Carnegie Mellon University Policy #02424A Employee Presentation. 28th October 2014

Transcription

1 Carnegie Mellon University Policy #02424A Employee Presentation 28th October 2014, Qatar Kuwait, Oman, in ra ah B a, rabi UAE, Saudi A

2 Cigna Global Health Benefits in the Middle East Part of the global Cigna corporation Worlds largest corporate provider of Expatriate Healthcare services Alliance in the GCC with Saudi Arabia Insurance Company (SAICO) Operations in Abu Dhabi (UAE), Bahrain, Riyadh (KSA) and Delaware (USA) Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna 2

3 The Scope of your Healthcare Scheme There for you Experience the difference with Cigna Rule of thumb Pre-authorisation Access to medical treatment in the case of an accident, injury, disease or illnesses Simplified processes and a common sense approach to claiming If treatment is prescribed as medically necessary, this would be within the scope of your scheme Pre-authorisation by members is not mandatory but if you are unsure or want to check for reassurance you are encouraged to do so. In network providers will seek authorisation as a matter of course for services over 1,500 AED

4 The scope of your healthcare scheme Exclusions Benefits Treatment that is for cosmetic purposes Laser eye correction Experimental treatment Injuries arising from professional sports activities Incidental expenses Medical with Pharmacy Dental Vision Evacuation/Repatriation Pre-existing conditions covered from inception

5 Healthcare Benefits Annual Maximum: Unlimited per person per year International/ In-Network US Out of Network US Paid in full 80% Deductible $0 $350 individual/$700 family Out of Pocket Limit $0 $2,350 individual/$4,700 family Physician Office Visits (General/Specialist) Paid in full 80% Inpatient Hospital Services Room & Board Paid in full 80% Prescription Drugs Paid in full 80% Plan Coinsurance SAICO Network Providers offer direct billing which means you pay nothing out of pocket and there are no claims to submit. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna 5

6 Healthcare Benefits International/ In Network US Out of Network US Hospital Charges Nursing, accommodation, consumables Paid in Full 80% Surgeon & Anesthetist fees Paid in Full 80% Radiology, Pathology, Diagnostics Paid in Full 80% Radiotherapy, Chemotherapy, Oncology Paid in Full 80% Maternity (Inpatient & Outpatient) Paid in Full 80% 6

7 Healthcare Benefits Medical Benefits International/ In Network US Out of Network US Specialist, Medical practitioners Consultations Prescribed medicines, drugs and dressings Paid in Full 80% Prescribed Physiotherapy, Osteopathy, Chiropractic and other complementary therapies Paid in Full 80%l Radiology, pathology & diagnostics Paid in Full 80% Well Child Care (Birth through age 17)/ Routine Immunizations Paid in Full Paid in Full Adult Travel Vaccinations Paid in Full Paid in Full Adult Preventive Care/ Routine Immunizations/ Cancer Screenings Paid in Full Paid in Full Oncology treatment Radiotherapy and Chemotherapy Paid in Full 80% 7

8 Healthcare Benefit Dental & Vision Dental* Annual Maximum: $1,000 per year of insurance (excludes orthodontic treatment) Deductible: $50 Individual / $150 Family Class I- Preventive Care: Paid in Full Check-ups, X-rays, scale and polish Class II- Basic Restorative: 100% of covered expenses Root canal treatment, extractions, surgical procedures, occasional treatment, anaesthetics, periodontal treatment Class III- Major Restorative: 50% of covered expenses Dentures Crowns, inlays, mouth guard or occlusal splint Class IV- Orthodontic Treatment (up to age 19) Lifetime Maximum: $1,500 Lifetime Deductible: $50 Vision* Annual Eye exam covered at 100%. Eyewear covered at 100% up to $200 annually. *Please note only medical treatment is available through the SAICO network. Dental and Vision services are adjudicated against your Cigna Global plan. Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna

9 Access to Medical Care An Easy Customer Experience Accessing Medical Care in the GCC üno prior pre-approval required for costs under AED1500. You receive immediate care At Your Service ü 24/7/365 access to doctor led local helpline ü Multilingual capabilities ü 90% pre-approvals üother Out-Patient and Inpatient treatment - network provider seek pre-approval. Member receives immediate or scheduled care üemergency - Member receives immediate care Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna within 30 minutes, 95% within 60 minutes and 100% within 48 hours ü Pre-approval offered verbally by phone, or or fax and through Waseel in KSA ü Paperless claiming via Cigna Envoy 9

10 Access to Medical Care An Easy Customer Experience Access medical care outside the GCC üoutpatient care member chooses preferred medical provider, seeks care, settles the invoice and submits to Cigna for reimbursement üinpatient care member contacts Cigna to provide details of required medical care. Cigna strives to place GOP for direct settlement and provides clinical support as needed üemergency member receives care, medical provider contacts Cigna in the background Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna At Your Service ü24 / 7 / 365 access to Cigna Customer Service team ümulti-lingual team with additional language line support on demand ümember website Cigna Envoy - with interactive provider directory and second opinion service to support member choice when accessing care 10

