Cigna Individual and Family Plans Confidential, unpublished property of Cigna. Do not duplicate or...

CignaIndividual and Family Plans

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2014 Cigna

2016 Offerings

2Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2014 Cigna


You can also access myCigna.com on the go with the myCigna.com Mobile App*. You can find a health care professional, hospital or

urgent care center in our directory and compare prescription drug costs. In addition, you can view and request a copy of your medical ID card(s), get up-to-date account information, check your balances and

review your medical claims.

* The downloading and use of the myCigna Mobile App is subject to the terms and conditions of the App and the online store from which it is downloaded. Standard mobile phone carrier and data usage charges apply.

myCigna.com: Designed to click with you

Your health has met its App

Tennessee Individual Medical

• Available ON and OFF the Marketplace (FFM)

• Memphis – Fayette, Haywood, Lauderdale, Shelby, Tipton

• Nashville – Cheatham, Davidson, Montgomery, Robertson, Rutherford, Sumner, Trousdale, Williamson, Wilson

• Tri-Cities – Carter, Greene, Hancock, Hawkins, Johnson, Sullivan, Unicoi, Washington

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2014 Cigna 4


A NEW innovative approach for 2016 in Nashville and Tri-Cities…

Cigna’s NEW Connect Network of providers offer quality care to help customers improve their health. The coordinated care between primary care physicians and specialists in our Connect

Network means more efficient and effective communication between providers centered around an individual’s specific healthcare needs.

2016 PORTFOLIO BY PLAN TYPE


Cigna Connect HSA or Cigna Health Savings

Cigna Connect Flex or Cigna Health Flex

Customer value

• Promotes financial health in additional to medical health allowing you to maximize your healthcare dollars for current and future needs

• Promotes choice to balance your needs between affordability and level of coverage

Key features • Lower premiums • Tax saving advantages

• Wide range of deductible options • Varying levels of office visit coverage • Varying levels of drug coverage with access to a

copay as low as $4 for generics

Metal offering Bronze and Silver Bronze, Silver, and Gold

Deductible $2,700 or $6000 $1200 - $6400

Maximum out-of-pocket $6500 $5000 - $6700

Medical coinsurance Plans vary between 85% or 100% Plan pays: 60%, 70%, or 80%

Preventive care Plan pays: 100% Plan pays: 100%

Office visits Ded/coins

(Qualified HDHP plan requirement) Copay-based


Cigna is offering our 5-Tier Pharmacy Plan:

Medications are divided into five tiers (categories)

Tier 1: Contains preferred generic medications. These medications are available at the lowest cost to you.

Tier 2: Contains non-preferred generic medications. These generic medications are available at a slightly higher cost to you.

Tier 3: Contains preferred brand medications. These are more cost-effective brand name medications.

Tier 4: Contains non-preferred brand medications. These are more costly brand name medications.

Tier 5: Contains high cost specialty medications used to treat complex chronic conditions.

Cigna Pharmacy

Cigna Home DeliveryConvenience and Quality You Can Trust

Manage your medications online at myCigna.com and compare prices, track orders, see the number of refills you have left and much more.

Delivery of prescription medications right to your door.

You’ll receive reminders so you don't forget to fill your prescription.

Licensed pharmacists are focused on serving you and are available 24/7 to answer medication questions.

7


Nashville/Tri-Cities – 2016 Bronze Medical Plans

Out-of-Network:•ce

•$12,500 Deductible

2016 Plan Name Cigna Connect HSA Bronze 6000 Cigna Connect Flex Bronze 6400

Combined Deductible $6,000 $6,400

Family Deductible $12,000 $12,800

OOP Max $6,500 $6,700

Family OOP Max $13,000 $13,400

Med Coinsurance 100% 60%

PCP/Spec Ded/CoinsPCP: $40

Spec: ded/coin

Office Services Ded/Coin Ded/Coin

ER Ded/Coins Ded/Coins

UC Ded/Coins $75

Inpatient Ded/Coins Ded/Coins

MH OV Ded/Coins Ded/Coins

MH Outpatient Ded/Coins Ded/Coins

OP Surgery - Facility Ded/Coins Ded/Coins

OP Surgery - Prof Fees Ded/Coins Ded/Coins

Advanced Radiology Ded/Coins Ded/Coins

Other Xray/Lab Ded/Coins Ded/Coins

Rx Tier 1 (Gen) Ded/Coins $8

Rx Tier 2 (Gen) Ded/Coins $40

Rx Tier 3 (Pref Brand) Ded/Coins Ded/Coins

Rx Tier 4 (Non-Pref)Ded/Coins 50% Ded/Coins 50%

Rx Tier 5 (Spec) Ded/Coins 100% $500

Mail Order Tier 1 Ded/Coins $20


Mail Order Tier 3 Ded/Coins Ded/Coins

Mail Order Tier 4 Ded/Coins 50% Ded/Coins 50%


Medical Out-of-Network No Elective Out of Network Benefit (except for emergency care)

