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Freedom of Choice
CIGNA Open Access Plus plans offer choice and convenience — access to our broad national provider network, while allowing members to make their own health care choices.
- Members are encouraged to choose a primary care physician (PCP) to coordinate care and treatment, but not required to do so. They can see any of the participating primary care physicians in our network, any time.
- Members have the freedom to visit any in-network specialist without a referral.
- During an emergency or urgent care situation, members may go to any emergency facility or 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's 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 your network primary care physician (PCP) 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 your network primary care physician (PCP) for an initial assessment, and he or she will refer you to a participating specialist if needed. You may also visit an in-network specialist without a referral.
Hospital Care (such as inpatient care and surgery, or outpatient surgery)
- For non-emergency care, call your network primary care physician (PCP) and he or she will coordinate all your hospital care.
Urgent Medical Care (such as fever, sprains or strains, eye or ear infections, or severe sore throat)
- Call your network primary care physician (PCP). 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 your network primary care physician (PCP) as soon as reasonably possible and he or she will coordinate all 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.
Next (Cost Example) >
How the HMO and Network Open Access plan works for you.
You make an appointment with a CIGNA physician for an annual wellness exam. At that time, she suggests you see a specialist for your high blood pressure. You check the CIGNA HealthCare provider directory, select a cardiologist and make an appointment.
| Cost Example |
|
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| Physician office visit/exam |
$85 |
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| Your employee pays |
$20 |
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| Cardiologist office visit fee |
$150 |
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| Your employee pays |
$20 |
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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 Advantage - Benefits) >
Employer Advantage
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.
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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?
You are not required to choose a primary care physician. However, a primary care physician gives you and your dependents a valuable resource and a personal health advocate.
What if my doctor is not on your list?
That means your doctor does not participate in the network. To ensure your care is covered, you should select a participating doctor from the CIGNA HealthCare Provider Directory. Participating providers must meet standards to become a part of the network.
Do I need a referral to see a specialist?
You do not need a referral to see a specialist who participates in the CIGNA HealthCare Network, although you may benefit from a primary care physician's advice.
What is pre-admission certification and continued stay review?
Pre-admission certification and continued stay review are programs designed to help you understand which services are covered by your benefit plan. The precertification process allows CIGNA HealthCare to determine if a requested service is a covered benefit. Requests for non-emergency hospital stays, other than maternity stays, must be approved in advance.
Who is responsible for obtaining precertification?
Your doctor will help you decide which procedures require hospital care and which can be handled on an outpatient basis. Your doctor also will arrange for precertification.
Can my current doctor be added to your network?
If your current doctor meets our credentialing standards and is interested in becoming a participating provider, he or she can call our Provider Relations Department to get more information on joining the network.
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 her to provide your care.
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 by your plan 24 hours a day, seven days a week.
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