Transcript Slide 1

Your Cigna Plans Open Access Plus (OAP) and
Health Savings Account (HSA)
Educational Service Center of Cuyahoga County
Effective July 1, 2013
balancing choice and convenience
Cigna
Open Access Plus
(OAP)
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Open Access Plus Plan Medical Plan
Choice and Convenience
• Your option to select a Primary Care Physician;
however we encourage you to have a relationship
with a doctor
• Save the most when you visit in-network doctors and
facilities
• Freedom to visit any licensed provider with no
referrals
• Access to a nationwide network of doctors and
hospitals
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
CHOICE
CONVENIENCE
a perfect balance
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Open Access Plus Copay Medical Plan
In Network Out-of-Pocket Costs
TYPE OF SERVICE
Copayment/Coinsurance
In-Network
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Deductible:
$300 Single / $600 Family
Out of Pocket Maximum:
$1,000 Single / $2,000 Family
(plan deductible does count towards OOP maximum – copays do not count)
Primary Care Physician visit:
$25 copay
Specialist visit:
$25 copay
Preventive Care Visits
No charge
In-patient hospital care:
10% charges after deductible
Out-patient hospital care:
10% charges after deductible
Emergency Room Copay:
$100 copay, then no charge
(waived if admitted)
• Urgent Care Copay:
$25 copay, then no charge
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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WHAT IS A HEALTH SAVINGS ACCOUNT (HSA) PLAN?
Qualified
Medical Plan
+
Health Savings
Account
=
Tax-advantaged
HSA Plan
• A tax-advantaged health plan that provides coverage for current medical/pharmacy
expenses with the option to save for future health expenses
• Combines a Qualified Medical Plan (medical/pharmacy coverage) with a Health
Savings Account
• You, your employer or both can contribute to the Health Savings Account
• Money put in the Health Savings Account is generally not taxable*
• You have investment options
* HSA contributions and earnings are not subject to Federal taxes and not subject to state taxes in most states. A few states
do not allow pretax treatment of contributions or earnings. Please consult your personal tax advisor or contact your plan
administrator for information about your state.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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HOW IS THIS DIFFERENT FROM A TRADITIONAL PLAN?
Your
Share
$1,000
HSA
(Employer
contribution)
$1,000
100% Preventive Care
(in-network)
Health
Plan
100% in-network
Deductible
$2,000
Different
• Lower premium but higher deductible
• Plan begins to pay after deductible is met; however, funds in
your Health Savings Account can be used to cover eligible
health expenses
• Amount can be used to pay the deductible
• Unused money rolls over to next year
Cigna HSA
Out-of-pocket Max
$2,000
Same
• Wide choice of doctors/hospitals
• Preventive care covered at 100%
• Plan begins to pay after deductible is met
• Covers routine, emergency and catastrophic care
• Plan pays percentage of bill for covered out-of-network care
• Plan pays higher percentage for covered in-network care
• Cigna receives bills, sends payment to doctors/hospitals
Unused $
rolls over to
next year
Employee Only Example
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Plan pays
100%
Deductible
$2,000
100% Preventive Care
(in-network)
Out-of-pocket Max
$2000
Deductible
Meet Karen
Single, in her 50s
Heart disease; controlling health through medication
HSA Deposits
$ 1,000
by Karen
$ 1,000
by Employer
$ 2,000 Total HSA Contribution
How Expenses Are Paid
$1,560 applied to deductible
$ 398 preventive care (covered by Plan)
$1,958 paid by Plan and Deductible
Preventive Care
$398
(covered 100% by Plan)
No cost to Karen
$1,560 What Karen Paid from HSA
$ 1,000
ER Visit
$ 320
4 PCP Visits
$ 240
Generic RX (12)
$ 1,560 medical expenses
Total = $1, 560
$2,000 in HSA
$1,560 Paid
$ 440 Rollover
$440
HSA Balance –
carried over to next
year
Contribution:
$1000 Employer + Employee $1000
= $2,000
Case example for illustrative purposes only, in-network.
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WHAT IS THE MAXIMUM I CAN CONTRIBUTE ANNUALLY TO THE HSA?
