Cost Management

Cost Containment Programs
Cigna's cost containment program is automatically included in all plans to help provide more medical savings to our clients and customers. It leverages a hierarchy of pricing techniques to maximize available discounts for out-of-network claims to help lower costs.

Out-of-Network Cost Containment Programs (Network Savings Program (NSP) and Bill Negotiation Services (BNS))
Out-of-network claims are first routed through the Network Savings Program to determine if savings can be achieved. This program supplements our current networks and delivers claim cost savings on many out-of-network health care professionals and facilities through a partner network. The claim is paid using the NSP discounted amount as the allowed amount and the customer cannot be balance billed.

If savings are not achieved through the Network Savings Program, the out-of-network claim is next routed though Bill Negotiation Services (BNS). BNS includes a number of pricing techniques to achieve savings.  If savings are achieved through BNS, the claim is returned to Cigna for payment.  The claim is paid using the BSN discounted amount as the allowed amount and the customer cannot be balance billed.

Maximum Reimbursable Charge (Out-of-Network Benefits)

The maximum reimbursable charge (MRC) benefit helps employers manage out-of-network medical costs. MRC represents the maximum amount under the medical plan that Cigna will pay an out-of-network health care professional for a covered service. For employers, MRC:

  • Helps keep health benefits more cost-effective by lowering unit costs
  • Includes all charges (health care professional and health care facility) at a greater discount
  • Reduces exposure to unnecessary billing by out-of-network health care professionals
  • Improves in-network use by providing a strong financial incentive for employees to use participating health care professionals and hospitals
  • Drives greater incentives for health care professionals and hospitals to join the Cigna network
Pre-Payment Bill Review Programs
Cigna has a number of Pre-Payment Bill Review Programs for in- and out-of-network claims:

Complex Claim Review
Complex Claim Review is a coding and billing review program done on a pre-pay basis. It helps ensure doctors and other health care professionals submit reasonable, accurate and appropriate charges for the services and supplies they provide.

Diagnostic related group (DRG) Claim Review Program
DRG Claim Review focuses on facilities that are billing higher weighted DRGs as compared to their peers for certain diagnostic categories. It helps ensure correct codes have been assigned and are supported by documentation in the medical record.

High Cost Claim Panel Review Program 
This program reviews high cost facility claims by requesting an itemized bill and/or medical records to support the total bill. Each claim is reviewed for accuracy as it relates to medical authorization/necessity, applicable coverage policies, eligibility, correct contract application/selection and correct billing prior to payment.

Post Pay Audit Recovery Programs 
Cigna's post payment programs review medical bills to determine the reasonableness, appropriateness and accuracy of charges. These programs can help employers and employees save on their health care costs.

Contact your Cigna representative for more information.

Customer Experience

24/7/365 Live Customer Support
Around the clock service when you need us. Personal and easy. On your schedule. On your terms. From real people.

Explanation of Benefits (EOB)
We provide each customer with a quick summary of recent claim activities. It's easy for them to see what's been paid and what's owed. The Cigna Explanation of Benefits ranked second among national health plans with an excellent designation for clarity, content and design in an evaluation by DALBAR, Inc.1

myCigna.com
With myCigna.com, registered users can easily manage their health and health plan to review their coverage, find doctors, compare costs and quality information, track account balances, refill prescription drugs, and more -  online or via the myCigna mobile app.

Clear Communication
We've developed customer interaction guidelines, including the use of easy-to-understand words, to help make sure our customer communication is as clear as possible.

Contact your Cigna representative for more information.

1DALBAR, Inc., [2014] Explanation of Benefits Statements Rankings.

Dental Coverage

Dental Health Maintenance Organization (DHMO)1
The Cigna Dental Care® DHMO is one of the largest Dental HMO network in the nation2 and offers 75% savings off average area charges3 with 40% lower premiums4, on average, than a Cigna Dental PPO. There’s a DHMO plan option to help meet any client's needs, with features like surgical implant coverage5, coinsurance customer out-of-pocket payment, discounts and more. Most preventive procedures are covered at no charge5, which supports our focus on prevention. And with teeth whitening coverage (take-home bleaching with gel trays), the ability to offer up to four cleanings a year, coverage for crowns/bridges over implants5, coverage for athletic mouth guards5, ID theft resolution services6, a Dental Information Line, and other value-added features, Cigna's DHMO plans are designed to offer a great customer experience.

Dental Preferred Provider Organization (DPPO)
Cigna's Dental PPO lets customers choose any dentist, in- or out-of-network. Coverage includes most preventive procedures at low or no cost, and individuals don’t need a referral  to see specialists.7 Cigna's Dental PPO is designed with network flexibility to help meet any employer’s benefit strategy:

  • Largest network of dentists contracted to discounted fee8, with customizable in- and out-of-network discount configurations
  • Customizable plan designs with numerous cost-saving features
  • Multiple funding options :
  • Cigna's network grew 88% from 2008 to 2015.9 

Dental Exclusive Provider Organization (DEPO)
The Cigna Dental EPO provides the flexibility of broad network access with in-network only coverage. Customers will be reimbursed for all or part of their costs for covered procedures, up to the annual dollar maximum, and after meeting a deductible and/or satisfying any waiting periods. Coverage includes most preventive procedures at low or no cost, and individuals don’t need a referral to see specialists.7

