January 1, 2021 through December 31, 2021
Cigna Health Care is the administrator for Pace University’s medical plans. Participants have access to the Cigna Open Access Plus network, which is a national network.
FOR ALL HEALTH PLANS: annual deductibles, plan maximums, etc., are based upon a calendar year.
- Network Core Plan
- Choice PPO Plan
- Consumer Core HDHP/HSA Plan
- Summaries of Benefits and Coverage (includes all medical plans)
- Side-By-Side Comparison of Medical Plans (PDF)
- Per Paycheck Premiums (PDF) (January 1, 2021–December 31, 2021)
- Explanation of Benefits (EOB) Information
Access your account on Cigna's website (to review claims, conduct a provider search, re-order ID cards, etc.).
Cigna customer service representatives are available at 1-800-CIGNA24.
- No referrals to see in-network specialists
- No requirement to select a Primary Care Physician (although it is recommended for coordination of care)
- Co-payments of $30 to see a Primary Care Physician and $50 to see a Specialist under the Network Core and Choice PPO plans
- In-network preventive care exams (PDF) are covered at 100%
- Memorial Sloan Kettering and Hospital for Special Surgery are among the in-network facilities
- Emergency care is covered 24 hours/day, no matter where the member receives such services (for the Network Core and Choice PPO plans, the ER co-payment is waived if you or a covered dependent are admitted to the hospital)
- For the Network Core and Choice PPO medical plans, in-network mental health and substance abuse outpatient visits will be covered at the primary office visit copayment ($30). Previously these services were covered at the specialist office visit copayment ($50).
- Access to discounted programs and products to promote a healthy lifestyle through Cigna Healthy Rewards
- Seasonal Flu Vaccines, administered by your participating local retail pharmacy (PDF), may be covered at no cost to you.
Coverage to end of calendar year in which dependent turns age 26 - A dependent is eligible for coverage under the medical/vision and dental plans until the end of the calendar year in which he/she turns age 26. A dependent who ages off the plans at age 26 will be offered the opportunity to continue dental coverage on COBRA and medical coverage on COBRA or under the New York State Young Adult Option (premiums are 2% less than COBRA).
Omada for Cigna - Pace University offers Omada®, a digital lifestyle change program that can help Cigna participants lose weight, feel fantastic, and develop long-term healthy habits. Each Cigna participant is eligible to participate in the program at no additional cost if he/she (or his/her covered adult dependents) are enrolled in the University’s medical plan, is at risk for diabetes or heart disease, and is accepted into the program. Participate in a brief survey to see if you're eligible. (Neither Pace University nor Cigna will receive the results of individual surveys; only aggregate data will be shared by Omada.)
MDLive Telehealth - As of January 1, 2021, Cigna is partnering with MDLive (PDF). Cigna participants are encouraged to register sooner rather than later. It is much easier to access this service if you have previously registered. Please note, MDLive offers both physical and mental health telemedicine services. For more information, please visit the MDLive for Cigna website or call 1 (888) 726-3171.
Urgent Care Facilities - In recent years, many Urgent Care centers have emerged in towns and cities, including within drug stores and medical groups. Urgent Care centers provide individuals with care when the situation isn’t life threating, but requires immediate attention. Urgent Care centers will typically cover conditions such as: earaches and infections, minor cuts, sprains and burns, fever and flu. Pace’s Network Core and Choice PPO plans require a co-payment of $30 for Urgent Care vs. an Emergency Room co-payment of $85. If a participant is enrolled in the Consumer Core HDHP, the cost of services will be less at an Urgent Care center than at the Emergency Room, so out-of-pocket costs will be less.
It is important to note that while a facility may be advertised as “Urgent Care”, the Urgent Care center or medical offices providing “urgent care services” could very well not be contracted with Cigna as a participating Urgent Care facility. Cigna participants have encountered this issue when a medical group has an Urgent Care center; however, this center is actually contracted with Cigna as a “specialist provider.” In this case, the Network Core and Choice PPO specialist co-payment – of $50 - applies. In order to find a contracted Urgent Care center ($30 co-payment), please contact Cigna or utilize the Cigna Mobile App (PDF) and search for “Urgent Care.”
For severe and life-threatening conditions (such as shortness of breath, chest pain, uncontrollable bleeding, etc.), the Emergency Room could be the more appropriate setting and a hospital will be better-equipped to handle these situations.
Cigna Lab Services - In most instances you should not experience any issues, as your physician automatically sends 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 not covered at all (if you are enrolled in an in-network only plan). As such, we strongly recommend that you inform your provider of the participating labs whenever you utilize these services. The following provides some guidance on how to best handle these services.
What you need to do when lab work is needed:
- Find network labs by going to mycigna.com or calling the number on your Cigna ID card.
- Tell your doctor you want to use a Cigna network lab.
- If your doctor takes a sample in the office, tell him/her to send it 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 the lab is contracted within 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 at all, if you are in the Consumer Core HDHP or Network Core plans), you do have the right to appeal the decision. Please contact Cigna’s customer service department at the number listed on your ID card.
Network Core Plan
(January 1, 2021 through December 31, 2021)
The Network Core Plan offers in-network coverage only. That is to say that your provider must be contracted through the Cigna Open Access Plus network, which is a national network (in-network providers are available nation-wide).
The features of this plan include:
- $30 co-payment to visit a Primary Care Physician, $50 to see a Specialist.
- No referrals are needed.
- In-network mental health and substance abuse outpatient visits are covered at the primary office visit copayment ($30). Previously, these services were covered at the specialist office visit copayment ($50).
- The annual (calendar year) Out-of-Pocket Maximum is $2,000 for individual coverage and $4,000 for employee +1 and family coverage.
- Preventive care exams (PDF) are covered at 100%.
- No charge for in-network hospitalization.
- $85 Emergency Room co-payment, which is waived if you (or a covered dependent) are admitted to the hospital.
- In-network prescription co-payments of: $20 for generic medications, $45 for preferred brand medications, and $70 for non-preferred brand medications, after the calendar year deductible for non-generic prescriptions ($125 per person, $375 for +1 and family) has been satisfied. $0 co-payments for generic preventive medications on this list (PDF).
- Please review the Cigna Value 3-Tier Prescription Drug List (PDF), especially the section entitled, “Medications That Are Not Covered” (beginning on Page 18).
There is no coverage for out-of-network services. The only exception may apply for an emergency situation, in which the charges are specifically coded as such.