8


2016 Plan NameCigna Connect HSA Silver

2700Cigna Connect Flex

Silver 2250Cigna Connect Flex

Silver 4000

Combined Deductible $2,700 $2,250 $4,000

Family Deductible $5,400 $4,500 $8,000

OOP Max $6,500 $6,700 $6,700

Family OOP Max $13,000 $13,400 $13,400

Med Coinsurance 85% 70% 80%

PCP/Spec Ded/Coins 20/60 20/60

Office Services Ded/Coin Ded/Coin Ded/Coin

ER Ded/Coins Ded/Coins Ded/Coins

UC Ded/Coins $75 $75

Inpatient Ded/Coins Ded/Coins Ded/Coins

MH OV Ded/Coins $60 $60

MH Outpatient Ded/Coins Ded/Coins Ded/Coins

OP Surgery - Facility Ded/Coins Ded/Coins Ded/Coins

OP Surgery - Prof Fees Ded/Coins Ded/Coins Ded/Coins

Advanced Radiology Ded/Coins Ded/Coins Ded/Coins

Other Xray/Lab Ded/Coins Ded/Coins Ded/Coins

Rx Tier 1 (Gen) Ded/Coins $8 $8


Rx Tier 3 (Pref Brand) Ded/Coins $60 $60

Rx Tier 4 (Non-Pref) Ded/Coins 50% Ded/Coins 50% Ded/Coins 50%

Rx Tier 5 (Spec) Ded/Coins $500 $500

Mail Order Tier 1 Ded/Coins $20 $20



Mail Order Tier 4 Ded/Coins 50% Ded/Coins 50% Ded/Coins 50%


Medical Out-of-Network No Elective OON benefits (except for emergency)

Nashville/Tri-Cities – 2016 Silver Medical Plans

9


Nashville/Tri-Cities – 2016 Gold Medical Plans

Out-of-Network:•50% Coinsurance

•$12,500 Deductible•$25,000 Out-of-Pocket

OON Note: •No OON coverage for

Pharmacy, Transplant, Dialysis, DME

TN Note: •There was an error made in

2014 and ABA therapy for autism was included when it

should not have been•We have honored those claims this year, but it will be removed for 2015 and will no longer be

covered

Out-of-Network:•50% Coinsurance

•$12,500 Deductible•$25,000 Out-of-Pocket

OON Note: •No OON coverage for

Pharmacy, Transplant, Dialysis, DME

TN Note: •There was an error made in

2014 and ABA therapy for autism was included when it

should not have been•We have honored those claims this year, but it will be removed for 2015 and will no longer be

covered

2016 Plan Name Cigna Connect Flex Gold 1200

Combined Deductible $1,200

Family Deductible $2,400

OOP Max $5,000

Family OOP Max $10,000

Med Coinsurance 80%

PCP/Spec 20/50

Office Services Ded/Coin

ER Ded/Coins

UC $75

Inpatient Ded/Coins

MH OV $50

MH Outpatient Ded/Coins

OP Surgery - Facility Ded/Coins

OP Surgery - Prof Fees Ded/Coins

Advanced Radiology Ded/Coins

Other Xray/Lab Ded/Coins

Rx Tier 1 (Gen) $4

Rx Tier 2 (Gen) $15

Rx Tier 3 (Pref Brand) $35

Rx Tier 4 (Non-Pref) Ded/Coins 50%

Rx Tier 5 (Spec) $220

Mail Order Tier 1 $10



Mail Order Tier 4 Ded/Coins 50%


Medical Out-of-Network No elective out of network benefits (except for emergency)

10

Memphis – 2016 Plan Offerings

11

2016 Plan Name Cigna Health Savings 6000 Cigna Health Flex 6400 Cigna Health Savings 2700 Cigna Health Flex 2250 Cigna Health Flex 4000 Cigna Health Flex 1200