For employers, the benefits of choosing DEPO include:

  • Customizable plan designs with numerous cost-saving features10
  • Multiple funding options:

Dental Indemnity
Cigna Traditional is our dental indemnity-style plan. Since there are no networks associated with Cigna Traditional, customers can visit any dentist or specialist they choose, without a referral. Coverage includes most preventive and diagnostic services.7 For all covered services, individuals pay a set coinsurance amount, and since there are no negotiated network discounts, they may pay the difference between coinsurance and the dentists' usual charges. Benefits of choosing this plan include:

  • Customizable plan designs with numerous cost-saving features10
  • Multiple funding options:

CignaFlex Advantage®
CignaFlex Advantage lets customers switch monthly between our Cigna Dental Care (DHMO) plan and either the Cigna Dental PPO or the Cigna Traditional indemnity plans—with no additional administrative work options for clients. There are three options available to meet clients' needs, including Cigna Managed Switch, Client Managed Switch and Client/Cigna Managed Switch.

CignaPlus Savings®11
CignaPlus Savings is a discount dental program—not an insurance product. This program is designed to meet the needs of employers looking to offer dental care to anyone who's ineligible for traditional insurance coverage, such as part-time employees, seasonal employees or retirees. It's a cost-effective option that gives customers access to dental care services at discounted rates.

Cigna Dental Oral Health Integration Program®
The Cigna Dental Oral Health Integration Program is available to all dental customers because better oral health may contribute to better overall health. Cigna dental customers who have any of the medical conditions below qualify for 100 percent reimbursement of out-of-pocket costs for certain related dental procedures12. There's no additional charge for the program-those who qualify get reimbursed.13

  • Diabetes
  • Maternity
  • Heart Disease
  • Stroke
  • Head and neck cancer radiation
  • Organ transplants
  • Chronic kidney disease

The Cigna Dental Oral Health Integration Program goes beyond typical dental coverage and offers:

  • More savings. Program participants get discounts on certain prescription dental products through Cigna Home Delivery PharmacySM regardless of their pharmacy carrier
  • More wellness. Participants can choose to get information on how behavioral issues are linked to oral health. These articles are designed to help program participants overcome these behaviors so they can improve their oral and overall health

Contact your Cigna representative for more information.

Some plans and plan features may not be available in all states. Actual plan coverages will vary based on plan design, location and funding type. All plans and insurance policies contain exclusions and limitations which are more fully set forth in the applicable plan documents. Cigna dental insurance plans and administrative services are offered by Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, or their affiliates.

1The term “DHMO” is used to refer to product designs that may differ by state of residence of enrollee, including but not limited to, prepaid plans (Oklahoma, et al), managed care plans, and plans with open access features (OK and MN, et al). The Cigna DHMO is not available in the following states: AK, HI, ME, MT, NH, NM, ND, PR, RI, SD, VI, VT, WV, and WY. For the DHMO company name and other information for your particular state, see Cigna Companies by State. Terms and conditions of coverage are set forth in DHMO policy forms GM6000 DEN201V1* (CGLIC) and HP-POL115* (CHLIC), and DPPO policy forms GM6000 ELI288* et al (CGLIC) and HP-POL99* (CHLIC) (*actual number may vary by state).

2Source: NetMinder. DHMO data as of March 2015 and is subject to change. The Ignition Group makes no warranty regarding the performance of the data and the results that will be obtained by using.

3The national average charges used in the calculation are based on a combination of Cigna and FAIR Health claim data projected to 7/1/2013 using a 3% annual cost trend. Calculation assumes customer out-of-pocket savings with Cigna DHMO plan versus no dental insurance coverage.

42014 Cigna Dental book of business; clients who offer both DHMO and DPPO have on average 40% lower DHMO premiums than their DPPO premiums.

5Individuals must receive services through their network general dentist for coverage to apply, except in emergencies. Prior authorization may be required for certain specialty care treatments. Only those procedures that are medically necessary and listed on the plan’s Patient Charge Schedule (PCS) are covered. Services related to the surgical placement of a dental implant are limited to one per year with replacement of a surgical implant frequency limitation of one every 10 years. The frequency limitations of certain other covered services are set forth in the PCS. The following are excluded from coverage unless otherwise listed on the PCS or required by law: (a) Experimental and cosmetic dentistry; (b) Treatments or surgery if associated with a poor or hopeless diagnosis; (c) Recementation of crowns, inlays and onlays, post and cores, and veneers within 180 days of initial placement; (d) Crowns, bridges and implant supported prosthesis used solely for splinting; and (e) Work already in progress for crowns, bridges, dentures, root canal treatment, or implant supported prosthesis. A complete list of your plan’s terms, including exclusions and limitations, is set forth in the applicable plan documents.

6Cigna's Identity Theft services are provided under contract with Europ Assistance USA. Full terms are contained in Cigna's Identity Theft Program service agreement.

7Routine exams and X-rays are limited to 2 per calendar year. Waiting periods may apply to basic restorative, major restorative, and orthodontic services and are more fully set-forth in the group insurance certificate or group service agreement.

8NetMinder. DPPO data as of March, 2015, reflecting Total Cigna DPPO counts of unique dentists. Data is subject  to change. The Ignition Group makes no warranty regarding the performance of the data and the results that will be obtained by using.

