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Town of Greenwich

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Employee Health Benefits Informational Meetings Town of Greenwich October 25, 2000 Today s Agenda Welcome Your new options in medical coverage How your options ... – PowerPoint PPT presentation

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Title: Town of Greenwich


1
Town of Greenwich
Looking Forward to Good Health Employee Health
Benefits Informational Meetings
October 25, 2000
2
Todays Agenda
  • Welcome
  • Your new options in medical coverage
  • How your options compare
  • Introducing
  • CIGNA PPO
  • PHS
  • Express Scripts
  • Whats next?
  • Questions answers

3
Introductions
  • Town of Greenwich
  • Al Cava
  • CIGNA HealthCare
  • Twila Palmer
  • PHS
  • Charlie Saccavino
  • Express Scripts
  • Sherry Krieger

4
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

5
Whats 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 thats not part
    of the network, youre still covered

6
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

7
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

8
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)

9
Introducing...
10
Meeting Objectives
  • CIGNA Overview
  • Our Network
  • PPO Review
  • What do plans cover?
  • Information Sources
  • Special Programs
  • Transitional Issues

11
Why CIGNA HealthCare?
  • Nationally recognized
  • Experienced
  • Stable
  • Local presence

12
CIGNAs National Network
  • National Network
  • Over 400,000 Physicians
  • Over 3,250 Hospitals
  • General Practitioners, Family Practice, OB/GYNs,
    Internists, and Specialists

13
CIGNAs Local Network
  • Over 2,000 physicians in Fairfield County
  • Total of 31 hospitals statewide

14
PPO Coverage
  • In-Network
  • Office Visit
  • 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)
  • Out-of-Network
  • Deductible
  • Individual - 200
  • Family - 500
  • You Pay 20 Up to Out-of-Pocket Maximum
  • Individual - 800
  • Family - 2,000

15
Emergency Care
  • PPO
  • Always covered at In-Network benefit levels
  • Does not need to be a contracted provider
  • Seek immediate care

16
Non-Emergency Hospital Care
  • Pre-Admission Certification (PAC) and Continued
    Stay Review (CSR)
  • Discharge Planning
  • Case Management

17
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

18
CIGNA HealthCare 24-Hour Health Information Line
  • Access to a Nurse for Health-Related Questions
  • Available 24-Hours Daily
  • Access to Audio Library

19
CIGNA HealthCare Healthy Babies Program
  • Prenatal Care and Education
  • Incentive to Receive Early Care
  • High-Risk Pregnancy Evaluation
  • Postpartum Follow-Up Call
  • Voluntary Program

20
CIGNA Lifesource Organ Transplant Network
  • Centers of Excellence
  • Travel Benefit

21
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

22
Information and Access
  • Serving Our Members Over the Internet
  • View our medical directory on-line (PPO / PPA)
  • Communicate via E-Mail with CIGNAs internal
    areas
  • Our Address www.cigna.com/healthcare

23
Introducing...
PHS
24
Prescription Drug Benefits
25
Rx Plan
  • When you select either the PPO or PHS plan, your
    prescription drug benefits are administered by
    Express Scripts

26
Prescription Drug Benefits
27
Whats Next?
28
Which Plan Do I Choose?
  • Choose the coverage thats 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

29
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
30
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

31
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

32
Questions Answers
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