Combined Deductible $6,000 $6,400 $2,700 $2,250 $4,000 $1,200

Medical Deductible NA NA NA NA NA NA

Rx Deductible NA NA NA NA NA NA

Family Deductible $12,000 $12,800 $5,400 $4,500 $8,000 $2,400

OOP Max $6,500 $6,700 $6,500 $6,700 $6,700 $5,000

Family OOP Max $13,000 $13,400 $13,000 $13,400 $13,400 $10,000

Med Coinsurance 100% 60% 85% 70% 80% 80%

PCP/Spec Ded/CoinsPCP: $40

Spec: ded/coinDed/Coins 20/60 20/60 20/50

Office Services Ded/Coin Ded/Coin Ded/Coin Ded/Coin Ded/Coin Ded/Coin

ER Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins

UC Ded/Coins $75 Ded/Coins $75 $75 $75

Inpatient Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins

MH OV Ded/Coins Ded/Coins Ded/Coins $60 $60 $50

MH Outpatient Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins

OP Surgery - Facility Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins

OP Surgery - Prof Fees Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins

Advanced Radiology Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins

Other Xray/Lab Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins Ded/Coins

Rx Tier 1 (Gen) Ded/Coins $8 Ded/Coins $8 $8 $4

Rx Tier 2 (Gen) Ded/Coins $40 Ded/Coins $20 $20 $15

Rx Tier 3 (Pref Brand) Ded/Coins Ded/Coins Ded/Coins $60 $60 $35

Rx Tier 4 (Non-Pref) Ded/Coins 50% Ded/Coins 50% Ded/Coins 50% Ded/Coins 50% Ded/Coins 50% Ded/Coins 50%

Rx Tier 5 (Spec) Ded/Coins 100% $500 Ded/Coins $500 $500 $220

Mail Order Tier 1 Ded/Coins $20 Ded/Coins $20 $20 $10


Mail Order Tier 3 Ded/Coins Ded/Coins Ded/Coins $150 $150 $87

Mail Order Tier 4 Ded/Coins 50% Ded/Coins 50% Ded/Coins 50% Ded/Coins 50% Ded/Coins 50% Ded/Coins 50%


Medical Out-of-Network (Memphis plans only)

50%12,500 Deductible

$25,000 Out-of-Pocket



Tennessee – 2015 Silver CSR Medical Plans

2016 Portfolio 2016 Plan Silver A Silver B4 Silver C5

HSA Compatible Yes No No

Combined Deductible $2,700 $2,250 $4,000

OOP Max $6,500 $6,700 $6,700

Med Coinsurance 85% 70% 80%

PCP/Spec Ded/Coins 20/60 20/60



Rx Tier 3 (Pref Brand) Ded/Coins $60 $60

Rx Tier 4 (Non-Pref) Ded/Coins 50% Ded/Coins 50% Ded/Coins 50%RX Tier 5 Specialty Ded/Coins $500 $500

Deductible $2,100 $2,100 $2,800

OOP $5,100 $5,400 $5,400

Plan Coinsurance 85% 70% 80%

PCP/Specialist Ded/Coin $20/$60 $20/$60

MH OV Ded/Coin $60 $60

RX Tier 1 (Retail/Mail Order) Ded/Coin $8/$20 $8/$20



RX Tier 4 (Retail/Mail Order) Ded/Coins (50%)Ded/Coins 50% Ded/Coins 50%


CSR 73% AV200 - 250% FPL

12


Tennessee – 2015 Silver CSR Medical Plans

Deductible $500 $150 $300

OOP $2,250 $2,250 $2,250





RX Tier 2 (Retail/Mail Order) Ded/Coin $15/37 $15/$37


RX Tier 4 (Retail/Mail Order) Ded/Coins (50%) Ded/Coins 50% Ded/Coins 50%


Deductible $100 $0 $100

OOP $1,200 $1,400 $1,000







RX Tier 4 (Retail/Mail Order) Ded/Coins (50%) Ded/Coins 50% Ded/Coins 50%


CSR 87% AV150 - 200% FPL

CSR 94% AV100 - 150% FPL

13

Sample mock ups* of Connect Network ID cards


*Please note these are illustrative mock ups of IFP ID cards and are not meant to be an exact

representation of the IFP ID cards.

14

ADD A DENTAL PLAN AND A SMILE…

Why over 12 million customers choose a Cigna dental plan:

•› Extensive network of more than 129,000 providers (Total Cigna DPPO Network)

•› 363,000 locations across the United States

•› Flexibility to visit in network and out-of network providers

•› In-network routine checkups, cleanings and x-rays covered at 100%

•› 45 years of experience offering Group Dental Products

•› No referral needed to see a specialist

•› Customer service available 24/7/365

15

For 45 years, Cigna has been offering Group dental products that are designed to meet the needs of our individual customers.