92013-2016 Cigna projections are based on previous recruitment and competitive positioning in the industry. Competitive positioning is measured using NetMinder data as of March 2015 program counts of unique dentists. Data is subject to change. The Ignition Group makes no warranty regarding the performance of the data and the results that will be obtained by using it.

10Options include: varying deductibles, coinsurance levels, maximums, stricter exclusion & limitation language, procedural class-shifting, benefit waiting periods, WellnessPlus plans, etc.

11CignaPlus Savings is a dental discount program that provides members access to discounted fees, pursuant to schedules negotiated by Cigna Dental with participating providers, which members are responsible for paying in full, directly to participating providers. Although all participating providers go through a credentialing process to assure that they are appropriately licensed and qualified, Cigna Dental does not otherwise guarantee nor is it responsible for the quality of any services or products purchased by members. This program is not available in all states. A discount program is NOT insurance, and the member must pay the entire discounted charge.

12The Cigna Dental Oral Health Integration Program offers 100% reimbursement for out-of-pocket costs for certain related dental procedures, subject to the following limitations: coverage for periodontal maintenance is limited to 4 per year during active therapy; customers undergoing treatment for chronic kidney disease, organ transplants, or head/neck cancer radiation receive coverage for topical fluoride application and varnish, and dental sealants (age limits removed, other plan limitations may apply); maternity patients receive coverage for one additional oral evaluation and cleaning during their pregnancy term. All other plan exclusions and limitations apply.

13Deductible does not apply. Reimbursement counts toward maximum for DPPO/indemnity plans. Program exclusions and limitations apply..

Group and Voluntary Coverage

Find cost-effective plan designs and solutions to meet your needs and help your employees actively engage in programs to help them be healthy, productive and more financially protected – even if they never file a claim.

Learn more about Group and Voluntary Coverage

Enrollment Technology

Choicelinx®

Choicelinx is dedicated to supporting our Clients' changing needs in benefits administration and enrollment. Our mission is to provide enrollment and benefits administration services to Cigna's clients who are looking for these services to augment their in-house benefits administration capabilities.

The key product at Choicelinx is Benefits Insight®; a proprietary HR Administration portal with an adjacent Employee Online Enrollment system. The HR Administrator portal helps staff to run reports, monitor enrollments and manage administration of benefits eligibility and business rules. Online enrollment with embedded decision support helps employees make complex benefit decisions and feel confident in their selections.

To learn more, visit choicelinx.com.

Funding Arrangements for Health Care

Clients have unique needs when it comes to managing risk and cash flow. A “one size fits all” approach to funding doesn't work. Cigna developed a suite of funding solutions to meet each client’s risk protection and cash flow needs, with complementing programs that engage employees in improving their health.

Cigna offers three unique insured solutions which combine:

  • Insurance protection: Maximum protection for covered claims and compliance with state/federal mandates
  • Budgeting ease: predictable monthly payment and/or cap on monthly/annual liability
  • Detailed financial and utilization reports and consultative advice to help you decide which programs are right for you
  • Opportunity to save: Cash back or real-time savings if actual costs are lower than expected

Two options provide a client experience similar to traditional fully insured/guaranteed cost plans. The client pays a fixed, predictable monthly payment and Cigna pays covered claims. These options provide a year-end settlement, which provides a cash-back opportunity for each client based on their unique experiences

1.)  50% Dividend Eligible: An introductory offering that lets you share in a portion of the plan savings. You receive 50% of savings back  if claims are lower than expected (renewal required)

2.)  Shared Returns®: Maximize potential savings across multiple years with greater participation/sharing in plan savings. You receive up to 100% of savings back if claims are lower than expected

Shared Returns® Minimum Premium (SRMP):  provides a “pay-as-you-go” experience

  • Pay less money up front with a fixed premium that includes health improvement services, administration and insurance premium
  • Pay claims as they occur. If claims are less than estimated, you save money in real time. If claims are higher than estimated,
  • We’ll reimburse the excess claim cost1 
  • Put money into a reserve fund for payment of future claims2

Cigna also offer industry standard options:

  • Fully Insured: Fully insured plans provide full insurance protection and predictable monthly premium. Clients pay a fixed monthly premium and Cigna pays the covered claims.
  • Self-Funded with Stop Loss insurance coverage: Self-Funded plans maximize cash flow as the client funds all claim activity directly, which appeal to clients that are financially oriented and can handle some level of claim volatility.

1For Shared Returns Minimum Premium, reimbursed claim costs are carried over and may be recovered in future years when claims are lower than expected. The amount we’ll carry forward for recovery is capped at 15% of policy year premium equivalent.

2Pending underwriting approval. Upon policy termination, reserves are paid into Cigna.

Contact your Cigna representative for more information.

Health and Wellness

Health Assessment
Cigna's gamified health assessment is simple and fun, right from the start. The picture-based, interactive assessment helps customers understand where they are on their health journey, and what to do next.  Using information from our health assessment, we are able to help our clients address, reduce and reverse health risks with the support of our health coaching interventions, including online coaching and clinical programs. Of health assessment respondents, 46% of new referrals that were engaged in health management programs were referred from the health assessment alone.1

Our health assessment service helps employers:

  • Identify the most appropriate health strategies to support the population
  • Monitor and evaluate an employee population's health, health changes and engagement of health management programs over time
  • Analyze current health risks and their impact on future health status, costs, productivity and disability

1Cigna analytics analysis for University of MI Health Assessment Trend book of business results from 1/1/2013–12/31/2013. Individual results may vary.

