Reinsurance Assessment Impact for Self-funded Employers with California Network Plans
Note: A few details have changed regarding California Network Plans. The information below is current as of August 5, 2013.
California Network plans (Maximum Premium)
Your Network plan is one-of-a-kind in the industry. It offers you the financial and cash-flow advantages of a self-funded plan, plus access to a network with health care professionals that are reimbursed on a capitated basis.
Under California law, only a licensed Health Maintenance Organization (HMO) can offer a capitated provider network. As a result, the in-network coverage for the California residents under a Network product is provided through a group service agreement of a licensed HMO, Cigna HealthCare of California.
Given this unique contractual arrangement, we want to help you understand how the Reinsurance Fee applies to your Network plan.
Network: The Network product provides only in-network benefits through a group service agreement of an HMO, Cigna HealthCare of California, Inc. (CHC/CA)
Network Point-of-Service (POS): The Network Point-of-Service product provides in-network coverage through a group service agreement of a licensed HMO, CHC/CA, and out-of-network coverage that is self-funded by you.
For both plans - One Reinsurance Assessment payment is due by Cigna.
CHC/CA is required to pay the reinsurance assessment. We will charge for the assessment separately from your current administration fee (periodic charges) and claims.
You will not need to do anything for your California Network plan to be compliant.
Payment Responsibility for the Reinsurance Assessment
|Type of Plan||Responsible for Payment|
|CA Network Point-of-Service||CHC/CA|
|Network plans (including POS) outside of California||Employer|
Please contact your Cigna representative for additional details.