Plans
Overview
CIGNA has been serving the needs of area residents since 1978, making us one of the most experienced managed care organizations in the state.
We offer a number of products, services, tools, and capabilities to a wide variety of clients such as:
- Private sector Employers (Small, Medium, and Large size
- Federal, State & Local Government Employers
- Labor Unions
CIGNA specializes in offering to your employees the following state of the art health care benefits:
- Medical
- Dental
- Vision
- Pharmacy
- Behavioral
CIGNA Group Insurance offers
- Life, Accident & Disability Benefits
CIGNA International offers worldwide, world-class employee benefits for multinational companies with employees on assignment throughout the world or traveling on international business.
Our Benefit Plans
In California, we offer a variety of health benefit plans, including but not limited to:
Network Plans:
HMO
Network
Point-of-Service Plans:
Network Point-of-Service
Open Access Plus Plans
PPO Plans
Indemnity Plans
Consumer Driven Health Plans
Health Reimbursement Arrangement (HRA) Medical Plans
Health Savings Account (HSA) Medical Plans
Voluntary, Limited Benefit Plans
If you are a member and would like a better understanding of the benefit plan(s) offered to you, look for general descriptions in Our Plans.
Next (Services) >
Services
Our Provider Network Access
CIGNA HealthCare offers a broad network of high quality providers throughout California. Our interactive Provider Directory can show you the participating physicians, hospitals and pharmacies located in the area you specify.
- For PPO/OAP plans we serve all counties in the state.
- For HMO/Network/POS plans we serve in the following counties:
Alameda, Butte, Contra Costa, El Dorado*, Fresno, Glenn, Kern, Kings, Los Angeles, Marin, Merced*, Placer*, Riverside*, Sacramento, San Bernardino*, San Diego, San Francisco, San Joaquin, San Luis Obispo, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Solano, Sonoma*, Stanislaus, Tulare*, Ventura and Yolo.
Services We Provide
We are dedicated to providing quality service to every CIGNA HealthCare customer. This means assisting our members in understanding their benefits and plan requirements, streamlining plan administration for benefits managers, and providing educational programs for participating providers. Our Customer Care section explains a variety of important services we provide to our members.
For non-English-speaking members, we provide a 140-language capability through the Language Line Service.
We have a toll-free, CIGNA HealthCare 24-hour Health Information LineSM staffed with trained nurses who answer questions, help direct members to the nearest CIGNA HealthCare participating provider and help process urgent care referrals when necessary. Additionally, through this toll-free number, callers have access to a Health Information Library of audio tapes on more than 1,000 various health conditions and topics.
Within minutes, our network physicians can automatically refer members to specialists and submit referral data through our automated systems. Paperwork is virtually eliminated through our streamlined electronic claims submission service. We also feature CIGNA for Health Care Professionals, which allows physicians to check the status of a claim, access patient eligibility and benefits, and view policies and procedures, including provider reference guides and administrative guidelines. These paperless, web based capabilities can help save time, money, and help simplify health care administration.
Quality
We demonstrate our commitment to quality every day in all aspects of our business.
CIGNA is committed to quality through demonstration of its achievement of superior clinical outcomes.
For 2006, CIGNA HealthCare announced that it has been awarded an Accreditation status of Excellent from the National Committee for Quality Assurance (NCQA), an independent, non-profit organization that assesses and reports on the quality of the nation's managed care plans. CIGNA HealthCare's Accreditation status -- the highest possible level -- is based on a voluntary review of how a health plan ensures that its members are receiving high quality care.
CIGNA HealthCare of California has maintained an "Excellent" accreditation status from the National Committee for Quality Assurance (NCQA) for its HMO and POS products. CIGNA is also engaged in a variety of initiatives to strengthen quality, which include:
- Benefit designs that offer incentives to members to use high-performing physicians
- Pay for performance contracts and programs that directly reward providers for quality
- Public reporting of CIGNA's quality efforts and results through NCQA and other entities, such as the Pacific Business Group on Health.
Next (Special Programs) >
Special Programs
Health & Well-Being Programs
CIGNA HealthCare benefit plans provide access to preventive care and health education programs. Through our local and national wellness programs, members can receive information and support that helps them learn how to stay fit and enjoy healthier lives.
Health care options are expanding every day. The CIGNA HealthCare Healthy Rewards® program offers discounts to health and wellness programs and services. There are no added membership fees for the Healthy Rewards® discount program. CIGNA HealthCare members and their covered family members are already qualified. Please contact Member Services using the number on your ID card to learn which Healthy Rewards programs are available in California. A discount program is NOT insurance, and the member must pay the entire discounted charge.