11 Exceptional Customer Service An Easy Customer Experience Member Reimbursement Online At Your Service At Your Service Claims reimbursement 90% within 5 business days, 95% within 10 business days Online claims submission, claims tracking and Explanation of Benefit Post/Fax Electronic transfer of funds in 140 major currencies 11 Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel Cigna

12 WORLD CLASS CUSTOMER SERVICE Customer Support Services Assistance finding a local doctor or hospital at any time, day or night Nearly 100% success rate in establishing guarantees of payment to doctors and hospitals* Information to help you understand how health care works in your country Immediate access to our in-house team of international doctors and nurses for information or referrals Claims Services More than 92% of clean customer claims are paid in 10 days or less regardless of language or currency* Quick claims reimbursements in nearly 100 currencies Reimbursement options, such as international direct deposit, electronic funds and wire transfers, or checks 12

13 Your points of contact o Cigna Customer Service Team /7/365 access/collect Calls Accepted o Cigna Customer Service fax number o SAICO helpline numbers on the back of your SAICO ID Card are designed for hospitals to use for treatment authorisation Qatar: Telephone: Fax: Mail Delivery: Office 71, LMC Building 852, Road 3618 Block 436 Al Seef District, Kingdom of Bahrain saicome@saicoins.com Helpline numbers can also be found on your cards and web portal

14 CIGNA ENVOY: FOCUSED ON YOUR NEEDS i Multi-Modal: Access on any Device (Desktop, Mobile, Tablet) Easy & Reliable: Login/Register Navigation Health Care Search ID Cards Tracking Service: Claims Status Benefits Tracking 14

15 INNOVATIVE.SELF-SERVE.CIGNA ENVOY Everything employees need in a single place: Online claim submissions Print and order ID cards Find a doctor or hospital anywhere in the world View explanation of benefits Opt-out of explanation of benefits in the mail ( go green ) Access health and wellness tools Update personal information and communication preferences Review eligibility Send and receive secure 15

16 CIGNA ENVOY: LANDING PAGE Where do I go? Easy to choose which site they need New Promotional Images 16

17 CHECK MY CLAIMS Quick Link Icon Sortable Claims History Submit New Claim Button Instant Claims Status Icons 17

18 FIND HEALTH CARE 18

19 CIGNA ENVOY MOBILE APP: DOWNLOAD TODAY! At Cigna Global Health Benefits, we are dedicated to making sure our globally mobile customers have quick and easy access to their Cigna benefits and services anytime and anywhere they need them. That s why we created the Cigna Envoy mobile app. Cigna Envoy is the online source for our customers benefit needs and now they can access it right on their smartphone. Instant, real-time access to health information on the go Cigna Envoy Easy and simple navigation Available whenever, wherever Find health care all over the world Check the status of your claims View and Print your family s ID cards Always have a way to contact Cigna 24/7/365 Download the App now from the App StoreSM or Google Play. 19

20 CIGNA ENVOY: HOW TO REGISTER How to login: 1.) Go to 2.) From the green I am box, select I have not registered yet. 20

21 CIGNA ENVOY: HOW TO REGISTER 3.) Enter the Identifying Information located on your Cigna ID. 4.) Click Register. 21

22 CIGNA ENVOY: HOW TO REGISTER 5.) Enter the identifying information including your account number and security word then click Register. 22

23 CIGNA ENVOY: HOW TO REGISTER Receive your registration confirmation. Remember your secure PIN to complete the registration in the next steps. Please note: Secure PINs are case-sensitive. 6.) Click Continue to Login. 23

24 CIGNA ENVOY: HOW TO REGISTER 7.) From the green I am box, select I have an existing login. 24

25 CIGNA ENVOY: HOW TO REGISTER 8.) Enter the first 9 digits of your ID Number in the Cigna ID # field. 9.) Enter the secure PIN that was generated in the Password/PIN field. 10.) Click Go. 25

26 CIGNA ENVOY: HOW TO REGISTER 11.) Complete the security questions. Be sure to remember these answers. You ll need them if you forget your password. 12.) Enter your preferred address. 13.) Enter the black numbers that appear on the screen in the box below them. 14.) Click Continue. 26

27 CIGNA ENVOY: HOW TO REGISTER 15.) Create your password. Password rules: At least 7 characters 1 upper-case letter 1 lower-case letter 1 number No symbols 16.) Enter the black numbers that appear on the screen in the box below them. 17.) Click Continue. 27

28 CIGNA ENVOY: HOW TO REGISTER 18.) Read and accept the terms and conditions and any other informational messages. 19.) Click Continue. 28

29 CONGRATS! YOU ARE NOW REGISTERED! You can now download and access Cigna Envoy on any device 29

30 CIGNA Global Health Benefits Thank you for your time Any Questions?