your cigna plans - open access plus (oap) and health savings account (hsa) educational service...

Your Cigna Plans - Open Access Plus (OAP) and Health Savings Account (HSA)

Educational Service Center of Cuyahoga County

Effective July 1, 2013

2Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna

Cigna

Open Access Plus

(OAP)

balancing choice and convenience


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

a perfect balance

CHOICE CONVENIENCE


Open Access Plus Copay Medical PlanIn Network Out-of-Pocket Costs

TYPE OF SERVICE Copayment/Coinsurance In-Network

• 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


WHAT IS A HEALTH SAVINGS ACCOUNT (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

+ =Qualified Medical Plan

Tax-advantagedHSA Plan

Health Savings Account

* 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.


HSA(Employer

contribution)$1,000

Your Share$1,000

HealthPlan100% in-network

100%

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Unused $rolls over to

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Employee Only Example

Cigna HSA

HOW IS THIS DIFFERENT FROM A TRADITIONAL PLAN?

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

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


Meet Karen

Single, in her 50s

Heart disease; controlling health through medication

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ax$2

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Deductible$2,000

Plan pays 100%

10

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Ded

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Contribution:$1000 Employer + Employee $1000 = $2,000

HSA Deposits $ 1,000 by Karen $ 1,000 by Employer $ 2,000 Total HSA Contribution

Preventive Care $398(covered 100% by Plan)No cost to Karen

$ 1,000 ER Visit $ 320 4 PCP Visits $ 240 Generic RX (12) $ 1,560 medical expenses

Total = $1, 560

Case example for illustrative purposes only, in-network.

How Expenses Are Paid$1,560 applied to deductible$ 398 preventive care (covered by Plan)$1,958 paid by Plan and Deductible

$1,560 What Karen Paid from HSA

$2,000 in HSA$1,560 Paid$ 440 Rollover

$440HSA Balance –

carried over to next year


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.


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.

Sick visit to an in-network doctor/hospital/facility.

Show Cigna Choice Fund ID card to obtain Cigna discounted rates.

Doctor bills Cigna.

Cigna receives the claim and processes it based on the HSA- qualified plan deductible, covered expenses and Cigna-negotiated discounts.

If Auto Claim Forwarding was elected, Cigna automatically subtracts theamount 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 doctorbill using your HSA (debit card/checkbook) or pay out of pocket.

HOW ARE MY MEDICAL CLAIMS PAID?

Medical claim payment process


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


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.


WHAT ARE MY HSA SAVING AND INVESTMENT FEATURES?

• $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.


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

CAN YOU HELP ME UNDERSTAND AND TRACK MY HEALTH CARE EXPENSES?

At-A-Glance

Account Summary


Let’s do a comparison


Open Access Plus (OAP) Health Savings Account (HSA)

Single Family Single Family

Preventative Care No charge No charge No charge No charge

Deductible $300 $600 $2,000 $4,000

Out-of-pocket maximum $1,000 $2,000 $2,000 $4,000

Health Savings Account contribution from employer

n/a n/a $1,000 $2,000

Lifetime maximum Unlimited Unlimited Unlimited Unlimited

Medical plan highlights In-network


Open Access Plus (OAP) Health Savings Account (HSA)

Retail

(30 day supply)

Mail Order

(90 day supply)

Retail

(30 day supply)

Mail Order

(90 day supply)

Generic You pay $15 You pay $30

You pay 100% of drug cost until the deductible

is met – after the deductible is met then

plan pays 100%



plan pays 100%

Cigna-preferred brand You pay $35 You pay $70



plan pays 100%



plan pays 100%

Non-preferred brand You pay $55 You pay $110



plan pays 100%



plan pays 100%

Pharmacy plan highlightsIn-network


helpfulresourcesthe information you need


Explanation of Benefits (EOB)• 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

Quarterly Health Statement• 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

CAN YOU HELP ME UNDERSTAND AND TRACK MY HEALTH CARE EXPENSES?


24/7 customer phone assistance

CAN YOU HELP ME UNDERSTAND AND TRACK MYHEALTH CARE EXPENSES?

• One toll-free number – on the back of theID card and debit card

• Specially trained Customer ServiceRepresentatives 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

20Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna 20Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna

SO MANY WAYS TO CONNECT WITH CIGNA.

Cigna.com• Simple to navigate• Find what you’re looking for, quickly and easily

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

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

WHENEVER. WHEREVER.

21Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna 21Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2012 Cigna

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


Programs for you


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


Lifestyle Management ProgramsCIGNA Healthy Steps to Weight Loss, CIGNA Quit Today and Stress & Resilience

– 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

http://www.mycigna.com/


Helping you stay healthy.

• 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

Cigna Healthy Rewards®

Discounts on a full range of health and wellness programs and services*

*Healthy Rewards is a discount program. Some Healthy Rewards programs are not available in all states. A discount program is NOTinsurance, and the customer must pay the entire discounted charge.


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


Q & A

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