NEWPORT-MESA UNIFIED SCHOOL DISTRICT

Transcription

1 NEWPORT-MESA UNIFIED SCHOOL DISTRICT BELIEVE IN YOURSELF. WE DO. Cigna FAQ Belw please find details and frequently asked questins regarding the Cigna Netwrk (HMO), St. Jseph Hag Health (SJHH) Select Netwrk and Open Access Plus plans available t active Newprt Mesa Unified Schl District emplyees. Pre-Enrllment Infrmatin Line. If yu have questins regarding the Cigna plans that are available t yu, yu can call ur Pre-Enrllment Infrmatin Line at Talk t an enrllment specialist wh can answer all yur questins. Get infrmatin n specific plans Find dctrs and ther health care prfessinals in yur netwrk Cmpare Cigna prducts and resurces Steps fr Navigating the Pre-Enrllment Infrmatin Line 1. Call When Prmpted press #3 calling abut enrllment 3. Representative will ask fr yur name and yur emplyer. Prvide full name Newprt Mesa United Schl District 4. If needed, prvide Grup Number Find a dctr. Want t knw which dctrs are in which plan? Visit Cigna.cm r call and use the plan names t search fr in-netwrk dctrs: Select Find a Dctr : Select If Yur Insurance Plan is Offered Thrugh Wrk r Schl Enter yur lcatin, select yur plan, and input what yu re lking fr (such as yur dctr s name, a keywrd r facility) Be sure t pick the plan yu re interested in searching: If yu re interested in the Netwrk (HMO) plan, chse: HMO/Netwrk Cigna Healthcare f Califrnia, Inc. S. CA HMO/Netwrk If yu re interested in the SJHH Select Netwrk plan, chse: Suthern CA Select (St Jseph Hag Health Select Plan, Scripps Select Plan, HealthCare Partners Select Plan) If yu re interested in the Open Access Plus (OAP) plan (a plan similar t a PPO plan), chse: Open Access Plus, OA plus, Chice Fund OA Plus

2 Guest Privileges. If yu have enrlled in either the Netwrk (HMO) r SJHH Select Netwrk plan and have eligible dependents living utside f Califrnia, yu may have access t the Netwrk plan benefits depending n the zip cde in which they reside. Please cntact the Pre-enrllment Line at fr further infrmatin n if an HMO Netwrk is available in yur dependent s area and hw t setup privileges at that Netwrk. Cigna Hme Delivery Pharmacy. Use QuickSwitch t change yur mail-rder medicatins t Cigna Hme Delivery Pharmacy. Please refer t yur NMUSD enrllment package fr mre infrmatin n hw t switch ver yur current mail rder prescriptin t Cigna mail rder. Q. Hw d I determine if the Netwrk (HMO), SJHH Select Netwrk r Open Access Plus (OAP) plan is best fr me and my family? A. When selecting a plan, there are a few things t keep in mind abut hw the plans wrk. With a Netwrk (HMO) plan, yu have In-Netwrk benefits nly, which means there is n Outf- Netwrk cverage (except during emergencies). Yu and yur family members will have t select a Primary Care Physician (PCP) during pen enrllment. If yu fail t select a PCP, ne will be autmatically assigned fr yu. Yur PCP will act as a gatekeeper directing all f yur care, meaning that yu will need t get a referral frm yur PCP fr any specialty care. It is als imprtant t nte that yur PCP will direct yur care within their Medical Grup. That means if yu ve been getting care frm different dctrs in different Medical Grups yu may need t change dctrs s that yu are nly utilizing ne Medical Grup. If nt, yu may want t lk int the OAP plan. Fr the Netwrk plan, the nly exceptin t the referral requirement is chirpractic care. NMUSD has elected a rider that allws emplyees t self-refer t participating chirpractrs within the American Specialty Health Netwrk. Yu can find participating dctrs n mycigna.cm by selecting the Find a Dctr, Dentist OR Facility tab. Then select the American Specialty Health Netwrk f cntracted chirpractrs St. Jseph Hag Health Select Netwrk is a netwrk f St. Jseph Hag Health and CHOC hspitals and physicians: Hag Hspital (Irvine/Newprt Beach), Hag Orthpedic Institute (Irvine), St. Jseph Hspital (Orange), St. Jude Medical Center (Fullertn), Missin Hspital (Missin Viej/Laguna Beach) and CHOC (Orange/Missin Viej) in Orange Cunty. This netwrk ffers yu quality health care with integrated delivery systems that are dedicated t imprving yur verall utcme and experience while reducing cst. Fr mre infrmatin n St. Jseph Hag Health Select Netwrk, refer t the SJHH FAQ and Brchure lcated n the Newprt Mesa Unified Schl District micrsite under the FAQ sectin. With an OAP plan, yu have the ptin f chsing a PCP t guide yur care, thugh it is nt required. Yu have the freedm t self-refer fr any services yu need and can get care bth In and Out f Netwrk, thugh seeking care Out f Netwrk will mean yu receive a lesser benefit amunt, d nt get the benefit f Cigna negtiated rates and can be subject t balance billing by the health care prfessinal if their fee is ver and abve the usual and custmary rate fr services in that area. In additin t the abve, yu will als want t take int accunt the different benefits within bth the Netwrk and OAP plans, as well as the cst f each plan. 2

