800682a member kit final for pdf - international sos · please take a few moments to review all of...

C I G N A I N T E R N A T I O N A LE X P A T R I A T E B E N E F I T S ®

Member Benefits

www.cigna.com/expatriates

800682a 11/06

800682a Member Kit FINAL for PDF 11/9/06 10:13 AM

CIEB Members and Your Covered Family Members

CIGNA International Expatriate Benefits (CIEB) is pleased to have beenselected as your health care benefits provider while you are living andworking outside your country of citizenship. Your satisfaction is veryimportant to us, and we have developed many specialized health careservices tailored just for you and your covered family members, whetherthey are with you on assignment or not.

Please take a few moments to review all of the services we offer, described in this Member Information Kit. You and your covered family members have all the advantages of our services available to you whenever you need them, wherever you are in the world. We offer:

24-Hour Access to Customer Service: It’s important for you to be able to reach us anytime from your location, so we offer 24-hour free telephone and fax service to our International Customer ServiceCenter, as well as secure email communication. (If free telephone is notavailable from your location, please call us collect.)

Health Care Answers and Access: While you’re on assignment,your health care questions are likely to be different than when you’re athome, and the answers may be too! For instance, if you’re experiencingsymptoms, our International Customer Service Representatives will immediately connect you with a regional coordinating doctor experiencedin international medicine and knowledgeable about providers in yourlocale. You will be referred to a medical provider based on your symptomsand location.

Shortly, you will receive your permanent ID card to take with you wherever you go. In the meantime, our service representatives are alwaysavailable to you and to providers for verification of eligibility and/or benefit questions.

Providing international health care benefits to you and your covered family members is our only business. Keep this kit in a convenient location at home or at work, to review all the services available to you.And remember, we’re always only a free phone call, fax, or email away.

Promoting the right care, in the right place, at the right time.SM

Welcome


800682a Member Kit FINAL for PDF 11/9/06 10:13 AM

Call the toll-free

(free line) phone

number on your

ID card or

1.800.441.2668

Free fax

1.800.243.6998

TABLE OF CONTENTS

2 How to Contact Us –

Anytime, Anywhere

3 How the International Customer

Service Center Can Help You

4 CIEB Member Web Site


5 Choosing a Provider

Network and Alliance Providers

6 Global Health Solutions

Health Services and Wellness

8 Using Your CIGNA

International ID Card

8 Your Eligibility

8 Enrollment Change Form

9 Claims Processing

10 Payment Options

11 Important Facts About Your

International Health Coverage

12 Glossary of Terms

800682a Member Kit FINAL for PDF 11/9/06 10:13 AM Page 1

2

HOW TO CONTACT US – ANYTIME, ANYWHERE

Free Telephone Call the toll-free (free line) number on your ID card or 1.800.441.2668(If dialing internationally, use that country’s AT&T Direct® access number.)

Direct Telephone 1.302.797.3100(call collect)

Free Fax 1.800.243.6998(If dialing internationally, use that country’s AT&T Direct® access number.)

Direct Fax 1.302.797.3150

Mail Delivery CIGNA International Expatriate BenefitsP.O. Box 15050Wilmington, DE 19850-5050 USA

Courier Delivery CIGNA International Expatriate Benefits590 Naamans RoadClaymont, DE 19703 USA

CIEB Member Web Site www.cigna.com/expatriatesRegistration required. (See page 4 for registration information.) Secure email available at this site.


HOW THE INTERNATIONAL CUSTOMER SERVICE CENTERCAN HELP YOU

What if…■ You become ill while on assignment

and need expert clinical advice and professional support locally, or

■ You need a referral or recommendation to a local provider, or

■ You have a question regarding how to filea claim or the current status of a claim, or

■ You need a guarantee of payment for ahospital before it will accept you for treatment, or

■ Your doctor needs to verify your eligibilityand benefits, or

■ You have a medical emergency and need afamily member to travel to your location,quickly, or

■ You need to have a prescription filledfrom your assignment location.

