A copay (or copayment) is a flat fee that you pay on the spot each time you go to your doctor or fill a prescription. For example, if you hurt your back and go see your doctor, or you need a refill of your child's asthma medicine, the amount you pay for that visit or medicine is your copay. Facets - 10469296 - V 18 - 09/03/20 09:31 PM ET 1 of 10 ©Cigna 2020 BENEFIT SUMMARY Cigna Health and Life Insurance Co. For - Alteryx, Inc. Open Access Plus OAP Effective - Selection of a Primary Care Provider - your plan may require or allow the designation of a primary care provider. You have the right to designate any primary care.
Another Way To Help Pay For Medical Expenses
A Cigna Choice Fund® plan combines an Open Access Plus or Preferred Provider Organization (PPO) medical coverage plan with a consumer health care account. The Open Access Plus or PPO medical plan typically has a deductible, coinsurance and an out-of-pocket maximum.
- Health Reimbursement Account (HRA)
- Health Savings Account (HSA)
- Choice Fund HRA and HSA
When AutoPay is selected, the HRA or HSA account is available for eligible services. During the medical claim process, you’ll receive payment directly from Cigna (from both the medical plan and the Choice Fund account) on behalf of your patient. Once the HRA or HSA account is empty, you may bill your patient directly. - Choice Fund HSA
Your patients with Cigna administered Choice Fund HSA plans also have an option to pay you with a debit card, online bill pay or a checkbook that draws directly from their HSA. - Coinsurance/deductible amounts should not be collected at the time of service unless you have accessed the Cigna Cost of Care Estimator® to obtain an estimate of the patient’s costs and provide a copy of the Explanation of Estimate to the patient.
- Submit the claim as usual.
- The amount the patient owes is determined by the claim settlement process under the medical plan’s terms.
- You receive an Explanation of Payment (EOP) or Explanation of Benefit (EOB) from the medical claim system.
- For most of the claims process, a single remittance EOP or EOB will reflect the claim processing for the medical plan. It will also provide access to the available account dollars as authorized through ACF.
- Sometimes, to ensure timely claim processing, the medical plan and the health account processing are separate. See if the medical plan EOP or EOB has this remark code: “Final payment determination will follow the review of available funds in a Cigna Choice Fund Health Reimbursement Account or Flexible Spending Account.” That code means the remaining amount the patient owes has been sent to their account for consideration.
- In these cases, you receive a second EOP or EOB (and a check, if funds are available) from Cigna Choice Fund along with the final amount your patient owes. You receive EOPs or EOBs on the same day or a few days apart. In rare situations, you may receive the Choice Fund EOP or EOB before the medical plan EOP or EOB.
- Then you may bill your patients for the final amount they owe as shown on the Cigna Choice Fund EOP.
Options and Coverages
There are two Choice Fund options:
Both options include a consumer account that can help your patients pay the share of health care expenses not reimbursed by their medical plan. This can include pharmacy, dental and vision expenses.
Your patients with this coverage can keep unused HRA or HSA account dollars and apply them to covered health care costs the following year. Careful management enables patients with Cigna administered Choice Fund plans to build their HRA or HSA accounts to help pay for future health care costs.
Reimbursement
Many patients in Cigna administered Choice Fund plans select a feature called AutoPay to pay claims. With this feature, the HRA or HSA account is automatically accessed to pay your claims. This feature helps alleviate the need for your office to pursue patients for applicable coinsurance/deductible payments.
There are other Choice Fund programs that aren’t identified on the member ID card. These include FSA plans and incentive award plans. To avoid duplicate payment or patient reimbursement situations, you should not collect deductibles or coinsurance at the time of service, unless you have accessed the Cigna Cost of Care Estimator® to obtain an estimate of the patient's costs and provide a copy of the Explanation of Estimate to the patient.
Debit Cards: For a patient that has both an HRA and FSA, one debit card can provide patients easy access to account dollars.
The best experience with debit cards is when paired with copay plans. A copay plan allows quick and instant approval of transactions, as opposed to coinsurance plans, which can be more challenging to substantiate. It is not recommended a debit card be used at point of sale for a coinsurance/deductible plan design.
Due to a change in IRS Regulations, over-the-counter (OTC) drugs and medicines no longer qualify for reimbursement from health plan spending accounts.
