Your Share$1,000
HealthPlan100% in-network
100%
Pre
ven
tive
Car
e(i
n-n
etw
ork
)
De
du
cti
ble
$2
,00
0
Ou
t-o
f-p
oc
ke
t M
ax
$
2,0
00
Unused $rolls over to
next year
Employee Only Example
Cigna HSA
HOW IS THIS DIFFERENT FROM A TRADITIONAL PLAN?
Same• Wide choice of doctors/hospitals• Preventive care covered at 100% • Plan begins to pay after deductible is met• Covers routine, emergency and catastrophic care• Plan pays percentage of bill for covered out-of-network care• Plan pays higher percentage for covered in-network care• Cigna receives bills, sends payment to doctors/hospitals
Different• Lower premium but higher deductible• Plan begins to pay after deductible is met; however, funds in
your Health Savings Account can be used to cover eligible health expenses
• Amount can be used to pay the deductible• Unused money rolls over to next year
7Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Meet Karen
Single, in her 50s
Heart disease; controlling health through medication
Ou
t-o
f-p
ock
et M
ax$2
000
Deductible$2,000
Plan pays 100%
10
0%
Pre
ve
nti
ve
Ca
re(i
n-n
etw
ork
)
Ded
uct
ible
Contribution:$1000 Employer + Employee $1000 = $2,000
HSA Deposits $ 1,000 by Karen $ 1,000 by Employer $ 2,000 Total HSA Contribution
Preventive Care $398(covered 100% by Plan)No cost to Karen
$ 1,000 ER Visit $ 320 4 PCP Visits $ 240 Generic RX (12) $ 1,560 medical expenses
Total = $1, 560
Case example for illustrative purposes only, in-network.
How Expenses Are Paid$1,560 applied to deductible$ 398 preventive care (covered by Plan)$1,958 paid by Plan and Deductible
$1,560 What Karen Paid from HSA
$2,000 in HSA$1,560 Paid$ 440 Rollover
$440HSA Balance –
carried over to next year
8Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
WHAT IS THE MAXIMUM I CAN CONTRIBUTE ANNUALLY TO THE HSA?
The IRS has set the following limits for 2013:
• Under age 55 and not enrolled in Medicare (based on a 12-month period):
2013– Up to $3,250 individual coverage*– Up to $6,450 family coverage*
• Age 55 or older:
– Maximum contribution increases by $1,000 (considered a “catch-up” contribution)
– Up to $4,250 individual coverage*
– Up to $7,450 family coverage*
• To make the maximum contribution in a calendar year, you must:
– Meet all requirements to be eligible for HSA contributions on January 1
– Remain qualified through December 1
– If these criteria are not met, maximum contribution is prorated = if 1/12 maximum contribution for each month then individual is qualified
*Contributions to your HSA that you receive from your employer and incentives count toward your maximum.
9Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Cigna updates quarterly Health Statement; sends email alert or mails to your home, based on preference setting.
Cigna provides an Explanation of Benefits or EOB (“receipt”) showing: Doctor’s fee, Cigna discount, amount billed, amount deducted from the HSA, amount paid to doctor, remaining HSA balance, and what you saved.
Sick visit to an in-network doctor/hospital/facility.
Show Cigna Choice Fund ID card to obtain Cigna discounted rates.
Doctor bills Cigna.
Cigna receives the claim and processes it based on the HSA- qualified plan deductible, covered expenses and Cigna-negotiated discounts.
If Auto Claim Forwarding was elected, Cigna automatically subtracts theamount owed to the doctor from your HSA and pays the doctor.
If no Auto Claim Forwarding in place, you have the option to pay the doctorbill using your HSA (debit card/checkbook) or pay out of pocket.
HOW ARE MY MEDICAL CLAIMS PAID?
Medical claim payment process
10Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
AM I ELIGIBLE TO PARTICIPATE IN AN HSA PLAN?
Because HSA plans have special tax advantages, the IRS defines specific rules for participation. To be eligible, you:
– Must be enrolled in an IRS-qualified high-deductible medical plan (high-deductible medical plans sold with Cigna’s Choice Fund HSA meet IRS requirements)
– Cannot have any other health coverage – Not covered by spouse’s medical or pharmacy plan– Not covered through Medicare Part A or Part B– Not covered through a general-purpose Flexible Spending Account (FSA) plan
(either employer’s or spouse’s)
– Cannot be claimed as a dependent on another person’s tax return
11Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
JP Morgan Chase enrollment information
You will need to go to the intranet to open an account
• Before opening the account, JPMorgan Chase will:
– Verify your identity (required by the Federal government) using information provided in the HSA application and enrollment form
– Notify you if additional documentation is needed to verify your name, social security number or address
– You can get a letter or a phone call from JP Morgan Chase
• JPMorgan Chase will send your HSA information and a debit card within 7–10 days of the start of the plan year or the verification of identity (whichever is later)
• ID cards are mailed from Cigna
• Debit cards are mailed separately from JPMorgan Chase
JPMorgan Chase cannot open an HSA until it is able to satisfy the requirements of the Federal government.
12Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
WHAT ARE MY HSA SAVING AND INVESTMENT FEATURES?
• $2,000 minimum in HSA to invest• Once the investment account is open, no minimum balance applies• Several mutual funds to choose from• Investments can be put into one fund or multiple funds• No minimum deposit for any fund• Tax-free growth of interest or investment earnings*• Monthly fees apply• Online trading – no fees apply • Track your balance online or with convenient monthly statements
*HSA contributions and earnings are not subject to Federal taxes and not subject to state taxes in most states. A few states do not allow pretax treatment of contributions or earnings. Please consult your personal tax advisor or contact your plan administrator for information about your state.
13Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
24/7 online health account management
• Review personalized plan coverage
• Check available balances• Track claims and payments• Get HSA bank account
information• Manage investment
accounts via link to JPMorgan Chase
CAN YOU HELP ME UNDERSTAND AND TRACK MY HEALTH CARE EXPENSES?
At-A-Glance
Account Summary
14Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Let’s do a comparison
15Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Open Access Plus (OAP) Health Savings Account (HSA)
Single Family Single Family
Preventative Care No charge No charge No charge No charge
Deductible $300 $600 $2,000 $4,000
Out-of-pocket maximum $1,000 $2,000 $2,000 $4,000
Health Savings Account contribution from employer
n/a n/a $1,000 $2,000
Lifetime maximum Unlimited Unlimited Unlimited Unlimited
Medical plan highlights In-network
16Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Open Access Plus (OAP) Health Savings Account (HSA)
Retail
(30 day supply)
Mail Order
(90 day supply)
Retail
(30 day supply)
Mail Order
(90 day supply)
Generic You pay $15 You pay $30
You pay 100% of drug cost until the deductible
is met – after the deductible is met then
plan pays 100%
You pay 100% of drug cost until the deductible
is met – after the deductible is met then
plan pays 100%
Cigna-preferred brand You pay $35 You pay $70
You pay 100% of drug cost until the deductible
is met – after the deductible is met then
plan pays 100%
You pay 100% of drug cost until the deductible
is met – after the deductible is met then
plan pays 100%
Non-preferred brand You pay $55 You pay $110
You pay 100% of drug cost until the deductible
is met – after the deductible is met then
plan pays 100%
You pay 100% of drug cost until the deductible
is met – after the deductible is met then
plan pays 100%
Pharmacy plan highlightsIn-network
17Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
helpfulresourcesthe information you need
18Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Explanation of Benefits (EOB)• Clearly shows how and when claims were
paid, and by which plan and/or account(s)• Available in print or online at myCigna.com• Choose if you would like EOBs mailed to your
home, or go paperless and receive email alerts after each claim is processed and posted to myCigna.com
Quarterly Health Statement• Available online at myCigna.com• You will be alerted by email after each
statement is posted to myCigna.com • Shows year-to-date deductibles, all
claim activity and out-of-pocket expenses for that quarter
CAN YOU HELP ME UNDERSTAND AND TRACK MY HEALTH CARE EXPENSES?
19Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
24/7 customer phone assistance
CAN YOU HELP ME UNDERSTAND AND TRACK MYHEALTH CARE EXPENSES?
• One toll-free number – on the back of theID card and debit card
• Specially trained Customer ServiceRepresentatives answer questions about: – Medical and pharmacy benefits and claims– HSA IRS requirements– HSA transaction activity and balance– Live transfer to JPMorgan Chase for
specialized activity (investments, lost debit card, debit card transaction questions)
– Help with the tools and resources available on myCigna.com
20Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna 20Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
SO MANY WAYS TO CONNECT WITH CIGNA.
Cigna.com• Simple to navigate• Find what you’re looking for, quickly and easily
Interactive Voice Response (IVR)• New “natural language” system recognizes over 150 languages and dialects
Expanded Cigna mobile• All Cigna sites available via any web-enabled mobile device
myCigna.com• Personalized• Easy access to doctor and facility searches, cost and quality of care and more
24/7/365 live phone service• Around-the-clock customer service
WHENEVER. WHEREVER.
21Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna 21Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
FIND DOCTORS AND SERVICES
• Search for a health care professional in Cigna’s national network
• Valuable quality-of-care ratings
• Easily navigate using consumer-friendly language, not jargon
• Access maps for driving directions right from your smartphone
22Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Programs for you
23Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Your Health First
Resources for members with chronic conditions
Educational materials, self-care tools, support and information for the following conditions:– Asthma– Heart Disease– Coronary Artery Disease– Angina– Congestive Heart Failure– Acute Myocardial Infarction– COPD (Emphysema and Chronic Bronchitis)– Type I & II Diabetes– Metabolic Syndrome– Peripheral Arterial Disease– Low Back Pain– Osteoarthritis– Depression– Anxiety– Bipolar Disorder
24Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Lifestyle Management ProgramsCIGNA Healthy Steps to Weight Loss, CIGNA Quit Today and Stress & Resilience
– Call 1.866.417.7848 or visit www.mycigna.com to enroll
– Designed to help you set and manage your goals
– Scheduled one-on-one calls for ongoing support and goal-setting
– Online program participation available
– Set Personal Healthy Living Plan
– Dedicated Health Coach
– Workbook and Toolkit
– Weekly educational emails with key learning themes and tips*
* - If participate online
25Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Helping you stay healthy.
• Eye care – exams, frames and lenses, laser vision correction
• Jenny Craig®
• Smoking cessation programs• Hearing care• Fitness club memberships • Alternative medicine – acupuncture,
chiropractic care, massage therapy• Mind/body – Yoga Journal and SpaFinderTM
and much more
Cigna Healthy Rewards®
Discounts on a full range of health and wellness programs and services*
*Healthy Rewards is a discount program. Some Healthy Rewards programs are not available in all states. A discount program is NOTinsurance, and the customer must pay the entire discounted charge.
26Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
CIGNA HealthCare Healthy Babies
– Voluntary prenatal education– Helpful informational materials from
the March of Dimes®
– Toll free, round-the-clock access to information and support from registered nurses
– Post-delivery support and service