The IRS has set the following limits for 2013:
• Under age 55 and not enrolled in Medicare (based on a 12-month period):
2013
– Up to $3,250 individual coverage*
– Up to $6,450 family coverage*
• Age 55 or older:
– Maximum contribution increases by $1,000 (considered a “catch-up” contribution)
– Up to $4,250 individual coverage*
– Up to $7,450 family coverage*
• To make the maximum contribution in a calendar year, you must:
– Meet all requirements to be eligible for HSA contributions on January 1
– Remain qualified through December 1
– If these criteria are not met, maximum contribution is prorated = if 1/12 maximum contribution for
each month then individual is qualified
*Contributions to your HSA that you receive from your employer and incentives count toward your maximum.
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HOW ARE MY MEDICAL CLAIMS PAID?
Medical claim payment process
Sick visit to an in-network
doctor/hospital/facility.
Show Cigna Choice Fund ID card to
obtain Cigna discounted rates.
Cigna updates quarterly Health
Statement; sends email alert or mails to
your home, based on preference setting.
Cigna provides an Explanation of
Benefits or EOB (“receipt”) showing:
Doctor’s fee, Cigna discount, amount
billed, amount deducted from the HSA,
amount paid to doctor, remaining HSA
balance, and what you saved.
Doctor bills Cigna.
Cigna receives the claim and
processes it based on the HSAqualified plan deductible, covered
expenses and Cigna-negotiated
discounts.
If Auto Claim Forwarding was elected,
Cigna automatically subtracts the
amount owed to the doctor from your
HSA and pays the doctor.
If no Auto Claim Forwarding in place,
you have the option to pay the doctor
bill using your HSA (debit card/
checkbook) or pay out of pocket.
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AM I ELIGIBLE TO PARTICIPATE IN AN HSA PLAN?
Because HSA plans have special tax advantages, the IRS defines specific rules
for participation. To be eligible, you:
– Must be enrolled in an IRS-qualified high-deductible medical plan (high-deductible
medical plans sold with Cigna’s Choice Fund HSA meet IRS requirements)
– Cannot have any other health coverage
– Not covered by spouse’s medical or pharmacy plan
– Not covered through Medicare Part A or Part B
– Not covered through a general-purpose Flexible Spending Account (FSA) plan
(either employer’s or spouse’s)
– Cannot be claimed as a dependent on another person’s tax return
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JP Morgan Chase enrollment information
You will need to go to the intranet to open an account
• Before opening the account, JPMorgan Chase will:
– Verify your identity (required by the Federal government)
using information provided in the HSA application and
enrollment form
– Notify you if additional documentation is needed to verify
your name, social security number or address
– You can get a letter or a phone call from JP Morgan Chase
• JPMorgan Chase will send your HSA information and a debit
card within 7–10 days of the start of the plan year or the
verification of identity (whichever is later)
• ID cards are mailed from Cigna
• Debit cards are mailed separately
from JPMorgan Chase
JPMorgan Chase cannot open an HSA until it is able to
satisfy the requirements of the Federal government.
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WHAT ARE MY HSA SAVING AND INVESTMENT FEATURES?
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$2,000 minimum in HSA to invest
Once the investment account is open, no minimum balance applies
Several mutual funds to choose from
Investments can be put into one fund or multiple funds
No minimum deposit for any fund
Tax-free growth of interest or investment earnings*
Monthly fees apply
Online trading – no fees apply
Track your balance online or with convenient monthly statements
*HSA contributions and earnings are not subject to Federal taxes and not subject to state taxes in most
states. A few states do not allow pretax treatment of contributions or earnings. Please consult your personal
tax advisor or contact your plan administrator for information about your state.
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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CAN YOU HELP ME UNDERSTAND AND TRACK MY
HEALTH CARE EXPENSES?
24/7 online health account
management
• Review personalized plan
coverage
• Check available balances
• Track claims and payments
• Get HSA bank account
information
• Manage investment
accounts via link to
JPMorgan Chase
At-A-Glance
Account Summary
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Let’s do a
comparison
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Medical plan highlights
In-network
Open Access Plus (OAP)
Preventative Care
Deductible
Out-of-pocket maximum
Health Savings Account
contribution from employer
Lifetime maximum
Health Savings Account (HSA)
Single
Family
Single
Family
No charge
No charge
No charge
No charge
$300
$600
$2,000
$4,000
$1,000
$2,000
$2,000
$4,000
n/a
n/a
$1,000
$2,000
Unlimited
Unlimited
Unlimited
Unlimited
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Pharmacy plan highlights
In-network
Open Access Plus (OAP)
Retail
(30 day supply)
Generic
Cigna-preferred brand
Non-preferred brand
You pay $15
You pay $35
You pay $55
Health Savings Account (HSA)
Mail Order
(90 day supply)
Retail
(30 day supply)
Mail Order
(90 day supply)
You pay $30
You pay 100% of drug
cost until the deductible
is met – after the
deductible is met then
plan pays 100%
You pay 100% of drug
cost until the deductible
is met – after the
deductible is met then
plan pays 100%
You pay $70
You pay 100% of drug
cost until the deductible
is met – after the
deductible is met then
plan pays 100%
You pay 100% of drug
cost until the deductible
is met – after the
deductible is met then
plan pays 100%
You pay $110
You pay 100% of drug
cost until the deductible
is met – after the
deductible is met then
plan pays 100%
You pay 100% of drug
cost until the deductible
is met – after the
deductible is met then
plan pays 100%
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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helpful
resources
the information you need
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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CAN YOU HELP ME UNDERSTAND AND
TRACK MY HEALTH CARE EXPENSES?