If you have patients with a HRA, HSA or FSA, and you determine they need an OTC medicine (other than insulin and diabetic supplies), they may ask you to provide a prescription* for that medicine. Under the latest legislation, patients need a prescription to receive reimbursement for any qualified OTC purchases made with funds from their health account.
For a list of eligible IRS 213d expenses you can visit https://www.cigna.com/qualified-health-care-expenses
*The U. S. government defines 'prescription' as a written or electronic order for a medicine or drug that meets the legal requirements of a prescription in the state in which the medical expense is incurred and is issued by an individual legally authorized to dispense prescriptions in that state.
Reimbursement Process
The claim submission process is basically the same as the process for any plan with deductibles and coinsurance:
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Cigna True Choice Medicare (PPO) H7849-002 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Cigna available to residents in Illinois. This plan includes additional Medicare prescription drug (Part-D) coverage. The Cigna True Choice Medicare (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $4,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,400 out of pocket. This can be a extremely nice safety net.
Cigna True Choice Medicare (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
Cigna works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Cigna True Choice Medicare (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Cigna and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Cigna except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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2021 Cigna Medicare Advantage Plan Costs
| Name: | |
|---|---|
| Plan ID: | H7849-002 |
| Provider: | Cigna |
| Year: | 2021 |
| Type: | Local PPO |
| Monthly Premium C+D: | $0 |
| Part C Premium: | $0 |
| MOOP: | $4,400 |
| Part D (Drug) Premium: | $0 |
| Part D Supplemental Premium | $0 |
| Total Part D Premium: | $0 |
| Drug Deductible: | $0 |
| Tiers with No Deductible: | 0 |
| Gap Coverage: | No |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Similar Plan: | H7849-003 |
Cigna True Choice Medicare (PPO) Part-C Premium
Cigna plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
H7849-002 Part-D Deductible and Premium
Cigna True Choice Medicare (PPO) has a monthly drug premium of $0 and a $0 drug deductible. This Cigna plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Cigna above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Cigna Gap Coverage
In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Cigna plan does not offer additional coverage through the gap.
H7849-002 Formulary or Drug Coverage
Cigna True Choice Medicare (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2021 Cigna True Choice Medicare (PPO) Summary of Benefits
Additional Benefits
| No |
|---|
Comprehensive Dental
| Diagnostic services | $0 copay |
|---|---|
| Diagnostic services | $0 copay (Out-of-Network) |
| Endodontics | $0 copay |
| Endodontics | $0 copay (Out-of-Network) |
| Extractions | $0 copay |
| Extractions | $0 copay (Out-of-Network) |
| Non-routine services | $0 copay |
| Non-routine services | $0 copay (Out-of-Network) |
| Periodontics | $0 copay |
| Periodontics | $0 copay (Out-of-Network) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Out-of-Network) |
| Restorative services | $0 copay |
| Restorative services | $0 copay (Out-of-Network) |
Deductible
| $0 |
|---|
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $0-150 copay |
|---|---|
| Diagnostic radiology services (e.g., MRI) | 30% coinsurance (Out-of-Network) |
| Diagnostic tests and procedures | $0-50 copay |
| Diagnostic tests and procedures | 30% coinsurance (Out-of-Network) |
| Lab services | $0 copay |
| Lab services | 0-30% coinsurance (Out-of-Network) |
| Outpatient x-rays | $10 copay |
| Outpatient x-rays | 30% coinsurance (Out-of-Network) |
Doctor Visits
| Primary | $0 copay |
|---|---|
| Primary | $15 copay per visit (Out-of-Network) |
| Specialist | $30 copay per visit |
| Specialist | $40 copay per visit (Out-of-Network) |
Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
|---|---|
| Urgent care | $30 copay per visit (always covered) |
Foot Care (podiatry services)
| Foot exams and treatment | $30 copay |
|---|---|