Personal Health Solutions
Cigna's personal health solutions can improve health and productivity, and lower costs for populations with acute health care needs, such as hospitalization and/or significant outpatient treatment. The Utilization Review Accreditation Commission (URAC) and/or the National Committee for Quality Assurance (NCQA) have accredited our programs. In addition, the programs are guided by evidence-based guidelines.

Gaps In Care
Cigna's gaps in care program uses medical, pharmacy and laboratory data to proactively identify and address customers' gaps in care. Gaps in care occur when people don't receive, or adhere to, medical care that is consistent with medically-proven guidelines for prevention and treatment. This can result in more serious illnesses and additional costs for customers and employers.

The gaps in care program helps:

  • Identify and communicate gaps to Cigna customers and providers
  • Create greater health awareness among Cigna customers and effective interactions with doctors
  • Improve health, productivity and quality of life for employees
  • Reduce costs 

The gaps in care program is integrated with Cigna health advocacy products.

Biometric Screenings
Biometric screenings give participants a convenient way to assess their current health status. They also help clients identify health risks in their employee population. Through preferred vendors, Cigna offers a variety of screenings at the worksite, including blood pressure, glucose testing, body mass index and cholesterol testing.

Contact your Cigna representative for more information. Biometric screenings are independently administered by a third party biometric screening service provider and not by Cigna.

24-Hour Health Information Line
The health information line is a 24/7 resource that provides live support from a nurse about general health conditions and their symptoms. Nurses also help determine the appropriate level of care. Employees may also listen to hundreds of podcasts on almost any health topic.

Employee Assistance Program (EAP)
Cigna's Employee Assistance Program helps deliver the support employees and employers need to better manage work and life issues so they can manage their health, stay focused and productive. The service is designed to meet the personal assistance needs of employees and managers, and the organizational needs of businesses. Depending on the services purchased, support is available via:

  • Telephone
  • Online
  • Face-to-face at the worksite or via a referral to a mental health professional

Mental Health and Substance Use

Almost every employee can benefit from integrated behavioral health services. By increasing the use of behavioral services across your organization, you can help decrease overall medical and behavioral expenses.

Contact your Cigna representative for more information.

Health Advisor-Personal Health Team 
Cigna offers health coaching for healthy and at-risk populations to help customers reduce risks related to cholesterol, blood pressure, nutrition, physical activity and pre-diabetes. Health coaches also provide valuable information to help customers make treatment decisions, close gaps in their care and prepare for an admission or discharge from the hospital.The team also manages short term case management needs to help improve productivity, and reduce benefit costs by improving employee health, and preventing future illnesses and their expenses.

Cigna Healthy Pregnancies, Healthy Babies®
While most women have healthy, uncomplicated pregnancies, others may need specialized support to deliver healthy babies. Cigna Healthy Pregnancies, Healthy Babies can give women the support they need to have healthier pregnancies and deliveries.

Contact your Cigna representative for more information.

Health Focus: Ongoing Care
For those requiring ongoing care, we offer services to help them live better with their condition. Cigna offers:

Your Health First®
Health coaching focuses on the entire health needs of people with chronic conditions, such as diabetes, asthma, depression, back pain, cardiac conditions and more. Health coaching can help reduce health risks related to tobacco, weight, stress, cholesterol and blood pressure. Depending on the services purchased, we deliver health coaching through:

  • Telephone
  • Online
  • Face-to-face at the worksite

Cigna Cancer Support Program
The Cigna Cancer Support program supports employees and their families with information and assistance from diagnosis to treatment to remission.

Cigna Total Behavioral HealthSM
This integrated approach can help improve health, productivity and a company's bottom line by focusing on the individual. Cigna's behavioral health coverage can increase the cost effectiveness of medical and pharmacy plans. This can result in decreased costs and peace of mind.

Contact your Cigna representative for more information.

Health Focus: Preserving Health and Well-Being
For those people who want to maintain, preserve, or improve their health and well-being, we find opportunities to reduce risks through:

Cigna Health Advisor®
Health coaching can help customers reduce risks related to cholesterol, blood pressure, nutrition, physical activity and pre-diabetes. Health coaching also can help customers by providing information about treatment options and helping to close gaps in care.

Lifestyle Management Programs
Health coaching can provide the support employees need to make lasting behavior changes to reduce risks related to tobacco, weight and stress. These changes can result in decreased medical costs and improved productivity. Depending on the services purchased, health coaching for these topics is provided via:

  • Telephone
  • Online

Flu Clinics
One of the best ways to help prevent the flu is with annual flu vaccinations. To help people fight the flu and avoid its consequences, Cigna offers flu immunizations through preferred providers at worksites. The benefits of our flu clinics include:

  • Coordination of the planning and delivery of the on-site flu clinics
  • Promotional and educational materials that deliver coordinated and cohesive messages to encourage participation
  • Potential reduced costs from the flu
  • A safe, convenient way to provide health needs to employees

Contact your Cigna representative for more information. Flu clinics are independently administered by a third party provider and not by Cigna.

