Cigna Health and Life Insurance Company
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1 Cigna Health and Life Insurance Company Network Access Information Filed with Texas Department of Insurance March 31, 2017
2 CIGNA HEALTH AND LIFE INSURANCE COMPANY NETWORK ACCESS Cigna Health and Life Insurance Company Geographic Area insured TX residents Does Network Meet TX Adequacy Definition? Does Network have a Local Market Access Plan? Yes (Click link below) s Local Market Access Plan Applies to s? Internal Medicine Family General Practice Pediatric Obstetrics and Gynecology Anesthesiologists Physchiatry General Surgery 28 TAC Substantial Decrease in 7. Central TX 0 No Yes 19 Yes N/A 121 Nothing to Report Cigna Health and Life Insurance Company Network Access Plan Submitted to Texas Department of Insurance Follows As Submitted to TDI 3/31/17 Page 1
3 Cigna Health and Life Insurance Company Local Market Access Plan Filed with Texas Department of Insurance
4 OVERVIEW When contracted providers are not available within the TDI mileage access standards Cigna provides for in-network benefit coverage in a variety of ways depending on the type of provider and the specific medical need of the patient. The most common practices include: 1. Negotiating ad hoc agreements with local providers within the access standards. Ad hoc agreements prohibit balance billing of members. 2. Paying in-network benefit levels for non-contracted local area providers within the mileage standards. 3. Assisting members in identifying contracted providers in alternative specialties within the mileage standards who are qualified to threat the condition. When using contracted providers in-network benefit are paid and providers are prohibited from balance billing the member. 4. When no appropriate providers are available within the mileage standard, in-network benefits will be paid for the nearest reasonably located contracted provider or a reasonably located non-contracted provider. Contracted providers are prohibited from balance billing the member. 5. To further prevent balance billing we calculate plan payments using the providers billed charges as the basis for the allowable charges. See detailed worksheets for access information by county and by specialty. Network Access Plan_AUS-WACO Reproductive EPO_2017
5 County Bastrop Bell Burnet Williamson Bosque Hamilton Hill Provider Type PCP-Children PCP-Children PCP-Children Reason Network Not Available General Plan for Access Ad Hoc / other Health Care Services Made Available of Bastrop County to provide certain health care services that Healthcare Services. See Column E nearest s are in Travis County of Bell County to provide certain health care services that Healthcare Services. See Column E nearest is in Bell County of Burnet County to provide certain health care services that Healthcare Services. See Column E nearest s are in Williamson and Travis County of Williamson County to provide certain health care services that Healthcare Services. See Column E nearest is in Williamson County There are no physicians in this portion of Bosque County. There are no physicians in this portion of Hamilton County. There are no physicians in this portion of Hill County. PCP's are adequately trained to provide services PCP's are adequately trained to provide services PCP's are adequately trained to provide services General Description of Day to Day Procedures There are PCP's in Bosque County. Nearest Ped is in Coryell and McLennan County There are PCP's in Hamilton County. Nearest Ped is in Coryell County There are PCP's in Hill County. Nearest Ped is in McLennan County Network Access Plan_AUS-WACO Reproductive EPO_ Medical Access Plan
6 Service Area
7 Network Analysis - Texas Network Adequacy Report Cigna Network Approval Filing 3 Service Area 2017 Quest Analytics, LLC. Service Areas Service Area miles
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