Call our International CustomerService Center free, 24/7/365Our representatives are trained to immediatelyidentify who can best help you, whether it’s a medical emergency, expert advice, professional support, a lost claim or even alost passport. We can also issue a guaranteeof payment for a hospital. It’s just part ofwhat we do, all day, every day.

AT&T Direct® access numbersAT&T Direct access numbers make it easyand convenient to call Customer Service.AT&T Direct access is available in manycountries of the world. However, if you are on assignment in one of the few countries where AT&T Direct access is not available, please call us collect through the international operator.

AT&T publishes a foldable wallet guide in .pdf format. You may download thisguide from the AT&T Web site:www.att.com/traveler.

Call the toll-free

(free line) phone

number on your

ID card or

1.800.441.2668

Free fax

1.800.243.6998

3

“Since the accident, I have found CIEB,

and especially (nurse case manager),

to be exceptionally easy to deal with, very

responsive and thoroughly professional in all aspects.”


CIEB MEMBER WEB SITEwww.cigna.com/expatriates

Registering for the site:Once you receive your CIGNA InternationalID card, it’s easy to register online forunlimited access to the CIEB Member Website. With your ID card handy, enter the site (www.cigna.com/expatriates) and clickon the Member Login Page. Follow the registration instructions on this page.

When finished, click where indicated to submit your registration information. Thenext screen will notify you that a temporaryPIN has been successfully generated (or you will receive an error message andinstructions to correct the error).

You will be instructed to copy and pasteyour temporary PIN into the Login screen.You must also re-enter your 9-digit MemberID at the Login screen.

The following screens, which are secure,allow you to enter account security information, your email address, and create your own personal password forfuture access. (Please retain your password in a secure location offline.)

Features available at the site:Once you’re in the site, you’ll find lots of features only a click away, improvingyour access to quality health care anytime,anywhere. Take a look at the directories and services available to you:■ The International Provider Directory;■ The CIGNA Preferred Provider Directory

(for the U.S. and Puerto Rico);■ Country Guides;

■ Health and Wellness Resources, includinglinks to CIGNA-managed Web sites suchas myCareAllies.com; plus

■ Links to other important directories andservices, such as the CIGNA PharmacyManagement Network in the U.S. and its territories.

At the site, you have the ability to reviewyour claims, payment information and current eligibility, as well as to update your personal information.

Did you knowAt our Member Web site, you can:

• Download claim forms in any of more than a dozenlanguages, including Hindi and Arabic

• Email your completed, scanned claim form and supporting documentation directly to Customer Service

• Review your claims history

• Check the status of your current claims(refreshed daily)

• Check your enrollment status and plan details

• Update your personal information

• Search for general, cultural, medical and other pertinent information on more than 190 countries in the world

• Search for prescreened, quality providers in your locale

• Access a comprehensive Health and Wellness database at the site

• Check network pharmacies in the U.S. and its territories

4

“We are all here safe and well withminimum stress on the trip over…

All in all, a job well done, so thanks a lot for your

help and support.”

800682a Member Kit Inside 11/20/06 11:29 AM Page 4

You also have secure messaging, the most convenient means to send us your health care claims and to communicate via email with CIEB Customer Service. (We highly recommend always using securemessaging to send us an email. It’s easier,faster, and of course, confidential.)

We encourage you to register for the site and provide your email address at registration. We will then be able to sendyou service updates, online newsletters and secure email communications.

CHOOSING A PROVIDER Network and Alliance Providers

We recommend you establish relationshipswith primary health care providers in yourlocation in advance of requiring care. That’swhy we created the International ProviderDirectory and make it easily accessible toyou and all of our members through theMember Web site. ■ If you haven’t yet established a relationship

with a health care provider and are experiencing symptoms, call CustomerService. Our representatives will connectyou directly with a knowledgeable international doctor. You’ll receive a telephonic medical assessment and bereferred to the most appropriate providerbased on your condition and location.

■ Additional provider referrals, includingspecialists, can be obtained by callingCustomer Service for access to a databaseof quality, prescreened providers worldwide.

As a member of CIEB you may go toany hospital, clinic, doctor or dentistworldwide, unless your specific plan of benefits requires that you use a network provider.

