Review Your Benefits

Review Your Benefits

Plan Documents
10/1/2019 Medical Benefit Plans

St. Joseph Hoag Health Select Network

St. Joseph Hoag Health Select Network

Network (HMO)

Network Summary of Benefits

Open Access Plus (OAP)

OAP Summary of Benefits

Preferred Provider Organization (PPO)

PPO Summary of Benefits

Medicare Expand Open Access Plus (OAP)

Medicare Expand OAP Summary of Benefits

10/1/2019 Dental Benefit Plans

Dental HMO

Dental HMO Patient Charge Schedule

Dental PPO

Dental PPO Benefit Summary

Additional Information
Cigna Plan FAQs

SJHH Select Network FAQ

Network (HMO) FAQ

OAP FAQ

Travel Information

It's important that you understand your coverage if you're planning to be away from home.

If you are enrolled on the Cigna Network plan you have coverage outside of your service area for urgent or life threatening emergencies. If you plan to be away from home for an extended period of time (at least 60 days) you may be eligible for the Cigna Guesting Program. If Cigna has an HMO network in the area in which you intend to reside while away from home you can be setup with "Guesting" privileges which will give you the coverage offered through your NMUSD plan in that Guesting network area. To determine if Guesting privileges apply, please have the zip code ready, then call the 800.244.6224 customer service line. The representative will walk you through the entire process. Guesting can only be set up after the effective date and will typically take effect within two weeks of being requested.

If you are enrolled on a Cigna OAP or PPO plan, you have access to in-network coverage through a national network of health care professionals and facilities. You also have coverage outside of your plan's network, but your costs can be much higher. Visit www.cigna.com or call 800.244.6224 for help locating a participating provider in your area.

Outside of the Country

When traveling outside of the Country coverage is only available for urgent or life threatening emergencies. See our flyer regarding receiving Urgent & Emergent Care outside the United States.

Chiropractic Care

Cigna Network (HMO) or St. Joseph Hoag Health Select Network

For members enrolled in either of the Network plans (Cigna Network (HMO) or St. Joseph Hoag Health Select Network) NMUSD has elected a rider that allows employees to self-refer to participating chiropractors within the American Specialty Health Network. This means that you can visit a participating chiropractor without first visiting your primary care physician for a referral. You can find participating chiropractors on Cigna.com by searching for chiropractors.

If you are on either of the Network plans and want to search for a chiropractor please follow these steps:

  1. Log on to www.mycigna.com, with your username and password, click on “Find a Doctor”
  2. Enter desired zip code or city for your “Search Location”
  3. Click the plan you are enrolled in:
    • CIGNA HealthCare of California, Inc. - So. CA HMO/Network
    • Southern CA Select (St Joseph Hoag Health Select Plan, Scripps Select Plan, HealthCare Partners Select Plan)
  4. Under the “Looking for” box type in: CA Chiropractic Self-Refer
    Results for Chiropractic self-refer will populate

 

OAP & PPO Plans

For members enrolled on the OAP or PPO plans, you have the freedom to self-refer for covered health care services, including chiropractic care. You can get care both In and Out of Network, though seeking care Out of Network will mean you receive a lesser benefit amount, do not get the benefit of Cigna negotiated rates and can be subject to balance billing by the health care professional if their fee is over and above the usual and customary rate for services in that area.

If you are on the OAP or PPO plan and want to search for a chiropractor please follow these steps:

  1. Log on to www.mycigna.com, with your username and password, click on “Find a Doctor”
  2. Enter desired zip code or city for your “Search Location”
  3. Click the plan you are enrolled in:
    • For the OAP plan, select “Open Access Plus, OA Plus, Choice Fund OA Plus” option
    • For the PPO plan, select “PPO, Choice Fund PPO”
  4. Under the “Looking For” box, type in “chiro“ and a box will pop up with options. Click the “Chiropractic” option
  5. You will then see the results pop up for your desired area. You can expand the search by using the filter keys on the top of the screen and widen the miles within your search.

 

*Review your plan documents for details of coverage, including plan exclusions and limitations.

Medical Necessity Review

Any chiropractic service(s) will be reviewed for “medical necessity.” Medical necessity means services needed to diagnose, prevent, or treat your condition and that meet accepted standards of medical practice. Your plan won’t cover chiropractic services if no review is done or if the review determines the service(s) aren’t medically necessary for you.

When seeking chiropractic care through a contracted provider, your doctor will be responsible for submitting the required information for medical necessity review and will work with Cigna and American Specialty Health Network to do so.

For members on the OAP or PPO plan that seek chiropractic care outside of the network, your out-of-network doctor may take care of sending the necessary information to American Specialty Health Network for review. But if not, you’ll have to ask American Specialty Health Network to review your treatment plan to see if it’s medically necessary.

There are three ways you or your doctor can provide American Specialty Health Network with the necessary information for the review:

  • By phone: 1-800.972.4226
  • By fax: 1.877.304.2746 (in California, please call 1.877.427.4777)
  • By mail: ASH Networks
                 P.O. Box 509001
                 San Diego, CA 92150-9001
Urgent Care Information

As a customer on one of Cigna's Network plans, your medical care is directed by your Primary Care Physician (PCP). Many PCPs have extended hours or are contracted with local Urgent Care centers to provide you access to care beyond your PCP’s normal office hours. Urgent Care centers may treat patients for acute services such as sprained ankles, cuts, fevers or other conditions that need prompt medical attention, but pose no immediate threat to life and health.

If you are in need of Urgent Care services, you should always first ask if your PCP has extended hours or can refer you to the nearest contracted Urgent Care center available to you through your affiliated Medical Group.

If you are traveling out of your service area and are in need of Urgent Care services, your Cigna medical plan provides coverage for Urgent Care Centers even if they are not contracted with your PCP or affiliated Medical Group.

If you experience problems with receiving care at an Urgent Care Center and need assistance, or if you have questions regarding your Cigna medical benefits, please contact Cigna at 800.244.6224. We’re here to assist you 24 hours a day, 7 days a week.”

Hearing Aid benefit and Amplifon

Cigna Healthcare contracts with an outside vendor, *Amplifon, for hearing aid devices. Follow these easy steps below to obtain the device from your local Amplifon center.

Step 1. Request a referral from your primary care physician to a contracted audiologist

Step 2. Schedule a hearing exam with audiologist

Step 3. Upon receiving the results of your exam, if a hearing aid is required, contact Amplifon to get a referral to an Amplifon center where you can fulfill the order for the hearing aid. Have your audiologist fax or email the prescription for the hearing aidto that designated Amplifon center.

For further information please call:
Amplifon: 855.531.4693

*Disclaimer: Hearing aid devices obtained outside of Amplifon vendors, are not covered through Cigna.