Freedom of Choice
CIGNA Open Access Plus In-Network plans offers choice and convenience – access to our broad national provider networks, while allowing members to make their own health care choices. For example:
- The option to choose a Primary Care Physician (PCP) to serve as a personal physician – providing routine care and referrals to specialists, and helping to coordinate health needs.
- No referrals are necessary to see specialists in the network. Just choose the participating doctor prefered and make an appointment.
- The option to see any licensed physician within or outside of the Open Access Plus network. However, health services are covered only when a member receives care from a provider within the CIGNA Open Access Plus network.
- Emergency care is covered 24 hours a day, no matter where you receive it. A member may go to any emergency facility, anywhere.
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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).
• A doctor within the network will provide medical advice and/or schedule an office visit for the member.
Specialty Care (such as orthopedic or heart disease)
• A specialist within the network will make 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, a network physician will coordinate all hospital care.
Urgent Medical Care (such as fever, sprains or strains, eye or ear infections, or severe sore throat)
• A network doctor will assess the situation and if necessary, give advice on where to seek immediate care. more.
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. Then call CIGNA HealthCare as soon as reasonably possible, so that someone can coordinate follow-up care. more
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How the Open Access Plus In-Network Plan Might Work
You visit an in-network orthopedic specialist and it is determined that you will require outpatient surgery. You undergo day surgery at a participating facility, which also include X-Rays and Laboratory services. Your benefit plan covers:
| |
In Network |
|
| PCP Visits (Copay) |
$15 |
|
| Specialist Visits (Copay) |
$30 |
|
| Emergency Room (Copay) |
$100 |
|
| In-patient Services (Copay) |
$350 |
|
| Hospital Coinsurance |
30% |
|
| |
|
|
| Specialist office visit/exam |
|
|
| Submitted charge |
$ 150 |
|
| Covered expense |
$ 100 (CIGNA contracted rate) |
|
| Member Cost share |
$ 30 (specialist copay) |
|
| CIGNA Plan |
$ 70 |
|
| |
|
|
| Day Surgery |
|
|
| Submitted charge |
$1500.00 |
|
| Covered expense |
$ 975.00 (CIGNA contracted rate) |
|
| Member Cost share |
$ 292.50 (30% co-insurance) |
|
| CIGNA Plan |
$ 682.50 |
|
| |
|
|
| Laboratory |
|
|
| Submitted charge |
$500.00 |
|
| Covered expense |
$325.00 (CIGNA contracted rate) |
|
| Member Cost share |
$ 97.50 (30% co-insurance) |
|
| CIGNA Plan |
$227.50 |
|
| |
|
|
| X-Rays |
|
|
| Submitted charge |
$250.00 |
|
| Covered expense |
$162.50 (CIGNA contracted rate) |
|
| Member Cost share |
$ 48.75 (30% co-insurance) |
|
| CIGNA Plan |
$113.75 |
|
Next (Special Programs) >
Special Programs
As a member of a CIGNA HealthCare plan, you may also have access to valuable Health and Wellness programs and support.
- 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.
Check your plan materials or log in to myCIGNA.com for more information about your Open Access Plus plan, including your eligibility for health and wellness programs and discounts. Or ask your employer or benefits manager for more information about enrolling in a CIGNA HealthCare plan.
Next (Employer Advantages - Benefits) >
Employer Advantages
Cost control … a part of the plan
- Employees are encouraged but not required to select a PCP
- Customized plan design options: co-payments, deductibles and coinsurance
- Option to limit benefits to in-network services only with Open Access Plus In-Network
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We've designed a flexible communication program to help your employees understand their plan.
Pre-enrollment
- Intranet articles
- e-mail notices
- presentation scripts
- posters
Open enrollment
- enrollment kits
- toll-free help line
Post-enrollment
- handbook
- ID card
- monthly e-mail copy
- secure employee portal, myCIGNA, with extensive, reliable health information from WebMD®, physician and hospital ratings, side-by-side drug comparisons and health records and trackers
Next (Options) >
Fully Insured
- Full premium paid monthly
- Predetermined and guaranteed rates
- Predictable, easy-to-budget expenses
- Protection from high claim costs
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 Open Access Plus network. To receive your maximum benefit, you should select a doctor from the list of participating Open Access Plus providers. Participating providers must meet standards to become a part of the network. You can continue seeing your current doctor, even if he or she is not a participating provider. However, health services are covered only when you receive care from a provider within the CIGNA Open Access Plus network.
Do I need a referral to see a specialist?
Though you may want your personal doctor's advice and assistance in arranging care with a participating specialist, you do not need a referral to see a participating specialist. If you choose to see an out-of-network specialist, the health care services you receive will not be covered by the Plan
How do I find participating doctors?
Search for participating Open Access Plus doctors in the Provider Directory or visit the online directory at www.cigna.com and select Open Access Plus.
What is utilization review?
Utilization review is a process that helps determine if the services you receive are a covered benefit. CIGNA HealthCare performs utilization review, including hospital pre-admission certification, continued stay review and case management. Requests for non-emergency hospital stays other than maternity stays must be approved in advance.
Precertification is not required for a maternity stay of 48 hours for vaginal deliveries, or 96 hours for caesarean sections. Depending on your benefits plan, you may be eligible for additional benefits. Any maternity hospital stay beyond the initial 48 or 96 hours must be approved. Please call the toll-free number on your CIGNA HealthCare ID card for details.
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. If your doctor participates in the Open Access Plus network, he or she will arrange for precertification.
What if my doctor keeps me in the hospital longer than my precertification allows?
CIGNA HealthCare will contact your hospital the day before you are scheduled to be discharged. If your physician has extended your stay, then the additional days will be reviewed for coverage. CIGNA HealthCare will continue to review your hospital stay for coverage until you are discharged. If you remain in the hospital for services that are not covered, your out-of-pocket costs may be higher.
Can my current doctor be added to your network?
If your current doctor meets our credentialling 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 Open Access Plus 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.
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