Resources for identifying preferred providers1.CIEB’s International Provider Directory

■ Access to more than 3,200 prescreeneddoctors, dentists, hospitals and clinics in800+ locations worldwide.

■ Access to the Directory at the MemberWeb site or by placing a free phone call to our International Service Center, 24/7/365.

2.CIGNA’s Preferred Provider Directory in the U.S. and Puerto Rico

■ Access to CIGNA’s comprehensive networkof prescreened doctors and dentists, hospitals and clinics.

■ Access to the Directory at the MemberWeb site or by placing a free phone call to our International Service Center, 24/7/365.

3.CIGNALinks® Alliance Provider Networks

■ CIGNALinks enhances our existing globalservices in selected countries throughout the world. CIGNA International has integrated its global medical plans withthe administrative services and preferredprovider networks of leading local administrators.

Your employer will inform you if you are able to benefit from CIGNALinksdiscounted network services while you’re on assignment. CIGNALinks is currently available in more than 12 countries in the world.

You will receive a separate Member Kit andin some instances a separate ID card to takeadvantage of in-country health care servicesand discounts.

■ Access to the CIGNALinks ProviderDirectories at the Member Web site or by placing a free phone call to ourInternational Service Center, 24/7/365.

Call the toll-free

(free line) phone

number on your

ID card or

1.800.441.2668

Free fax

1.800.243.6998

5

800682a Member Kit Inside 11/13/06 3:30 PM Page 5

GLOBAL HEALTH SOLUTIONS Health Services and Wellness

With CIEB as your access to health care, youhave entered a world of specialized servicesunmatched by any other international benefitsprovider. Known as Health Services andWellness, these services are designed to giveyou answers and access to quality healthcare wherever you are in the world.

CIEB is the only expatriate insurance carrierwith a full-time medical director and staff of nurses with international experience. This in-house expertise is fully integratedwith a worldwide network of more than3,000 clinical professionals at regional centers throughout the world.

Emergency transportationWhen you have a medical emergency thatcannot be treated appropriately in yourlocation, CIEB pays for emergency groundtransportation to the nearest health carefacility able to handle your case. If youexperience such an emergency, we stronglyurge you to contact Customer Service, toassure you get the emergency care you need through a qualified coordinating doctor in your locale.

CIEB’s standard policy does not cover emergency medical evacuation to anothercountry. However, your employer may haveelected to provide optional evacuation aspart of your benefits. Please check with yourbenefits representative or plan administratorto determine your company’s coverage foremergency evacuation and repatriation.

Hospital admissions■ If you or a covered family member is

admitted to a hospital within the U.S.through the emergency room, you need to contact us within 48 hours.

■ For a non-emergency in the U.S., youneed to contact CIEB before the admissionto obtain pre-admission certification.

■ In other worldwide locations, you do not need to contact CIEB for hospitaladmissions. You may go to any hospital atany time. (For prepayment of charges, refer toDirect Settlement with Providers on page 9.)

myCareAllies.comThrough this interactive health informationportal at the CIEB Member Web site, youhave access to CIGNA’s Healthy Rewards®

discount programs, Smart Health topics, a drug interaction tool, local and nationalsupport groups, an online smoking cessationprogram, and other helpful information.

e-Cleveland Clinic expert second opinionsWe have teamed up with the world-renowned Cleveland Clinic to offer onlineexpert second opinions to our memberswith life-threatening or life-altering diagnoses. Each opinion is provided by aCleveland Clinic doctor who specializes in the condition. Further support includestelephonic consultation and secure emailcommunication with a nurse.

(For more information on e-Cleveland ClinicExpert Second Opinions, refer to the flyer in theback pocket or visit our Member Web site.)

6

Did you knowAll Global Health Solutions services are available to you whenever you need them, directly through Customer Service:

• Immediate telephonic access to professionally directed medical advice and consultation

• Global medical and dental referrals, anytime, anywhere

• Appointment and admission assistance (outside the U.S.)

