Transcript Employee Health Benefits Informational Meetings

Town of Greenwich
Looking Forward to Good Health
Employee Health Benefits Informational Meetings
October 25, 2000
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


CIGNA HealthCare


Twila Palmer
PHS


Al Cava
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-Network
Out-of-Network
Office Visit
Deductible
 Individual - $200
 Family - $500
You Pay 20% Up to Outof-Pocket Maximum
 Individual - $800
 Family - $2,000
lllness / Injury - $10
Copay
 Preventive Care*- $0
Copay
Hospital
 $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)
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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 Hospital
Care



Pre-Admission Certification (PAC) and
Continued Stay Review (CSR)
Discharge Planning
Case Management
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CIGNA HealthCare
Care Line
 Toll-Free
National Network Information
 Questions On Claims, Benefits and Other
Programs After You Enroll
 Inpatient Pre-Certification
 Convenient, Extended-Hours Access

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CIGNA HealthCare 24-Hour Health
Information Line
 Access
to a Nurse for Health-Related
Questions
 Available 24-Hours Daily
 Access to Audio Library
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CIGNA HealthCare
Healthy Babies® Program
 Prenatal
Care and Education
 Incentive to Receive Early Care
 High-Risk Pregnancy Evaluation
 Postpartum Follow-Up Call
 Voluntary Program
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CIGNA Lifesource Organ
Transplant Network®
 Centers

of Excellence
Travel Benefit
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CIGNA HealthCare
Transition Care
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

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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...
PHS
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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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Prescription Drug Benefits
In-Network
Retail
Prescription
Card
Program
$5 for generic drugs
$10 for brand name drugs
Mail Order
Plan
$7 for generic drugs
$10 for brand name drugs
(up to a 30-day supply at
participating pharmacies)
(up to a 90-day supply)
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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
You must submit a form in order to receive
coverage!

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
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Questions & Answers
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