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Looking Forward to Good Health
Employee Health Benefits Informational Meetings
Town of Greenwich
October 25, 2000
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Today’s Agenda
Welcome Your new options in medical coverage How your options compare Introducing:
CIGNA PPO PHS Express Scripts
What’s next? Questions & answers
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Introductions
Town of Greenwich Al Cava
CIGNA HealthCare Twila Palmer
PHS Charlie Saccavino
Express Scripts Sherry Krieger
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New Plans - Jan. 1, 2001
Two medical plans are being offered:
Preferred Provider Organization (PPO),
administered by CIGNA HealthCare
Physicians Health Services (PHS), lower-cost HMO plan administered by PHS
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What’s a PPO?
A PPO is a medical plan that features a special network of doctors and hospitals When you use doctors and hospitals who are part
of the network, you pay less out of your pocket for care
If you use a doctor or hospital that’s not part of the network, you’re still covered
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What a PPO is NOT...
A PPO is NOT: An HMO
You are NOT required: To use ONLY doctors and hospitals that are part
of the HMO network To see a primary care physician before seeing a
specialist
In the PPO, you CAN: Use any doctor you want See a specialist without receiving a referral
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PHS
Physicians Health Services (PHS) is a traditional HMO
All services are offered by in-network providers
No referrals are required $10 copay for most services
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How PPO & PHS Compare to the Indemnity Plan
Key similarities Freedom of choice No referral requirement
Key differences (in-network care) No deductible or claim forms 100% coverage with $10 copay for illness & injury 100% coverage with $0 copay for some types of
preventive and routine care (preventive care sticker must be affixed to your ID card for the PPO plan)
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Introducing...
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Meeting Objectives
CIGNA Overview Our Network PPO Review
What do plans cover? Information Sources Special Programs Transitional Issues
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Why CIGNA HealthCare?
Nationally recognized
Experienced
Stable
Local presence
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CIGNA’s National Network
National Network
Over 400,000 Physicians
Over 3,250 Hospitals
General Practitioners, Family Practice, OB/GYN’s, Internists, and Specialists
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CIGNA’s Local Network
Over 2,000 physicians in Fairfield County
Total of 31 hospitals statewide
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PPO Coverage
In-NetworkOffice Visit lllness / Injury - $10
Copay Preventive Care*- $0
CopayHospital $0 Copay ** * To avoid paying copay, you must
place the preventive care sticker on your ID card
** Pre-Admission Certification Required (in-and out-of-network)
Out-of-NetworkDeductible Individual - $200 Family - $500You Pay 20% Up to Out-
of-Pocket Maximum Individual - $800 Family - $2,000
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Emergency Care
PPO Always covered at In-Network benefit
levels Does not need to be a contracted provider Seek immediate care
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Non-Emergency HospitalCare
Pre-Admission Certification (PAC) and Continued Stay Review (CSR)
Discharge Planning Case Management
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Toll-Free National Network Information Questions On Claims, Benefits and Other
Programs After You Enroll Inpatient Pre-Certification Convenient, Extended-Hours Access
CIGNA HealthCareCare Line
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Access to a Nurse for Health-Related Questions
Available 24-Hours Daily Access to Audio Library
CIGNA HealthCare 24-Hour Health Information Line
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Prenatal Care and Education Incentive to Receive Early Care High-Risk Pregnancy Evaluation Postpartum Follow-Up Call Voluntary Program
CIGNA HealthCareHealthy Babies® Program
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Centers of Excellence
Travel Benefit
CIGNA Lifesource Organ Transplant Network®
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Ongoing Conditions and Treatment Potential to Maintain Relationship With
Your Current Doctor Pre-Approval Required Within 90 Days of
Effective Date Upon Approval - Paid In-Network for
Specific Amount of Time
CIGNA HealthCareTransition Care
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Information and Access
Serving Our Members Over the Internet View our medical directory on-line (PPO / PPA) Communicate via E-Mail with CIGNA’s internal
areas
Our Address: www.cigna.com/healthcare
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Introducing...
PHSPHS
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Prescription Drug Benefits
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Rx Plan
When you select either the PPO or PHS plan, your prescription drug benefits are administered by Express Scripts
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In-Network
RetailPrescriptionCardProgram
$5 for generic drugs$10 for brand name drugs
(up to a 30-day supply atparticipating pharmacies)
Mail OrderPlan
$7 for generic drugs$10 for brand name drugs
(up to a 90-day supply)
Prescription Drug Benefits
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What’s Next?
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Which Plan Do I Choose?
Choose the coverage that’s best for you and your family: PPO - In- and out-of-network coverage PHS - In-network coverage only
Both plans are administered by experienced companies: PPO - CIGNA HealthCare PHS - Physicians Health Services
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How Do I Enroll?
To Enroll In the CIGNA PPO: Complete a CIGNA enrollment form and
write “GMEA” at the top Return the form promptly to the Human
Resources Dept. at Town Hall so that it is received no later than November 13, 2000
Remember to place the preventive care sticker on your ID card when it arrives
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How Do I Enroll?
To Enroll In PHS: Complete a PHS enrollment form and
write “GMEA” at the top Return the form promptly to the Human
Resources Dept. at Town Hall so that it is received no later than November 13, 2000
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Other Important Information
If your enrollment form is not received at Town Hall by November 13, 2000, your coverage will be denied as of Jan. 1, 2001, and you will not be able to obtain benefits until the Town receives your form
You must submit a form in order to receive coverage!
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Questions & Answers