CIGNA Choice Fund^®

An innovative way to pay for medical expenses

A CIGNA Choice Fund plan packages a consumer health care fund with an underlying PPO or Open Access Plus medical plan that has a deductible, coinsurance and out-of-pocket maximum.

Options and benefits

There are two Choice Fund options: a Health Reimbursement Arrangement (HRA) and a Health Savings Account (HSA). Both include a consumer fund that can help covered individuals pay their share of health care expenses; these are expenses that are defined under their medical plan and can often include expenses not covered by the underlying medical plan, such as pharmacy costs and dental and vision expenses.

Unused Choice Fund dollars may also be rolled over to the following year. Careful management enables covered individuals to build their Choice Fund to help offset their future health care costs.

Reimbursement

Most individuals covered by a CIGNA Choice Fund plan have Automatic Claim Forwarding (ACF) in which the fund is automatically accessed to pay the health care professional directly. ACF offers significant bad debt mitigation through automatic and direct payments, and helps alleviate the need for your office to pursue the patient for any applicable coinsurance/deductible payments.

• Choice Fund HRA and HSA
  When ACF is enabled, funds are available to be used for eligible services. As part of the medical claim process, you will receive payment directly from CIGNA from both the medical plan and the Choice Fund account on behalf of the covered individual. After funds have been used, you may bill the covered individual as you would with any plan when remaining monies are due after the medical claim has been processed.
  
  
• Choice Fund HSA
  Individuals with a Choice Fund HSA also have an option to pay health care professionals with a debit card or a checkbook that draws directly from their HSA funds.

Please note there are other Choice Fund programs that are not identified on an individual's ID card, including FSA plans and Incentive Fund plans, but may have ACF enabled. To avoid duplicate payment or patient reimbursement situations, we ask that you not collect coinsurance or deductibles at the point of care for any individuals covered by CIGNA plans.

For more information about ACF, access the Frequently Asked Questions. (pdf)

Reimbursement Process

The claim submission process is basically the same as any plan with deductibles and coinsurance

• You should not collect deductibles or coinsurance at the time of service. (These plans typically do not have copayments.) Note that Preventive Care visits are paid 100% in virtually all the Choice Fund medical plans.
• Submit the claim as usual.
• The amount the covered individual owes will be determined by the claim adjudication under the terms of the medical plan.
• You will receive an Explanation of Payment/Benefit (EOP/EOB) from the medical claim system.
• For most of the claims process, a single remittance EOP/EOB will reflect the claim processing for the medical plan as well as access to available Choice Funds as authorized through the ACF election.
• In some situations, to ensure timely processing of the claim, the medical plan and the Choice Fund processing may be separated. If the medical plan EOP/EOB has the following remark code, "Final payment determination will follow the review of available funds in a CIGNA Choice Fund Health Reimbursement Arrangement or Flexible Spending Account", the remaining amount the covered individual owes has been sent to the Choice Fund for consideration.
• In these situations, you will receive a second EOP/EOB (and a check if funds are available) from CIGNA Choice Fund along with the final amount the covered individual owes. You will receive both EOP/EOBs on the same day or a few days apart. In rare situations you may receive the Choice Fund EOP/EOB prior to receipt of the medical plan EOP/EOB .
• You may then bill the covered individual for the final amount they owe shown on the Choice Fund EOP.