Better Health. Guaranteed.®
With this program Cigna will guarantee to reduce the health risks of identified High and Medium at risk individuals.  Our commitment to measurably improve health includes access to Cigna's exclusive health risk identification tool and an employer health improvement fund to support your strategy. To support this promise, we'll offer:

  • Cigna resources aligned to help you achieve your health and wellbeing goals  
  • Access to Cigna's exclusive health risk identification tool, early risk identification, risk education, increased engagement with Cigna clinical resources
  • An employer Health Improvement Fund to support your strategy to pursue a culture of health
  • Consumer-driven programs
  • Health coaching with optional incentive packages 
  • A year over year progression with successful clients receiving a Graduation Guarantee

Healthy Awards
Through our Healthy Awards Account® (tied to the Cigna Choice Fund® product), healthy activities offer an incentive for employees to live healthier and allow them to earn money to be deposited in their health spending accounts.

Cigna MotivateMe Incentive Program®
MotivateMe makes it easy for our customers to understand all their health incentive opportunities and track their progress and rewards as they take actions to improve their health. The program is fully integrated into Cigna’s coaching programs.

Key initiatives include:

Well-being Solutions
Cigna can deliver some of most relevant, engaging and cost-effective well-being solutions for your organization. This can result in healthier, happier, more productive employees and a better bottom line. Success is grounded in Cigna's commitment to delivering personalized well-being solutions, based on our knowledge of your company.

Through our consultative approach, we assess the top health risks of your employee population, along with your values, goals and budget for supporting well-being in the workplace. Then we recommend a well-being solution set, designed to meet the needs of your organization. 

Our programs are organized by specific goals and can be mixed and matched to design the perfect fit for your workforce. Our programs include:

  • Health Awareness. Hands-on services to help people know their numbers and better understand their health status and potential risks
  • Education. Easy-to-understand resources to help people learn how to be well for life
  • Prevention. Helpful programs aimed at preventing illness and disease
  • Lifestyle. Highly engaging, behavior-change programs that encourage your employees to practice healthy habits for a lifetime
  • Activity. Motivational programs and challenges to help inspire people to actively participate in their health
  • Coaching. Expert guidance and consultation to support organizations and individuals throughout the process

Our tailored, personalized approach sets Cigna apart and can deliver meaningful behavior change-potentially leading to better health and a better bottom line.

Contact your Cigna representative for more information.

Medical

Cigna Choice Fund Consumer-Driven Health Plans
Cigna Choice Fund® delivers a true consumer-focused solution-one that puts a person's needs and goals first. We focus on shifting behaviors, not costs, to create active participants who are encouraged and rewarded for choosing quality care.

Health Reimbursement Account (HRA)
The Cigna Choice Fund® Health Reimbursement Account (HRA) is a consumer-driven health plan that combines a medical plan with an account funded by the employer. The Cigna Choice Fund HRA is designed to help lower overall medical costs through a focus on engaged participants. It also offers the added security of rolling over unused funds to the next plan year to save for future expenses. The benefits of choosing a Cigna HRA include:

  • Choice in the underlying medical plan
  • Choice in your own limits on remaining HRA dollars that roll over to future plan years
  • Choice in incentive programs to reward employees for healthy behaviors
  • Choice in offering a Flexible Spending Account in addition to the HRA
  • Automatic claim forwarding option to pay providers directly from the HRA

Health Savings Account (HSA)
The Cigna Choice Fund® Health Savings Account (HSA) is a consumer-driven health plan that lets individuals make a personal investment in improving their health and quality of life. Accompanied by an IRS-qualified, high deductible health plan, the HSA gives individuals ownership of a tax-advantaged savings account they can use to put aside money to help pay for current or future medical, prescription drug, dental and other IRS-approved health care expenses.

The benefits of choosing a Cigna HSA include:

  • Support for the installation of the medical plan and Health Savings Account 
  • A centralized point-of-contact for the health plan, interest-bearing savings account and investment options
  • A single website, myCigna.com, for members to access information about medical and pharmacy plan and claim activities
  • Enhanced and integrated online decision support tools
  • An option to pay providers directly from health savings accounts

Flexible Spending Account (FSA)
With a Flexible Spending Account (FSA), people can set aside pre-determined, pre-tax dollars to help pay for eligible medical, dental and pharmacy expenses. FSAs are a cost-effective way for participants to manage eligible out-of-pocket expenses not covered by medical plans. Participants pay no taxes on contributions or withdrawals.

As an employer, all you need to do is make payroll deductions and report funds. Cigna takes care of the rest, including accounting, eligibility verification, claim verification, customer service and reimbursement. The benefits of choosing a Cigna FSA include:

  • A valued resource for employees
  • Reduced costs for employers
  • Automatic claim forwarding option to pay providers directly from the FSA
  • Option of allowing participants to carry over up to $500 of unused funds at end of plan year
  • Integration with medical plans

Contact your Cigna representative for more information.

Health Maintenance Organization (HMO)
Our HMO is a physician directed, participating health care professional-only plan for employers concerned about cost. The benefits of choosing a Cigna HMO include:

  • Primary care physician (PCP) involvement that can result in early interventions and cost-effective outcomes
  • Referrals to see specialists
  • Wellness features and disease management programs

Contact your Cigna representative for more information.