• Medical monitoring and case management

• Concierge and travel assistance services

In addition, our Health Services and Wellness clinical staff isdedicated to assuring that you receive quality health careservices and follow-up care for as long as you need it:

• Coordination of medically supervised evacuations/repatriations

• Return-to-assignment coordination of treatment plans

• Expert second opinions through our exclusive agreementwith The Cleveland Clinic

• Provider referrals for emergency care or to establish a local relationship with a doctor

• Emergency prescription replacement/transfer from yourlocation outside the U.S. (where legally permissible)


Call the toll-free

(free line) phone

number on your

ID card or

1.800.441.2668

Free fax

1.800.243.6998

International EAPYour employer may have purchased anInternational Employee Assistance Program(I-EAP) for all its international employeesand eligible family members. If so, you will have access to telephonic behavioralcounseling toll free from your location.

(If your employer has elected International EAP,refer to the flyer in the back pocket or visit ourMember Web site.)

Concierge and travel assistance servicesCIGNA International Expatriate Benefits hasConcierge and Travel Assistance Services foryou and your covered family members.Knowing help is only a phone call away inan emergency – wherever you are – providesthe peace of mind you need while livingand working outside your home country.

(For more information on Concierge and TravelAssistance Services, refer to the flyer in the backpocket or visit our Member Web site.)

CIGNA Pharmacy Management If your employer has purchased CIGNAPharmacy Management coverage, then you have several options for obtaining prescription medicines:■ Ask your doctor for a one-year prescription

for medications you take routinely. Takethis supply with you on assignment. Orderrefills as needed on return trips home.

■ If you need medications while on assignment (new or refills), call CustomerService and ask for information onwhether your medication is available in your location.

Customer Service will transfer you immediately to a regional coordinatingdoctor. If the medicine is available, thedoctor will refer you to a local providerwho will prescribe.

■ If a prescribed medication is not availablein your assignment country, contact us forassistance in ordering and shipping.

Retail pharmacies in the U.S.■ You always have access to the CIGNA

Pharmacy Management network of manythousands of pharmacies in the U.S. and its territories. Prescription medicinesare offered at significant discounts at network pharmacies.

Mail order pharmacy in the U.S.■ CIGNA Tel-Drug® mail order pharmacy

is a convenient means to receive medications when you are in the U.S. or its territories.

■ By law, Tel-Drug prescription medicinesmust be shipped to an address in the U.S. or its territories, or to an APO/FPOaddress.

(For more information on CIGNA PharmacyManagement and Tel-Drug services, refer to the flyer in the back pocket or visit our Member Web site.)

7

“It is not too often in life thatone tests the real performance

of a health plan… We have been really

pleased and I have passed this on to (my employer).”


USING YOUR CIGNA INTERNATIONAL ID CARD

Carry your CIGNA International ID cardwith you wherever you go.

When you receive your permanent ID card:■ Verify that your information is correct.■ Call our International Customer Service

Center if something needs to be changed. ■ Present your CIGNA International

ID Card whenever you receive servicesfrom a provider.

■ If you need assistance in paying for healthcare services, don’t hesitate to contact us.Each year CIEB makes thousands of payments directly to internationalproviders. We offer direct payment withthe most wide-ranging provisions of anyglobal insurer, extending to doctors and dentists – not just hospitals.

■ We also offer ‘real-time’ guarantees of payment to virtually all types of healthcare providers and facilities, freeing youfrom an up-front financial burden whenwhat you really want and need is qualitycare. Acceptance of these guarantees ofpayment from CIEB to hospitals, clinics,doctors and dentists is nearly 100%.

■ Providers also may call our multilingualCustomer Service staff at any time to verify your coverage.

Use your ID card as your passport tohealth care wherever you are in the world.

YOUR ELIGIBILITY

Your employer has requested that you provide detailed information on yourselfand your eligible family members, includingfull name(s), current address(es), and emailaddress (if you have one). We need thisinformation to process and pay your claims.You may review it for accuracy on theMember Web site.

Please notify your employer if you need toupdate your address information. Your HRrepresentative will inform CIEB by secureemail. You may also update your personalinformation at the Web site:www.cigna.com/expatriates.