| Foot exams and treatment | $40 copay (Out-of-Network) |
| Routine foot care | Not covered |
Ground Ambulance
| $225 copay |
|---|
| $225 copay (Out-of-Network) |
Hearing
| Fitting/evaluation | $0 copay |
|---|---|
| Fitting/evaluation | 30% coinsurance (Out-of-Network) |
| Hearing aids - inner ear | $0 copay |
| Hearing aids - inner ear | $0 copay (Out-of-Network) |
| Hearing aids - outer ear | $0 copay |
| Hearing aids - outer ear | $0 copay (Out-of-Network) |
| Hearing aids - over the ear | $0 copay |
| Hearing aids - over the ear | $0 copay (Out-of-Network) |
| Hearing exam | $0-30 copay |
| Hearing exam | $40 copay (Out-of-Network) |
Inpatient Hospital Coverage
| $300 per day for days 1 through 6 $0 per day for days 7 through 90 |
|---|
| $320 per day for days 1 through 6 $0 per day for days 7 through 90 (Out-of-Network) |
Medical Equipment/Supplies
| Diabetes supplies | 0-20% coinsurance per item |
|---|---|
| Diabetes supplies | 30% coinsurance per item (Out-of-Network) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 30% coinsurance per item (Out-of-Network) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs) | 30% coinsurance per item (Out-of-Network) |
Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
|---|---|
| Chemotherapy | 30% coinsurance (Out-of-Network) |
| Other Part B drugs | 20% coinsurance |
| Other Part B drugs | 30% coinsurance (Out-of-Network) |
Cigna Ppo Copay Form
Cigna Copay Plan
Mental Health Services
| Inpatient hospital - psychiatric | $300 per day for days 1 through 6 $0 per day for days 7 through 90 |
|---|---|
| Inpatient hospital - psychiatric | $320 per day for days 1 through 6 $0 per day for days 7 through 90 (Out-of-Network) |
| Outpatient group therapy visit | $0 copay |
| Outpatient group therapy visit | $40 copay (Out-of-Network) |
| Outpatient group therapy visit with a psychiatrist | $0 copay |
| Outpatient group therapy visit with a psychiatrist | $40 copay (Out-of-Network) |
| Outpatient individual therapy visit | $0 copay |
| Outpatient individual therapy visit | $40 copay (Out-of-Network) |
| Outpatient individual therapy visit with a psychiatrist | $0 copay |
| Outpatient individual therapy visit with a psychiatrist | $40 copay (Out-of-Network) |
MOOP
| $7,550 In and Out-of-network $4,400 In-network |
|---|
Option
| Yes, contact plan for further details |
|---|
Optional supplemental benefits
| No |
|---|
Outpatient Hospital Coverage
| $0-300 copay per visit |
|---|
| 30% coinsurance per visit (Out-of-Network) |
Preventive Care
| $0 copay |
|---|
| $0 copay (Out-of-Network) |
What Is The Copay For Cigna
Preventive Dental
| Cleaning | $0 copay |
|---|---|
| Cleaning | $0 copay (Out-of-Network) |
| Dental x-ray(s) | $0 copay |
| Dental x-ray(s) | $0 copay (Out-of-Network) |
| Fluoride treatment | $0 copay |
| Fluoride treatment | $0 copay (Out-of-Network) |
| Oral exam | $0 copay |
| Oral exam | $0 copay (Out-of-Network) |
Rehabilitation Services
| Occupational therapy visit | $30 copay |
|---|---|
| Occupational therapy visit | $40 copay (Out-of-Network) |
| Physical therapy and speech and language therapy visit | $30 copay |
| Physical therapy and speech and language therapy visit | $40 copay (Out-of-Network) |
Skilled Nursing Facility
| $0 per day for days 1 through 20 $184 per day for days 21 through 100 |
|---|
| 30% per stay (Out-of-Network) |
Transportation
| Not covered |
|---|
Vision
| Contact lenses | $0 copay |
|---|---|
| Contact lenses | $0 copay (Out-of-Network) |
| Eyeglass frames | $0 copay |
| Eyeglass frames | $0 copay (Out-of-Network) |
| Eyeglass lenses | $0 copay |
| Eyeglass lenses | $0 copay (Out-of-Network) |
| Eyeglasses (frames and lenses) | $0 copay |
| Eyeglasses (frames and lenses) | $0 copay (Out-of-Network) |
| Other | Not covered |
| Routine eye exam | $0 copay |
| Routine eye exam | 30% coinsurance (Out-of-Network) |
| Upgrades | $0 copay |
| Upgrades | $0 copay (Out-of-Network) |
Wellness Programs (e.g. fitness nursing hotline)
| Covered |
|---|
Ready to Enroll?
Or Call
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Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Cigna True Choice Medicare (PPO)
(Click county to compare all available Advantage plans)
| State: | Illinois |
|---|---|
| County: | Cook,DuPage,Kane,Kankakee,Lake, Will, |
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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.