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CIGNA HealthCare

CIGNA Medical Plans

CIGNA Healthcare is the administrator for Pace University's medical plan options. Participants have access to the CIGNA Open Access Plus network, which is a national network. Annual deductibles, plan maximums, etc. are based upon a calendar year.

Highlights of the CIGNA plans:

  • No referrals to see specialists in or outside of the network
  • No requirement to select a Primary Care Physician (although it is recommended for coordination of care)
  • In-network preventive care exams are covered at 100%
  • Mail Order Pharmacy Co-Payments – For Certain Maintenance Medications - One (1) copayment for a three (3) month supply of certain maintenance medications via CIGNA Home Delivery pharmacy. This benefit pertains to the maintenance medications on this list only
  • Emergency care is covered 24 hours a day, no matter where the member receives such services (for the Network Core $25 and Network Choice 90/70 plans, the ER co-payment is waived if you or a covered dependent are admitted to the hospital)
  • Access to discounted programs and products to promote a healthy lifestyle through CIGNA Healthy Rewards
  • Pharmacy program (including mail order) is managed by CIGNA Tel-Drug
  • Vision program is managed by CIGNA Vision

Side by Side Comparison of Plans

Per Paycheck Premiums (July 1, 2015 – June 30, 2016)


2015-2016 Medical Benefits

Medical Plans

Increase in Copayments for All Plans and Pharmacy Deductible

A $5 increase in copayment for medical and prescription benefits, as well as an increased prescription annual deductible for all plans will go into effect on July 1, 2015 with some exceptions. Please refer to the table below for actual increases by plan and service type.

Current Copayments and Deductibles

Copayments and Deductibles effective 7/1/2015


Change to Network Choice 90/70 and 100/70 Plans Out-of -Network Benefit

Effective July 1, 2015, the out-of -network deductible for the Network Choice 90/700 and 100/70 plans will increase from:

$1,000 individual / $2,000 family

To:

$1,200 individual / $2,400 family

In addition, the out-of-network reimbursement, for both plans, will no longer be based on 80% of the Usual, Customary and Reasonable (UCR) rate. Effective July 1, 2015, the 80% UCR will be replaced by 300% of Medicare.


Out-of-Pocket Maximum*

Effective July 1, 2015, as a condition of the Affordable Care Act (ACA), all medical plans will be required to include an in-network out-of-pocket maximum for out-of-pocket medical and prescription costs. All medical co-payments will count toward the medical out-of-pocket maximum and all prescription costs will count towards the prescription out-of-pocket maximum. After the out-of-pocket maximum is satisfied, the plan pays 100% of remaining eligible charges for the rest of the plan year. The out-of-pocket maximum is not the same as a deductible.

There is no change to the In-Network Medical Out-of-Pocket Maximum. This is the first year for the In-Network Prescription Out-of-Pocket maximum.

Plan

In-Network Medical Out- of-Pocket Maximum (Single / Family)

In-Network Prescription Out- of-Pocket Maximum (Single / Family)

In Net $50**

$5,000 / $10,000

$1,600 / $3,200

Network Core $25

$2,000 / $4,000

$4,000 / $8,000

Network Choice 90/70

$1,200 / $2,400

$4,000 / $8,000

100/70***

$1,750 / $3,500

$4,000 / $8,000

*Out of Pocket Maximum: The most you will pay for covered services during the plan year before the medical or prescription plan begins to pay at 100% of covered charges. The out-of-pocket maximum for medical does not include premiums, balance-billed charges, prescriptions and health care charges that the plan does not cover. The out-of-pocket maximum for prescription coverage does not include any medical costs or charges that the plan does not cover.

The HDHP plan out-of-pocket maximums are listed in the next section with other HDHP plan changes.

**Plan only available to employees enrolled prior to July 1, 2013.

***Plan only available to employees enrolled as of July 1, 2015.


IRS Change in High Deductible Health Plan (HDHP) & Health Savings Accounts (HSA)

The IRS has updated the following limits, effective January 1st of each respective year:

Plan

Coverage Type

2015

2016

HSA Contribution Limit

Individual

$3,350

$3,350

 

Family

$6,650

$6,750

HDHP Deductible

Individual

$1,300

$1,300

 

Family*

$2,600

$2,600

HDHP Out of Pocket Maximum

Individual

$2,500

$2,500

 

Family*

$5,000

$5,000

Please note: Per the IRS, the HDHP/HSA option’s in-network deductible will increase effective July 1, 2015.

CIGNA in-network lab coverage

For CIGNA in-network lab coverage, in most instances, your physician will automatically send your lab work to the correct CIGNA-participating lab. However, if the in-network provider sends your lab work to a non-participating vendor, the claim will be processed at the out-of-network level or will not be covered at all (if you are enrolled in an in-network only plan). As such, we strongly recommend that you notify your provider of the participating labs whenever you utilize these services. The following offers some guidance on how to best handle these services:

What you need to do when lab work is warranted:

  • Find network labs by going to www.myCIGNA.com or calling the number on your CIGNA ID card.
  • Inform your doctor that you want to use a CIGNA Open Access Plus network lab.
  • If your doctor takes a sample in the office, advise him/her that it must be sent to a CIGNA network lab.
  • Bring a print-out of participating labs to your appointment.
  • Make sure that the lab is an in-network lab. Just because a lab accepts your CIGNA ID card, it doesn’t necessarily mean that it’s part of the CIGNA Open Access Plus network.

If an in-network doctor does not send your lab work to a participating provider and your claim is processed at the out-of-network level (or not covered if you are in the CIGNA In-Net 50 or CIGNA In-Net 20 plans), you do have the right to appeal the decision. This can be done by contacting CIGNA’s customer service department at the number listed on your ID card.

Brand Cost on Pharmacy (does not apply to Consumer Core HDHP/HSA Plan)

Brand Cost on Pharmacy (does not apply to HDHP/HSA Plan): Effective July 1, 2014, CIGNA mandates that employees pay the actual full cost of brand medications less the actual full cost of the equivalent generic plus the generic co-payment.

Example:

  • Brand Medication Actual Cost: $150
  • Generic Actual Cost: $25
  • Generic Copayment: $10
  • Your Cost:$ 150 (Brand Cost) - $25 (Generic Cost) + $10 (Generic Copay) = $135.

This will not impact:

  • Brand prescriptions for which the healthcare provider has indicated “Dispense As Written”
  • Brand prescriptions where there is no generic alternative
  • Generic prescriptions

Note: Pharmacies in New York and New Jersey are required to automatically dispense medication as generic, unless the prescribing healthcare provider checks the “Dispense As Written” box.