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%
- Emergency care is covered 24 hours a day, no matter where the member receives such services (for the CIGNA In-Net 20, CIGNA 90/70, and CIGNA 100/70 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
2014-2015 Medical Benefits
CIGNA In-Net 50
The CIGNA In-Net 50 Plan is no longer available to new enrollees as of July 1, 2013. Those currently enrolled may continue to participate in this plan; however, once a current participant changes to a different plan option, he/she may not re-enroll in the CIGNA In-Net 50 Plan at a later date.
The CIGNA HDHP/HSA (High Deductible Health Plan with a Health Savings Account) became available on July 1, 2013, to active employees who are not enrolled in another health plan, including Medicare Part A and/or Part B.
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.
Out-of-Pocket Maximum*: Effective July 1, 2014, as a condition of the Affordable Care Act (ACA), all medical plans will be required to include an in-network out-of-pocket maximum and all medical co-pays will count toward that 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.
|Plan||New In-Network Out- of-Pocket Maximum (Single / Family)|
|In Net $50**||$5,000 / $10,000|
|In Net $20||$2,000 / $4,000|
|90/70||$1,200 / $2,400|
|100/70||$1,750 / $3,500|
*Out of Pocket Maximum: The most you will pay for covered services during the plan year before the medical plan begins to pay at 100% of covered charges. The out-of-pocket maximum does not include premiums, balance-billed charges, prescription co-payments/deductibles, and health care charges that the plan does not cover.
**Plan only available to employees enrolled prior to July 1, 2013.
Brand Cost on Pharmacy (does not apply to 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.
- 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.