Medical Indemnity

The traditional indemnity plan can help employees take charge of their health care choices, and offer the freedom to choose any health care professional, hospital or clinic without a referral or network boundaries. Cigna's exclusive network savings program uses preferred rates to lower claim costs and out-of-pocket costs for businesses and their employees. The benefits of choosing a Cigna indemnity plan include:

  • Cost control options through flexible plan designs and utilization management
  • Cigna's exclusive Network Savings Program that can lower claim and out-of-pocket costs for you and your employees
  • Wellness features and disease management programs

Contact your Cigna representative for more information.

Open Access Plus (OAP)
Cigna's Open Access Plus plan is a solution for employers who want choice, convenience and cost control. We offer access to a national network of health care professionals, hospitals and facilities, and consistent plan designs. The benefits of choosing a Cigna OAP include:

  • Competitive network discounts
  • Flexible plan designs and funding options
  • Cost control through customizable plan designs that encourage visiting in-network health care professionals
  • Encouragement of employees to see primary care physicians (PCPs)
  • No referral requirement to see specialists
  • Simplified administration and hassle-free service

Contact your Cigna representative for more information.

Open Access Plus In-Network (OAP-IN)
Cigna's OAP-IN can help control costs by requiring employees to see participating health care professionals to receive coverage under their plan, with the exception of for emergency services. With the plan, you’ll get flexible plan designs, funding options and competitive network discounts. The benefits of choosing a Cigna OAP-IN include:

  • Competitive network discounts
  • Flexible plan designs and funding options
  • Cost control by requiring employees to see participating health care professionals, with the exception of for emergency services
  • Encouragement of employees to see primary care physicians (PCPs)
  • No referral requirement to see specialists
  • Simplified administration and hassle-free service

Contact your Cigna representative for more information.

LocalPlus®
Cigna's LocalPlus plan is a solution for employers who want to control cost without sacrificing quality or scope services. We offer access to a network of health care professionals, hospitals and facilities in select LocalPlus geographies. The benefits of choosing Cigna LocalPlus include:

  • Competitive discounts in a more concentrated network
  • Flexible plan designs and funding options
  • Cost control through customizable plan designs, which encourage the use of in-network health care professionals
  • Primary care physician (PCP) use encouraged
  • No referral requirement
  • Simplified administration and hassle-free service

Contact your Cigna representative for more information.

LocalPlus In-Network
Cigna's LocalPlus IN can help further control costs by requiring employees to see participating health care professionals to receive coverage under their plan, with the exception of emergency services. We offer access to a network of health care professionals, hospitals and facilities in select LocalPlus geographies. The benefits of choosing a Cigna LocalPlus IN plan include:

  • Competitive discounts in a more concentrated network
  • Flexible plan designs and funding options
  • Cost control by requiring employees to see participating health care professionals, with the exception of for emergency services
  • Encouragement of employees to see primary care physicians (PCPs)
  • No referral requirement to see specialists
  • Simplified administration and hassle-free service

Contact your Cigna representative for more information.

Preferred Provider Organization (PPO)
Cigna's PPO option offers choice and convenience, with no referrals required. Customers can choose from a national network with a broad range of health care professionals and hospitals. The benefits of choosing a Cigna PPO include:

  • Quality, convenience and no referrals
  • Customizable plan designs and funding options
  • No primary care physician (PCP) requirement
  • Wellness features and disease management programs
  • Simplified administration and hassle-free service

Contact your Cigna representative for more information.

Network Open Access
Network Open Access offers all of the benefits of an in-network only plan for cost conscious employers who need choice, convenience and flexibility. This product combines the quality of care from participating health care professionals with referral-free access to specialists. The benefits of choosing Network Open Access include:

  • No referral requirement
  • Encouragement of employees to see primary care physicians (PCPs)
  • Wellness features and disease management programs
  • Flexible plan design and funding options

Contact your Cigna representative for more information.

Network Open Access Point of Service
Our Network Open Access POS provides all of the benefits of a standard network plan and adds out-of network coverage for cost conscious employers who need choice, convenience and flexibility. The benefits of choosing Network Open Access Point of Service include:

  • No referral requirement
  • Encouragement of employees to see primary care physicians (PCPs)
  • Out-of network coverage at reduced benefit levels
  • Wellness features and disease management programs
  • Flexible plan design and funding options

Contact your Cigna representative for more information.

Network Point of Service
Network Point of Service offers out-of network coverage at reduced benefit levels. It's designed for cost conscious employers looking to provide greater access to care. The benefits of choosing Network Point of Service include:

  • Primary care physician (PCP) involvement that can result in early interventions and cost-effective outcomes
  • Referrals required to see a specialist
  • Out-of-network coverage at reduced benefit levels
  • Wellness features and disease management programs
  • Flexible plan design and funding options

Contact your Cigna representative for more information.

Access (Cost and Quality)

Cigna Care Designation
This Cigna program can help encourage employees to seek care from doctors in 18 specialties in 68 markets who meet additional standards for performance. Specialists must meet objective, evidence-based criteria that includes more than just claims data, using instead a wide range of external and internal evidence.

The benefits of the Cigna Care Network® include:

  • An innovative benefit design that can encourage employees to use specialty care doctors who achieve performance measures
  • Multiple levels of in-network benefits that can provide incentives to use Cigna Care-designated doctors. Employees pay a regular co-pay or coinsurance when they visit a Cigna-contracted specialist, but get lower co-pays or coinsurance levels to access care from a Cigna Care-designated doctor
  • Relevant information for employees on quality and performance
  • An estimated first-year claim cost savings of one to three percent1

Contact your Cigna representative for more information.