We encourage our members to take advantage of these important wellness programs by sending them annual birthday card reminders. One of the many ways we emphasize early and regular access to proper prenatal care is by eliminating copayments for OB office visits after the initial visit. We also offer CIGNA HealthCare Healthy Babies®, our prenatal education program. Additionally, the CIGNA HealthCare Well-Being member newsletter features health education and wellness information.
Transition of Care and Continuity of Care
- If you are a new CIGNA HealthCare of California, Inc. enrollee and meet certain criteria, you may be able to continue to receive services from a provider who is not in the CIGNA HealthCare network. Please see our
Transition of Care Brochure (PDF | 164KB) for more information.
- If you are currently a CIGNA HealthCare of California, Inc. enrollee and your provider has left our network, you may be able to continue to receive services from that provider if you meet certain criteria. Please see our Continuity of Care Brochure (PDF | 160KB) for more information.
Next (Member Grievance & Appeals) >
Member Grievance & Appeals
Your Rights to File Grievances With CIGNA HealthCare of California, Inc.
We want you to be satisfied with the care that you receive. That's why we've established an internal grievance process for addressing your concerns and resolving your problems. Grievances include both complaints and appeals. Complaints can include concerns about people, quality of service, quality of care, benefit exclusions or eligibility. Appeals are requests to reverse a prior denial or a modified decision about your care.
How to File a Grievance
You can notify us of complaints or appeals in one of the following ways:
- Call us at 1.800.753.0540 or at the toll-free telephone number for mental health/substance abuse services on your CIGNA HealthCare ID card. The hearing impaired may call the California Relay Service at 1.800.735.2929 or 1.888.877.5378..
- Write to us at
CIGNA HealthCare of California, Inc.
National Appeals Unit
P.O. Box 5225
Scranton, PA 18505-5225
If you prefer, you can print and complete our medical grievance form (PDF)*. Simply mail the form to the address above or fax it to 1.818.500.6972.
- Submit an online grievance form.
If the CIGNA HealthCare member is a minor or is incompetent or unable to exercise rational judgment or give consent, the parent, guardian, conservator, relative or other legal representative acting on behalf of the member, as appropriate, may submit a grievance to CIGNA HealthCare or the California Department of Managed Health Care (DMHC or "the Department") as the agent of the member. In addition, a participating provider or any other person you identify may join with or assist you or act as your agent in submitting a grievance to CIGNA HealthCare or the DMHC.
A. Complaints
If you are concerned about the quality of service or care you have received, a benefit exclusion or an eligibility issue, you should contact us to file a verbal or written complaint. If you contact us by telephone to file a complaint, we will attempt to document and/or resolve your complaint over the telephone. If we are unable to resolve your complaint on the day your call was received, or if we receive your complaint in the mail, we will send written confirmation of receipt of your complaint within five days of receiving it. This notification will tell you who to contact if you have questions or if you would like to submit additional information about your complaint. We will investigate your complaint and will notify you of the outcome within 30 calendar days.
B. Appeals
If you are not satisfied with the outcome of a decision that was made about your care and are requesting that CIGNA HealthCare reverse a previous decision, you should contact us to file a verbal or written appeal within one year of receiving the denial notice. Be sure to share any new information that may help justify a reversal of the original decision. We will send written confirmation of receipt of your appeal within five days. We will tell you who to contact at CIGNA HealthCare should you have questions or if you would like to submit additional information about your appeal. We will make sure that your appeal is handled by someone who has authority to take action. We will investigate your appeal and notify you of our decision within 30 calendar days. You may request that the appeal process be expedited if the timeframes under this process would seriously jeopardize your life or health or your ability to regain maximum functionality, or if you are experiencing severe pain. A competent CIGNA HealthCare medical professional, in consultation with your treating physician, will decide if an expedited appeal is necessary. When an appeal is expedited, CIGNA HealthCare will respond orally and in writing with a decision within 72 hours.
You Have Additional Rights Under State Law
The California Department of Managed Health Care is responsible for regulating health care service plans. If you have a grievance against your health plan, you should first telephone your health plan at 1.800.244.6224 or the toll-free telephone number on your CIGNA identification card [The hearing impaired may call the California Relay Service at 1.800.735.2929 or 1.888.877.5378]and use your health plan's grievance process before contacting the Department. Utilizing this grievance procedure does not prohibit any potential legal rights or remedies that may be available to you.
If you need help with a grievance involving an emergency, or one that has not been satisfactorily resolved by your health plan, or one that has not been resolved after 30 days, call the Department for assistance.