To see if your DENTIST is in the Cigna network:Visit www.Cigna.com/ifp-providers or Call 1.800.Cigna24.

Pediatric / EHB – On & Off Exchange – Tennessee

Cigna Dental Pediatric

CIGNA DPPO ADVANTAGENETWORK

Offers the most savings, 35% national average.

OUT-OF-NETWORKYour out-of-pocket expenses will be higher; these

providershave not agreed to offer Cigna customers our

contracted fees

Calendar Year Deductible (Class II, III & IV)$150 Per Person

$300 Per Family

Calendar Year Out of Pocket Maximum (Class I, II, III & IV)

$350 Per Person

$700 Per Family

Benefit You Pay

Payment Levels Based on provider’s contracted fees Based on provider’s standard fees and the MAC

Class I – Preventive/DiagnosticNo Waiting Period

You pay $0 You pay the difference between the provider’s standard fee and 100% of the MAC

Class II – Basic Restorative

No Waiting Period

You pay 50% of the provider’s contracted fee(After Deductible)

You pay the difference between the provider’s standard fee and 50% of the MAC

(After Deductible)

Class III – Major Restorative

No Waiting Period



(After Deductible)

Class IV – Orthodontia (Medically Necessary)

No Waiting Period



(After Deductible)Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2014 Cigna 16

Pediatric / EHB – On Exchange – TennesseeCigna Dental Family + Pediatric

Under Age 19 Age 19 and Older

CIGNA DPPO ADVANTAGE NETWORKOffers the most savings, 35%

national average.

OUT-OF-NETWORKYour out-of-pocket expenses will be

higher

CIGNA DPPO ADVANTAGENETWORK

Offers the most savings, 35% national average.

OUT-OF-NETWORKYour out-of-pocket expenses will be

higher

Calendar Year Deductible (Class II, III & IV)

$150 Per Person $50 Per Person

$300 Per Family $150 Per Family

Calendar Year Out of Pocket Maximum (Class I, II, III & IV)

$350 Per PersonNot Applicable

$700 Per Family

Calendar Year Maximum (Class I, II, III) Not Applicable $1000 Per Person

Benefit You Pay You Pay

Payment Levels Based on provider’s contracted fees

Based on provider’s standard fees and the MAC

Based on provider’s contracted fees

Based on provider’s standard fees and the MAC

Class I – Preventive/Diagnostic

No Waiting Period No Waiting Period

You pay $0 You pay the difference between the provider’s standard fee and 100% of

the MACYou pay $0

You pay the difference between the provider’s standard fee and

100% of the MAC

Class II – Basic Restorative

No Waiting Period 6 Month Waiting Period (Can be Waived )

You pay 50% of the provider’s contracted fee

(After Deductible)

You pay the difference between the provider’s standard fee and 50% of

the MAC (After Deductible)


(After Deductible)

You pay the difference between the provider’s standard fee and

80% of the MAC (After Deductible)

Class III – Major Restorative

No Waiting Period 12 Month Waiting Period (Can be Waived)


(After Deductible)




(After Deductible)


(After Deductible)

Class IV – Orthodontia ( Medically Necessary)

No Waiting Period Not Applicable


(After Deductible)




(Discount May Apply)

You pay 100% of the provider's standard fee

Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. © 2014 Cigna 17


Benefit and Claim Questions and to Request a New ID Card:1.800.Cigna24 (1.800.244.6224)After 1/1/16 – 1.866.494.2111

Order prescriptions through Cigna Home Delivery Pharmacy

1.800.285.4812

Billing/Payments1.877.484.5967

8:00 am - 8:00 pm (EST), Monday through Friday

Federally Facilitated Marketplace (FFM)www.Healthcare.gov

1--800-318-2596

For Additional Assistance:

For Cigna Customers


Federally Facilitated Marketplace (FFM)www.Healthcare.gov

1-800-318-2596

Cigna Marketplace Subject Matter Expert (not for consumers)Bonnie Evelyn

[email protected]

For Additional Assistance:

For Those Assisting Consumers:

Questions?


Date post:	14-Jan-2016
Category:	Documents
Upload:	beverly-greene
View:	216 times
Download:	2 times

Cigna Individual and Family Plans Confidential, unpublished property of Cigna. Do not duplicate or...

Documents