Cigna Centers of Excellence
We review how successful a participating hospital or facility is in treating 28 common conditions and procedures. Hospitals and clinics that deliver better health outcomes at affordable prices earn our top three-star rating. They are identified as Centers of Excellence in search results for hospitals. It's just another way we help employees make informed choices about health care.

Contact your Cigna representative for more information.

Cigna Collaborative Care

With Cigna Collaborative Care, we help make the right connections between doctors and patients. And we give doctors the information, insights and support to help provide the right care for the right value. We think that’s a better way to deliver care.

Cigna Collaborative Care incentivizes health care professionals to deliver the right care for the right value. It gives them more information, insights and support than ever before. It empowers them to deliver better outcomes. And that means better results for everyone.

We continue to evolve our collaborative care initiatives. We use a disciplined, rigorous and results-oriented approach that:

  • Is based on deep health care professional and customer insights. And real-world testing.
  • Builds on our experience collaborating and connecting with health care professionals to optimize performance.
  • Helps us meet customer needs wherever they get health care: large and small primary care physician groups, hospitals and different specialist groups.

 By working together more closely, we’re helping to improve quality, affordability and patient satisfaction.

Contact your Cigna representative for more information.

1The actual savings will depend on many factors including the difference in benefits between the Cigna Care designation tier and the in-network tier, market location and current claim patterns.

Pharmacy

Benefit Design Choices for Clients
Not only does Cigna show strong pricing during the sales and renewal process, we offer choices for coverage and access designed to lower total costs – the two levers used to control cost – during the plan design phase. Our suite of pharmacy programs provides the flexibility to select from options such as multiple drug lists (with three and four tiers) and national networks that exclude some of the most costly pharmacies. We offer preventive medication benefit choices such as waiving deductibles for preventive drugs and promoting use of preventive generic drugs with little or no customer cost share. Our integrated pharmacy clinical programs drive improved health outcomes and lower costs.

Cigna Home Delivery PharmacySM
Get prescriptions delivered directly to your door. Cigna Home Delivery PharmacySM offers valuable benefits, such as:

  • Licensed pharmacists available 24/7/365
  • Up to a 90-day supply of medications in one fill
  • Free standard, on-time delivery to your mailbox
  • Reminders if you forget to fill your prescriptions
  • Specialty medications, including those that require refrigeration and overnight delivery
Visit myCigna.com or the myCigna Mobile App* and use the Prescription Drug Price Quote tool to search for medications, view costs based on your plan and see lower-cost alternatives. The tool provides guidance on options you can discuss with your doctor and shows annual savings when you use Cigna Home Delivery Pharmacy**.

*The downloading and use of the myCigna Mobile App is subject to the terms and conditions of the App and the online stores from which it is downloaded. Standard mobile phone carrier and data usage charges apply.

**Prescription savings opportunities may not be available for some medications.

Rx Savings Messenger
Rx Savings Messenger educates customers about generic and lower cost preferred brands, as well as the benefits of filling prescription drugs through Cigna Home Delivery Pharmacy. It shows real-time pricing based on customers' pharmacy plans and can provide cost-saving solutions to cut down on the amount of mail sent to customers. Our health coaches also receive alerts for these opportunities, so that they can address them in their discussions with customers. 

Contact your Cigna representative for more information.


Clinical Programs to Help Improve Health Outcomes 

CoachRx
CoachRx can help customers stay adherent to their drug therapy. It assists them in overcoming barriers through condition education, refill reminders, incentives and coaching with pharmacists.

Complex Psychiatric Case Management Program
This program can help customers using multiple psychotropic drugs, as well as customers who are seeing a primary care doctor, rather than a psychiatrist. It involves integration with a behavioral intensive care management program and support from a Cigna behavioral psychiatrist.

Gaps in Care
Gaps in Care focuses on identifying adherence issues and other gaps in care for customers with specific chronic conditions. These gaps are addressed as part of our full spectrum of health coaching programs.

Medication Safety Management Program
This program addresses the potential inappropriate use of narcotics and other controlled substances. We offer doctors resources, including behavioral health, disease management and low back pain programs, and investigation support.

Contact your Cigna representative for more information.


Clinical Programs to Help Lower Pharmacy Costs

Clinical Edits

We offer flexibility for clients to choose their level of clinical management edits. This might include:

  • Benefit exclusion-enforces the limits of prescription drug benefits
  • Unit cost and utilization management-manages prescription cost and promotes cost-effective medication alternatives
  • Clinical appropriateness of use-promotes appropriate use of medications

Prospective and Concurrent Drug Utilization Review Edits
We offer a series of point-of-service screenings (for which claim protocols are consistently applied) to prevent risk and costly stock piling, including drug-disease interactions, drug-drug interactions, over and under use, therapeutic duplications, refill too soon, duplicate prescriptions, gender, age and pregnancy edits.

Step Therapy
Step Therapy is a program designed to help customers and their doctor find the most affordable and suitable medication for the treatment of a condition, one step at a time. Step Therapy requires that at least Step 1 medication be used before a Step 2 or Step 3 medication is eligible for coverage without prior approval.

Contact your Cigna representative for more information.

