Looking Forward to Good Health Employee Health Benefits Informational Meetings Town of Greenwich...

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