You may also be eligible for an Independent Medical Review (IMR). If you are eligible for IMR, the IMR process will provide an impartial review of: medical decisions made by a health plan related to the medical necessity of a proposed service or treatment; coverage decisions for treatments that are experimental or investigational in nature; and payment disputes for emergency or urgent medical services. Call us at 1.800.753.0540 or at the toll-free telephone number for mental health/substance abuse services on your CIGNA HealthCare ID card. The hearing impaired may call the California Relay Service at 1.800.735.2929 or 1.888.877.5378. The Department's Internet Web site http://www.hmohelp.ca.gov has complaint forms, IMR application forms and instructions online.
Voluntary Mediation
If you have received an appeal decision from CIGNA HealthCare that you are not satisfied with, you may also request voluntary mediation with us before exercising the right to submit a grievance to the DMHC or participate in the IMR process. In order for mediation to take place, you and CIGNA HealthCare each have to voluntarily agree to the mediation. CIGNA HealthCare will consider each request for mediation on a case-by-case basis. Each side will equally share the expenses of the mediation. To initiate mediation, please submit a written request to:
CIGNA HealthCare of California, Inc.
National Appeals Unit
P.O. Box 5225
Scranton, PA 18505-5225
Mandatory Binding Arbitration
To the extent permitted by law, CIGNA HealthCare contractually requires the use of binding arbitration when disputes are left unsettled by other means. Arbitration may be initiated by a Demand to Arbitrate served on CIGNA HealthCare of California, Inc. Binding arbitration is not mandatory for disputes pertaining to coverage plans governed by the Employee Retirement Income Security Act of 1974 (ERISA). If your plan is governed by ERISA, you have the right to bring civil action under Section 502(a) if you are not satisfied with the outcome of the appeal procedure. In most instances, you may not initiate a legal action until you have completed the CIGNA HealthCare internal appeal process.
CIGNA Dental Health of California, Inc., Grievance Procedure
How to File a Grievance
You can notify us of complaints or appeals concerning the CIGNA Dental Care (DHMO) Plan in one of the following ways:
1.Call Member Services at 1.800.244.6224.
2.Write to us at
CIGNA Dental Health of California, Inc.
P.O. Box 188047
Chattanooga, TN 37422-8047
If you prefer, you can print and complete our dental grievance form (PDF)*. Simply mail the form to the address above or fax it to 1.559.735.8257.
3. Submit a dental online grievance form.
For specific information regarding the CIGNA Dental Health of California, Inc., grievance process, please
- refer to your Combined Evidence of Coverage and Disclosure Form in your plan booklet; or
- contact our Member Services Department.
CIGNA Behavioral Health of California, Inc., Grievance Procedure
How to File a Grievance
You can notify us of complaints or appeals concerning CIGNA Behavioral Health in one of the following ways:
- Call us at 1.800.753.0540 or at the toll-free telephone number for mental health/substance abuse services on your CIGNA HealthCare ID card. The hearing impaired may call the California Relay Service at 1.800.735.2929 or 1.888.877.5378.
- Write to us at
If you prefer, you may print and complete a behavioral health grievance form. Simply mail the form to the address above or fax it to the Complaint/Appeal Department at 1.818.551.2787.
For more specific information about these grievance procedures, please
- refer to your Group Service Agreement; or
- contact our Member Services Department.
If the CIGNA Behavioral Health member is a minor or is incompetent or unable to exercise rational judgment or give consent, the parent, guardian, conservator, relative or other legal representative acting on behalf of the member, as appropriate, may submit a grievance to CIGNA Behavioral Health or the California Department of Managed Health Care (DMHC or "the Department") as the agent of the member.
In addition, a participating provider or any other person you identify may assist you or act as your agent in submitting a grievance to CIGNA Behavioral Health or the DMHC.
Next (Contacts - Local Contacts) >
FAQ
Does CIGNA have any current events or sponsorships to make note of?
Since 1995, CIGNA HealthCare has been the exclusive National Health Care Sponsor of the March of Dimes WalkAmerica for Healthier Babies.
What is Conversion Plan Information?
To view the CIGNA HealthCare of California, Inc. Conversion Comparative Benefit Matrix and Rates, go to the California Department of Managed Health Care website.
What is Cal-COBRA Continuation?
If you began COBRA on or after January 1, 2003, and have recently exhausted that continuation, you may be eligible to continue your CIGNA HealthCare of California coverage through Cal-COBRA continuation. Please call us at 1.800.315.6011 or refer to your Group Service Agreement for more information. If you qualify for Cal-COBRA, please complete the State Continuation Application and submit it to the address on the form.
Next (Plans) >