Dispensing Logic choices for clients that promote affordable generic medications Mandatory Generic logic - with this benefit, customers are required to fill with generics when a brand name medication has an equivalent generic. Pharmacists automatically substitute generics for brand name prescriptions.  However, if the customer or the healthcare professional request the brand, the customer will be required to pay a higher amount for the medication when they choose the brand.  This amount includes the applicable cost share for the brand, plus the difference in cost between the brand and generic medication. 

Patient Requests Brand / Member Pay Difference logic - guides customers to choose generics when a brand name medication has an equivalent generic, and their healthcare professional is not requiring the brand name medication.  This is Cigna's recommended dispensing logic. Pharmacists automatically substitute generics for brand name prescriptions unless a doctor specifies the brand is necessary. But some customers continue to request a brand name prescription even though their doctor approved the generic equivalent. If a customer requests the brand name medication instead of the generic, even though the doctor is ok with the generic, he or she may pay a higher amount for the medication. The customer typically pays the generic* copay/coinsurance plus the difference in cost between the brand name medication and the generic.

*Some plans may require customers to pay the brand copay plus the difference in cost between the brand name and generic cost.

Specialty Pharmacy Management
Individuals with Cigna Medical and Pharmacy coverage benefit from a holistic and seamless approach to managing their specialty condition.

Cigna offers a personalized, integrated approach for our customers who use our Exclusive Specialty Home Delivery Pharmacy. We enhance specialty pharmacy care with our full benefit connectivity across pharmacy, medical and other Cigna administered benefits.

Cigna provides total health care by driving affordability for our clients and customers on an individual basis to help them to achieve superior outcomes within each condition and therapeutic area.  Our strategic objectives are to drive affordability, improve health and optimize human performance through our strategy that aligns key stakeholders, provides actionable insights, engages our customers and health care professionals and delivers comprehensive support.

TheraCare®
The Cigna TheraCare® program delivers whole-person coaching through our teams that are made up of clinical pharmacists, health advocates with nursing backgrounds and support coordinators. They help improve patient safety, productivity, and increase adherence to care guidelines by monitoring side effects and drug interactions, reviewing lab values, helping with prior authorizations and collaborating with the treating doctor when adjustments are needed.  TheraCare coordinates with other Cigna health coaching programs.

Contact your Cigna representative for more information.

30-day limits on specialty medications
Specialty medication wastage can lead to higher costs. As a customer goes through therapy, his or her prescription may change, a new medication may come to market, the doctor may alter the dosing or he or she may experience side effects, all resulting in the need for a new medication. To reduce the costs associated with the potential wastage generated by a 90-day supply, Cigna's preferred approach is to limit specialty medications to a 30-day supply at retail and Cigna Home Delivery Pharmacy.

Contact your Cigna representative for more information on any of our pharmacy plan strategies to drive better plan affordability.

Seniors and Retiree Services

Seniors and Retirees
We offer a variety of group retiree health coverage options including Medicare Advantage plans (available with or without Part D prescription drug coverage), Medicare Supplement plans, Medicare Part D plans, retiree drug subsidy support services and more. Our account teams can make it easy to transition active employees into Medicare.

Contact your Cigna representative for more information.

Vision

Vision PPO
Cigna Vision adds value to any Cigna medical or dental plan. It provides both in- and out-of-network coverage through a large national routine vision network. It offers access to quality eye care professionals, claims processing, eligibility and customer service, and no-hassle administration. Cigna Vision is a great addition to any Cigna medical or dental plan. The benefits of choosing Cigna Vision include:

  • A wide range of benefit plans with options for funding (administrative services only and fully insured)
  • Voluntary offerings
  • A national, fully-credentialed network of eye care professionals, including national and regional retail opticals and private practice optometrist and ophthalmologist offices
  • Hassle-free administration, with one monthly statement, one eligibility file and one account manager for all your Cigna Healthcare products

Contact your Cigna representative for more information.

Global

Cigna Global Health Benefits® Group Medical Plans
Cigna Global Health Benefits offers your globally mobile employees and their dependents access to the health care benefits and services they need, wherever they are on assignment. Our customizable medical plans and health and well-being solutions can be tailored to meet the needs of your employees working globally, as well as to help meet your business objectives. Available to groups of two or more, our wide range of flexible, cost-effective health plan options help provide peace of mind to your employees in the global marketplace.

International Business Travel
Cigna Global Health Benefits understands that not all of your employees working in other countries are going to be there for a long time. Our short-term plans are designed specifically for employees on assignment in another country for two years or less.

Value-added products and services
Cigna Global Health Benefits helps you meet all the health care coverage needs of your global workforce. Any of our value-added products and services can supplement your group medical coverage to create a targeted, customized program that fits your business and your employees’ needs. Choose from a full range of options that can be added to your plan, including:

  • Pharmacy Management 
  • Dental Insurance  
  • Vision Insurance
  • Long-Term Disability Insurance
  • Life / Accidental Death and Dismemberment Insurance
  • Medical Evacuation/Repatriation Services
  • International Employee Assistance Program
  • Global Wellness Services

Insurance Products and Services for Globally Mobile Employees
No matter what you’re looking for in a global health care plan, Cigna Global Health Benefits has you covered.  We offer a range of flexible products that can be customized to meet the changing needs of your globally mobile employees and the objectives of your business. To learn more, please visit cignaglobalhealth.com

Medium Employers

Improve performance with the help of easy-to-use health benefit plans. Read about tailored services and flexible funding solutions.