3 Q. Hw d I find ut if my dctr is cntracted in the Cigna netwrk? A. It s easy t find ut if yur dctr is cntracted in the Cigna netwrk. Belw are the steps that yu shuld take: G t r call Select Find a Dctr Select If Yur Insurance Plan is Offered Thrugh Wrk r Schl Enter yur lcatin, select yur plan, and input what yu re lking fr (such as yur dctr s name, a keywrd r facility) Be sure t pick the plan yu re interested in searching: If yu re interested in the Netwrk (HMO) plan, chse: HMO/Netwrk Cigna Healthcare f Califrnia, Inc. S. CA HMO/Netwrk If yu re interested in the SJHH Select Netwrk (HMO) plan, chse: Suthern CA Select (St Jseph Hag Health Select Plan, Scripps Select Plan, HealthCare Partners Select Plan) If yu re interested in the Open Access Plus (OAP) plan, chse: Open Access Plus, OA plus, Chice Fund OA Plus Q. If I elect either f the Netwrk (HMO) r SJHH Select Netwrk plan, d I have t have the same Primary Care Physician as the rest f my family? A. N. Each family member can select their wn Primary Care Physician as lng as they are in the Netwrk plan the emplyee has chsen. Q. Can I enrll in either the Netwrk (HMO) r SJHH Select Netwrk plan and enrll my family in the OAP plan? A. N. Yu will need t elect ne plan fr yu and yur cvered dependents. Q. Can I change my plan electin during the year? A. N. Typically speaking, nce yu have elected yur plan yu will need t cntinue in that plan until the next annual pen enrllment perid. The nly exceptin t this wuld be if yu are currently enrlled and experience a qualifying life event such as getting married, getting divrced r having a baby. If yu experience a qualifying life event yu will be eligible fr a special enrllment perid and can make changes t yur plan electins during that time. Q. I enrlled in either the Netwrk (HMO) r SJHH Select Netwrk plan and want t change my Primary Care Physician. Is this allwed? A. Yes. Yu can call and speak with a Cigna representative t make a change t yur Primary Care Physician. If yu call befre the 15 th f the mnth, the change will g int effect the fllwing mnth. Yu will receive a new ID card as part f yur change. Q. Can NMUSD help me enrll in a new plan r chse a new physician? A. N. Unfrtunately, NMUSD is prevented frm selecting medical cverage, health plans r physicians fr its emplyees. The gal is t prvide yu with quality chices and flexibility in plans s that yu can select the mst apprpriate cverage fr yu and yur family members. 3

4 Fr assistance frm Cigna, call the Cigna pre-enrllment line t learn mre abut the features f Cigna health plans ffered thrugh NMUSD at An enrllment specialist can prvide infrmatin n specific plans, help yu find participating dctrs and ther health care prfessinals, and help yu cmpare all Cigna prducts and resurces available t yu thrugh NMUSD. Q. I am currently n a different medical plan and in treatment, but I plan n getting cverage with Cigna and my Dctr isn t in the Netwrk. What are my ptins fr care? A. Infrm yur physician yur insurance cverage will be changing and discuss ptins. If yur physician participates in the Netwrk plan in which yu are enrlling, then yur care will be cntinued seamlessly. If yur physician is nw ut-f-netwrk and was in-netwrk with yur previus medical carrier yu may qualify fr Transitin f Care benefits, if yu have an acute cnditin, serius chrnic cnditin, pregnancy, terminal illness, care f a newbrn child, r authrized surgery. Please reference the Transitin f Care frm which can be fund n the Cigna.cm prtal. r call G t the search bar at the tp f the page and search Transitin f Care Click n Health Insurance and Medical Frms fr Custmers Click n Medical Frms Click n Transitin f Care/Cntinuity f Care Q. Hw can I cnfirm if the medicatin I m currently taking is n the Cigna frmulary (drug list)? A. Yu can access the Cigna drug list by visiting Cigna.cm: G t r call Scrll dwn t the bttm f the page n the left side under I Want t Click n View Drug Lists Yu can search fr a particular drug r select See a list f all drugs. Yu will see a list f drugs, can lcate yur drug and dse and determine which tier (generic, preferred r nn-preferred) yur drug is available under. Q. I am currently taking a medicatin that is listed as nn-preferred brand name under the Cigna standard drug list. It als shws a PA and ST next t the medicatin. What des that mean? A. PA means Prir Authrizatin and ST means Step Therapy. Prescriptin medicatin csts can vary greatly and these prgrams can help save yu mney and stay healthy. Dctrs in the Cigna Netwrk wrk directly with Cigna t get apprval fr any medicatins that require prir authrizatin. If yur dctr is nt in the Cigna netwrk, yu will be respnsible fr getting prir authrizatin fr yur medicatin. Cnsult with yur dctr abut the upcming change in carriers t ensure that any required prir authrizatins are being put in place with Cigna. Prir Authrizatin may be required fr different reasns. T learn the requirements needed fr cverage f a specific medicatin, feel free t give Cigna a call. Step Therapy is a prgram in which certain medicatins fr specific medical cnditins need apprval befre they re cvered. In Step Therapy, yu and yur dctr fllw a series f steps when chsing yur medicatin. Step Therapy encurages yu t try the mst cst effective and apprpriate medicatin available t treat yur cnditin. When yu fill a prescriptin fr a Step Therapy medicatin, Cigna will send yu and yur dctr a letter explaining what steps yu need t take befre yu refill yur medicatin. This may include trying a generic r lwer cst alternative, r asking Cigna fr authrizatin fr cverage f yur medicatin. At any time, if yur dctr feels a different medicatin isn t right fr 4