Explanation of Benefits (EOB)
Quarterly Health Statement
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Clearly shows how and when claims were
paid, and by which plan and/or account(s)
Available in print or online at myCigna.com
Choose if you would like EOBs mailed to your
home, or go paperless and receive email
alerts after each claim is processed and
posted to myCigna.com
•
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
Available online at myCigna.com
You will be alerted by email after each
statement is posted to myCigna.com
Shows year-to-date deductibles, all
claim activity and out-of-pocket
expenses for that quarter
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CAN YOU HELP ME UNDERSTAND AND TRACK MY
HEALTH CARE EXPENSES?
24/7 customer phone assistance
• One toll-free number – on the back of the
ID card and debit card
• Specially trained Customer Service
Representatives answer questions about:
– Medical and pharmacy benefits and claims
– HSA IRS requirements
– HSA transaction activity and balance
– Live transfer to JPMorgan Chase for
specialized activity (investments, lost debit
card, debit card transaction questions)
– Help with the tools and resources available on myCigna.com
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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SO MANY WAYS TO CONNECT WITH CIGNA.
Cigna.com
• Simple to navigate
• Find what you’re looking for, quickly
and easily
WHENEVER. WHEREVER.
myCigna.com
• Personalized
• Easy access to doctor and facility
searches, cost and quality of care
and more
24/7/365 live phone service
• Around-the-clock
customer service
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Interactive Voice Response (IVR)
• New “natural language” system
recognizes over 150 languages
and dialects
Expanded Cigna mobile
• All Cigna sites available via any
web-enabled mobile device
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FIND DOCTORS AND SERVICES
• Search for a health care professional
in Cigna’s national network
• Valuable quality-of-care ratings
• Easily navigate using consumer-friendly
language, not jargon
• Access maps for driving directions right
from your smartphone
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Programs
for you
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Your Health First
Resources for members with chronic conditions
Educational materials, self-care tools, support and information for the
following conditions:
– Asthma
– Heart Disease
– Coronary Artery Disease
– Angina
– Congestive Heart Failure
– Acute Myocardial Infarction
– COPD (Emphysema and Chronic Bronchitis)
– Type I & II Diabetes
– Metabolic Syndrome
– Peripheral Arterial Disease
– Low Back Pain
– Osteoarthritis
– Depression
– Anxiety
– Bipolar Disorder
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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Lifestyle Management Programs
CIGNA Healthy Steps to Weight Loss, CIGNA Quit Today and Stress & Resilience
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Call 1.866.417.7848 or visit www.mycigna.com to enroll
Designed to help you set and manage your goals
Scheduled one-on-one calls for ongoing support and goal-setting
Online program participation available
Set Personal Healthy Living Plan
Dedicated Health Coach
Workbook and Toolkit
Weekly educational emails with key learning themes and tips*
* - If participate online
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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Helping you stay healthy.
Cigna Healthy Rewards®
Discounts on a full range of health and wellness programs and services*
• Eye care – exams, frames and lenses,
laser vision correction
• Jenny Craig®
• Smoking cessation programs
• Hearing care
• Fitness club memberships
• Alternative medicine – acupuncture,
chiropractic care, massage therapy
• Mind/body – Yoga Journal and SpaFinderTM
and much more
*Healthy Rewards is a discount program. Some Healthy Rewards programs are not available in all states. A discount program is NOT
insurance, and the customer must pay the entire discounted charge.
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CIGNA HealthCare Healthy Babies
– Voluntary prenatal education
– Helpful informational materials from
the March of Dimes®
– Toll free, round-the-clock
access to information
and support from registered nurses
– Post-delivery support
and service
Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna
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Q&A
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