ENROLLMENT CHANGE FORM

Notify your company’s international benefits representative or plan administratorwithin 31 days if your family status changes.

Your employer needs to submit a newEnrollment Change Form with additions and change data to CIEB via secure email.Status changes may include marriage,divorce or legal separation; birth, adoptionor death of a family member; a change in your spouse’s employment status or a significant change in your spouse’s benefits.■ Please check with your plan administrator

for your company’s specific policies andguidelines.

8

“I would hope that anyone who suffers any kind of illness,

extreme or otherwise, whileworking outside of their home

country, has the good fortune to have the CIEB

(clinical) team on their side.”



Call the toll-free

(free line) phone

number on your

ID card or

1.800.441.2668

Free fax

1.800.243.6998

CLAIMS PROCESSING

Direct settlement with providers As a service to our members, we have thousands of providers around the worldwho accept direct settlement arrangementsfor claims, and many of these offer signifi-cant discounts to our members and CIEB.Inform your doctor that you have insurancecoverage that pays directly, quickly, and inlocal currency. We will even wire transferdirectly to the provider’s bank account, ifthis is preferable.

In addition, CIEB will guarantee payment to any network provider directly in the currency of their choice in advance of yourtreatment. This also eliminates the need for a claim.

You will not need to file a claim form ifyour provider accepts direct payment.

To initiate the direct payment process, askyour doctor or hospital to contact CustomerService by calling our free telephone number (or calling collect). You may also sign the appropriate section of your claimform authorizing direct payment to a doctoror a hospital following treatment.

Other than direct settlement with providersor guaranteed payment of claims, yourCIEB health coverage requires that you file aclaim form for a health care visit in order toreceive reimbursement. This form providesus with important reimbursement instructions,such as where to send reimbursement, typeof currency, method of reimbursement(check, EFT, direct mail deposit, etc.).

Once you have received treatment, eitheryou or your provider need to fill out a claim,then sign, date and submit it to us, alongwith itemized bills.

Filing claims inside the U.S.When you go to a provider in the CIGNA Preferred Provider Organization (PPO) in the U.S., no claim form is required. A non-network provider may ask you to pay for services; then you must submit a claim to us for reimburse-ment. Although some non-network providers in the U.S. will bill us directly, we encourage you to take advantage of network providers whenever possible, for optimum discounts.

How to submit a claimObtain a CIGNA International claim form.(There is one standard form for medical, dental and prescription claims.)■ Use the English claim form included in

this Member Information Kit■ Download a form in any of more than 12

languages directly from the CIEB MemberWeb site (www.cigna.com/expatriates), or

■ Call the International Customer ServiceCenter for a claim form in any languageto be faxed, mailed or emailed to you, ifyou’re a registered user of our Member site.

The most efficient means of submitting yourclaim to us is scanning and emailing directlyto Customer Service via our Member site.

If you choose to submit the claim by fax,use our international free fax: AT&T Direct® access number +1.800.243.6998, or direct fax 1.302.797.3150.

If you prefer to send your claims via international mail or carrier, please realize that mail may result in delays, or worse, loss of documentation. (Alwayskeep copies of your claims and supporting documentation.)

Tips to expedite claim processing:■ Fill out your claim form completely

(an incomplete form may delay processing).■ Separate claim forms must be completed

for each family member. ■ Provide a diagnosis or explanation of

treatment on the claim form.■ State how and where you want the

reimbursement issued.■ Email or fax your form instead of mailing it.■ Save copies of your bills, receipts and

claim forms.■ Clearly state where you want your

reimbursement issued and by whatmethod.

We process and distribute reimbursementchecks from strategic operations centerslocated in the U.S., Ireland and Singapore,which streamlines the reimbursementprocess and allows payments to reach youmore quickly.

9


Did you know• The most efficient means of submitting your claims to

us is scanning and emailing directly to Customer Servicevia our Member Web site.

• You may also fax your claims directly to us through our free fax number. Just be sure to check that your fax transmits successfully.