5 yu due t medical reasns, he/she can request authrizatin fr cntinued cverage f a Step Therapy medicatin. Yu can find Step Therapy medicatins n the Cigna standard drug list. Once yu are registered n mycigna.cm, yu can view the drug list by clicking n the view prescriptin drug list link in the Pharmacy sectin. If ST is listed next t yur medicatin name, then it is part f the Step Therapy prgram. Q. Hw d I set up mail rder delivery fr prescriptins with Cigna? A. As a Cigna custmer, yu ll have access t Cigna Hme Delivery Pharmacy, designed especially fr individuals wh take prescriptin medicatins n a regular basis, such as thse used fr diabetes, asthma, heart cnditins, high bld pressure and mre. After the initial effective date f yur Cigna plan, yu can call Cigna Hme Delivery Pharmacy at Be ready t prvide Yur name and Cigna ID number Prescriptin medicatin names and dsage Dctr s infrmatin (including name and phne number) Payment infrmatin (American Express, Discver, MasterCard r VISA) Cigna Hme Delivery Pharmacy will request a prescriptin frm yur dctr. Once it is received they will fill yur medicatin and mail it t yur hme. Cigna will call r yu when it s time t refill yur prescriptins. Yu can speak t a pharmacist 24/7 by calling Additinal infrmatin regarding Cigna Hme Delivery Pharmacy can be fund in NMUSD enrllment package. Q. I have ne dependent child wh is at cllege in Califrnia but utside the Cigna Netwrk plan I wuld like t chse and anther dependent child ging t cllege utside Califrnia and I want t chse ne f the Netwrk plans. What happens if either f my children needs medical care--whether it is rutine, urgent r emergency care? A. Typically, a persn is nly cvered ut f area fr urgent r life threatening emergencies. Hwever, if Cigna has a Netwrk (HMO) in the area in which yur child resides, yur child can be set up with Guesting privileges which will give yur child all the rights and privileges f yur NMUSD plan in that Guesting netwrk area. T determine if Guesting privileges apply, please have the zip cde ready, then call the custmer service line. The representative will walk yu thrugh the entire prcess. Guesting can nly be set up after the effective date and will typically take effect within tw weeks f being requested. Cigna OAP has a Natinal Netwrk f dctrs and facilities. Fr thse individuals that elect the Cigna OAP yu and yur dependents can access the netwrk even when away frm hme withut need fr guesting privileges. Q. Can my dependent child residing in Hawaii get cverage n the Netwrk r OAP plans? A. N, unfrtunately because f state regulatins these plans are nt available in Hawaii. Please refer t yur Human Resurces Department fr mre details. Q. My spuse is retired but I am still an actively wrking emplyee fr NMUSD. What are my ptins? A. If yu are an active NMUSD emplyee and yu cver yur retired spuse that is n Medicare in Califrnia yu have the ptin t chse the St. Jseph Hag Health Netwrk (HMO, the Netwrk (HMO) r the OAP (PPO) plan. If yur spuse has Medicare cverage, yur Cigna plan will be primary and Medicare will be secndary. 5

6 Q. My spuse and I bth are active emplyees n the NMUSD plan and we cver ur children. What are ur ptins? A. At pen enrllment yu have tw ptins 1) Enrll self r spuse as the main subscriber wh will cver the entire family. 2) Enrll as independent subscribers with either emplyee r spuse cvering the children. Dual cverage is nt available. All grup health insurance plicies cntain exclusins and limitatins. Fr csts and cmplete details f cverage, see yur enrllment materials r plan dcuments. All Cigna prducts and services are prvided exclusively by r thrugh perating subsidiaries f Cigna Crpratin, including Cigna Health and Life Insurance Cmpany, Cnnecticut General Life Insurance Cmpany, and HMO r service cmpany subsidiaries f Cigna Health Crpratin, including Cigna HealthCare f Califrnia, Inc. In Califrnia, Netwrk and HMO plans are ffered by Cigna HealthCare f Califrnia, Inc. All ther medical plans are insured r administered by Cigna Health and Life Insurance Cmpany. The Cigna name, lg, and ther Cigna marks are wned by Cigna Intellectual Prperty, Inc. 6