• CIEB is able to pay you or a provider within 10 days or less from receipt of your claim – for more than 90 percent of claims received.

• Guarantees of payment for large claims are typically accepted for more than 95 percent of claims worldwide. (Call Customer Service, or ask your provider to call us at our free number to ask about CIEB’s guarantee of payment service.)

• Claims must be submitted within 18 months fromdate of service.

PAYMENT OPTIONS

CIEB offers a variety of convenient paymentmethods:

ePayment PlusSM

ePayment Plus* is a robust, integrated andaccurate process that includes automatic email notification of payments directly into a bank account* you maintain in agiven country, regardless of where you areon assignment. You can quickly and easily self-enroll in ePayment Plus at our secure Member Web sitewww.cigna.com/expatriates.

ePayment Plus complements the existingarray of electronic payment options, such aswire transfer and Electronic Funds Transfer(EFT), available in the U.S. After you enrollin ePayment Plus, charges often applied byyour bank, such as for wire transfers, areremoved or minimized.

*For a listing of current countries acceptingePayment Plus, refer to the flyer in the backpocket or visit our Member Web site.

Direct depositWe will direct deposit reimbursementcheck(s) or wire transfer into your U.S. bank account:■ Complete the information on the front

of your claim form and be sure to specifythe currency type and bank account information.

Direct check paymentWe will also directly pay claims in U.S. dollars or local currency to the address youindicate on your claim form.

Wire transfer to a bank outside the U.S.Your claim reimbursement(s) may also besent via wire transfer to your bank accountoutside the U.S. Please contact CustomerService for additional instructions forrequesting a wire transfer.

In order to have a claim paid by wire transfer in local currency, the minimumamount is $100 U.S. equivalent. (You maywish to hold your claims until they exceed thisamount.)

Reimbursements in local currencyYou have the option of receiving paymentin a variety of currencies:■ U.S. dollars■ Your home country currency■ Your host country currency■ Currency of the country in which you

received medical or dental services.

Note: If your doctor requires payment in local currency, please indicate this on your claim form.

10


Call the toll-free

(free line) phone

number on your

ID card or

1.800.441.2668

Free fax

1.800.243.6998

Explanation of Benefits mailed and/orviewed onlineRegardless of the payment method youchoose, you can view your Explanation ofBenefits statements (EOBs) on the secureMember Web site. Currently, we are sendingpaper EOBs as well, but over time thisoption will be phased out for members whorequest online access to EOBs.

Workers’ compensation claimsIf you are unsure where to send a work-related claim, please contact your employer’sinternational benefits representative or planadministrator. Work-related claims are typically reimbursed by a Workers’Compensation fund or plan, and not by CIEB.

IMPORTANT FACTS ABOUT YOURINTERNATIONAL HEALTH COVERAGE

Your CIEB medical coverage reimburses the reasonable and customary charges formedically necessary care, according to thenorms in the country where you receivedcare. CIEB has many years of experience in this field and generally can determineappropriate charges without significant delays.

Some expenses are not covered; for instance,experimental treatments are generally not covered. There also may be dollar maximums (also called ‘caps’) or treatmentunits for some services. If you have a question about a specific treatment, contactCustomer Service to inquire about your specific plan of benefits, refer to your plan certificate booklet, or contact youremployer’s plan administrator.

If your employer has opted to include dental coverage as part of your benefits:■ We encourage you and your family to

obtain regular preventive care and possibly avoid major restorative treatment.

■ We provide coverage for dental services when dental problems occur.

■ You have the freedom to choose any licensed dentist.

Note: Our dental coverage reimburses reasonableand customary charges for routine dental examsand medically necessary care, but not for cosmetic work.

Once you reach the calendar year maximumin your dental plan, expenses will not be covered for the remainder of the year. If youhave a question about a specific treatment,contact Customer Service.

Inherent advantages of your CIGNA International ID cardCIEB has offered members and theirdependents coverage for more than 25years. The CIGNA International card is recognized worldwide by major hospitals.

Remember, our experience and the card’srecognition enable us to offer direct reimbursement to hospitals and clinics, and many other services while you are on assignment.

11

“I’d like to thank you for callingme in (my assignment country)and for offering your assistance

in facilitating medical andfinancial arrangements

for my (spouse).”


GLOSSARY OF TERMS

In the glossary below, we define many of the terms you’ll find in your Explanationof Benefits (EOB).

■ Benefit Amount: The amount paid to you or your provider. You may have tosatisfy a deductible (see below), and youmay also be responsible for copayments or coinsurance.

■ Coinsurance: The portion of eligibleexpenses that plan members are responsible for paying, most often after a deductible is met.

■ Copayment (copay): Amount that a plan member must pay the provider at the time of service, usually after thedeductible is met for eligible expenses.

■ Covered Charges: Those charges whichare considered medically necessary and which are within the terms and conditions of your benefit plan.

■ Deductible Amounts: This is the amountof covered expenses that must be paid byyou before the plan pays any benefit.

- Individual Deductible: Once a covered individual meets this threshold, the plan will begin to pay benefits for covered expenses incurred by that individual.

- Family Deductible: Once a family meetsthis threshold, the plan begins to pay benefits for all covered individuals in thefamily, whether or not that individual has met the individual deductible. Your plan may require that a specified numberof individuals satisfy deductibles before the family deductible is met.

■ In-Network and Out-of-NetworkProviders: These terms describe CIGNA’sdiscount arrangements with doctors, dentists, hospitals and clinics in the U.S.and in CIGNALinks® countries as well. In-network providers offer discounts forhealth care services both to you and youremployer. Often, network providers allowcashless settlement of claims at the pointof care. Out-of-network providers do notaccept CIGNA discounts for services andmay require that you pay for services atthe point of care. Also, keep in mind that if you choose a doctor who does not participate in our network, your out-of-pocket costs may be higher. (Note: As a member of CIGNA International,you may go to any provider you choose

worldwide, unless your plan of benefitsrequires that you use an in-network provider.)

■ Last Year Carry-Over Totals: This is thepart of the deductible satisfied during thelast three months of the previous calendaryear (October, November, December), whichmay be applied to the deductible for thecurrent year.

■ Lifetime Maximum: This is the maximum amount that the coverage will pay for all conditions for each covered individual.

■ Medically Necessary: To be covered, allmedical and surgical services, supplies and treatment must be deemed necessaryfor the health needs of the patient by aqualified provider.

■ Out-of-Pocket Maximum: This is themaximum amount of covered expensesyou would have to pay out of your ownpocket before most plan benefits arepayable at 100 percent:- Individual Out-of-Pocket: This is the amount each member must pay at the coinsurance rate before most benefits are paid at 100 percent. Note: If the family out-of-pocket maximum has been met, the individual out-of-pocket does not apply to the individual.

- Family Out-of-Pocket: This is the amount all covered members as a whole will pay atthe coinsurance rate before most benefits are paid at 100 percent. Your plan may require that a specified number of individuals satisfy their individual out-of-pocket limits.

■ Reasonable and Customary (R&C)means the charge is within the usualrange of charges in the location for similar services provided to people who have similar medical conditions.

12

800682a Member Kit Inside 11/13/06 3:35 PM Page 12

Promoting the right care, in the right place, at the right time.SM


Making a worldof difference®

The information herein is believed accurate as of the date of publication and is subject to change. This material is intended for informational purposes only and contains only a partial and general description of benefits. CIEB recommends that you examine your policy in detail to be certain of precise terms, conditions and coverage. Coverage andbenefits are available except where prohibited by applicable law.

“CIGNA” refers to CIGNA Corporation and/or one or more of its operating subsidiaries. CIGNA International and CIGNA International Expatriate Benefits (“CIEB”) refer to these operating subsidiaries and affiliates. Products and services are provided by these operating subsidiaries, affiliates and other contracted companies and not by CIGNA Corporation.“CIGNA” is also a registered service mark.

800682a 11/06 © 2006 CIGNA


800682a member kit final for pdf - international sos · please take a few moments to review all of...

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